Insomnia Case (don't forget insomnia)
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Insomnia Case (don't forget insomnia)

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Posted by QA on April 10, 2003 at 18:16:03:

Insomnia Case

35 year old wf corporate attorney
cc DIS and DMS for years
Daytime fatigue, no EDS
Now newly engaged and experiencing worsening of insomnia
PMH – anxiety, phobia of flying in recent years
Meds – OCP


SH- 15-20 u alcohol/ week. Non smoker, lives alone but fiancé frequently stays over
Bedtime routine- as interviewed with bed partner
Feels sleepy on couch.
Goes to bedroom at 1030-11pm.
Immediately feels alerted in the bedroom
Sleep onset insomnia- several hours


(watches illuminated bedside digital clock)
Finally achieves some sleep at 2 or 3 am.
Awoken by alarm clock at 6 30am
Uses snooze button for 60 mins
OOB at 7 30am
Feeling exhausted


Notes that she takes 2 glasses of wine in the evening to unwind- between 8-10pm
Daytime caffeine- 4 cups -6 cups a day
Social smoker
No pets
‘Uncomfortable’ bed
Bedroom has a window onto a main street in the City.
Disturbed with lights on ceiling of oncoming traffic
Ambient noise
Sleep quality is just as poor on vacation- sleep does not seem to improve

Data that could be shown on the exam

assume a Sleep log shows the following
Showing difficulty initiating sleep- sleep onset in excess of two hours, sometimes more
Insufficient total sleep time- consistently less than 6 hours of sleep nightly
Excess alcohol and stimulant use- evening alcohol consumption
late evening caffeine intake whilst finishing up at the office
Sleep debt at weekends- over sleeping until 2 pm on most weekends
Poor subjective sleep- she feels her sleep is terrible
Generally feels very anxious about her sleep and ‘how it must be affecting her health’

Sleep logs on the exam are usually easy to read and in Photostat appearance with patient comments or handwriting on them. The pattern being communicated to you will be obvious


1. List the sleep disorders that may be contributing to this patients insominia
2. List the perpetuating factors which are maintaining her condition
3. What is the relevance of her alcohol intake
4. Propose a management strategy and ongoing treatment plan


To help you
Disorders I am thinking of when describing this patient
1.chronic insomnia due to:
a. inadequate sleep hygiene
b. insufficient sleep syndrome
c.
d. psychophysiologic insomnia
2.compounded by
a. alcohol and caffeine excess
b. underlying generalized anxiety disorder
c. adjustment sleep disorder-forthcoming marriage- leading to a new level of anxiety

Answer to be posted as a follow-up. Answer question before reading it.

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PLEASE ONLY CLICK THE SUBMIT FOLLOW UP BUTTON ONCE!!. Thanks, Sandman

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