Posted by Strohl on April 13, 2003 at 16:41:48:In Reply to: Unusual Case posted by QA on April 13, 2003 at 15:08:36:
Interesting as it is so simple a sleep medicine question.
what treatment options would you recommend?
The timing of the events makes these more likely to be sleep terrors than nightmares, and the lack of motor events make RBD or seizures less likely. The heartburn makes it possible that a contributing factor is GERD. There is no history available to suspect panic attacks. Stimulus control and relaxation techniques might help with sleep onset and anxiety about going to sleep. Proton pump inhibitors might be used and if symptoms persist use clonazepam (0.5mg) to suppress NREM and arousal responses.how might you further evaluate the patient?
Further history from observer and from patient on the circumstances of these events, their chronicity, family history and medication/drug use or misuse. Caffeine and alcohol use are important. Sleep diary. Referral for GERD assessment and esophageal pH monitoring.why does the patient have insomnia
The precipitating cause is not clear for the poor sleep maintenance. 50year old men are more likely to have medical problems that might start insomnia. At present the perpetuating cause for sleep onset insomnia is the anxiety about night terrors.