1. Supplementation of which hormone is used in the treatment of insomnia?

• Dopamine
• Estrogen
• Melatonin
• Oxytocin

2. A patient aged 75 years old had a history of hypertension for the past 12-13 years and has been taking alpha-blockers on regular basis since then.For the past 2-3 years the patient is complaining of irregular sleep patterns and major disturbances in the same. The primary diagnosis given by the sleep physician was insomnia and this can be attributed to

• Inhibiting the secretion of melatonin
• Decreased Rapid eye movement (REM) sleep
• Negative effect on the flight-and-fight response mechanism
• Affects the circadian rhythm

3. A patient aged 69 years old, complains of a dry cough for 2 months. The patient has a history of cardiovascular disorder and is taking Ramipril for almost 5-6 years. The patient also complains of leg cramps causing a lot of discomfort and both together have led to severe sleep disturbances. What could be the reason for the sleep disturbance here?

1. Ramipril causes a decrease in acetylcholine which cause the cough and leg cramps, hence rendering the patient sleepless.
2. Ramipril causes an increase in bradykinin which causes a  dry cough, thus keeping the patient awake.
3. Ramipril causes potassium buildup leading to leg cramps,keeping the patient awake and sleepless.
4. Ramipril causes an increase in acetylcholine which cause the cough and leg cramps, hence rendering the patient sleepless.

Select the most appropriate combination

• a and b
• b and c
• a, b and d
• b, c and d

4. Insomnia can also cause other associated features except

• Hair loss
• Gastrointestinal (GI) disturbances
• Poor concentration and focus
• Daytime fatigue

5. Which of the following is considered to be the non-pharmacological treatment of choice for insomnia?

• Weight loss
• Cognitive behavioral therapy (CBT)
• Continuous Positive Airway Pressure (CPAP)
• Mandibular devices