Insomnia Case Answer (read after you answer)
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Insomnia Case Answer (read after you answer)

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Posted by QA on April 10, 2003 at 18:23:20:

In Reply to: Insomnia Case (don't forget insomnia) posted by QA on April 10, 2003 at 18:16:03:

Insomnia Pointers

The case describes a young female executive with long standing insomnia which is perpetuated by numerous factors which maintain her insomnia
obvious in the case is the inadequate sleep hygiene.
the noisy bedroom with ambient light
the sound of traffic
the use of alcohol in the evening to " relax" and unwind which predisposes to sleep fragmentation

the patient also has a component of psychophysiologic insomnia- she believes that she sleeps poorly and also she is fearful of the consequences. Sleep quality has become a central concern of hers- almost the central feature of her worries. Additionally it seems to have acquired a major significance to the new fiancé- perhaps the couple have centered many concerns around the bedroom.

The patient has insufficient sleep- her total sleep time during the week on interview was about 5 or 4.5 hours each night- she carries significant sleep debt expressed in lie-ins during the weekend- she needs more and is probably not a short sleeper.

That she goes on vacation and continues to have sleeping difficulties points to a long standing issue with chronic insomnia - we need to work with her to decatastrophize her insomnia and divorce the relationship of her bed ( wherever it may be) to her sleep quality.
the forthcoming wedding plans have added to her baseline high levels of anxiety. I would speculate that the patient has compounded her problem with an adjustment sleep disorder- we need more history/ more discussions with the patient to begin this

Recommendations
1. stop alcohol intake
2. no caffeine after 12 noon
3. change the shades in the bedroom
4. use ear plugs
5. stimulus control therapy- go to the bed when sleepy and get out of bed when sleep does not follow- this is key for this patient
6. fix the wake up time every day
7. reset the bed time to 1 am - she rises at 6 30 am and she estimates only 5 hours of sleep- this will build a sleep debt generating sleep pressure and encouraging sleep consolidation
8 her anxiety needs to be addressed- she describes herself as an anxious person and now is facing her wedding. additionally in recent years she has developed a fear of flying- it is appropriate to send her to a psychotherapist to teach her anxiety managing techniques whilst we reorganize her sleep habits
9. remind her she is highly functioning and doing well despite this sleep structure at present. Express some optimism that improvement is likely- as we have so much to work on!!!- give her some hope and explain that perhaps her problems with sleep are not as catastrophic as she imagines
10 be sure to complete a full medical history and detailed sleep history- uncovering any medical disorders which maybe contributing her insomnia
11. arrange frequent follow up and communicate with the psychotherapist

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

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