INSOMNIA

Question 1

25 yo F presents with a three-week history
of difficulty falling asleep. She sleeps
seven hours per night without nightmares
or snoring. She recently began college
and is having trouble with her boyfriend.
She drinks 3–4 cups of coffee a day.

Answer 1

Stress-induced insomnia Polysomnography
Caffeine-induced insomnia Mental status exam
Insomnia with circadian rhythm Urine toxicology
sleep disorder CBC
Insomnia related to major depressive disorder TSH

Question 2

55 yo obese M presents with several
months of poor sleep and daytime
fatigue. His wife reports that he snores
loudly.

Answer 2

Obstructive sleep apnea CBC
Daytime fatigue in primary hypersomnia TSH
Insomnia with circadian rhythm Polysomnography
sleep disorder ECG
Insomnia related to major depressive disorder

Question 3

33 yo F c/o three weeks of fatigue and
trouble sleeping. She states that she falls
asleep easily but wakes up at 3 A.M. and
cannot return to sleep. She also reports
an unintentional weight loss of 3.5 kg
along with an inability to enjoy the
things she once liked to do.

Answer 3

Insomnia related to major depressive disorder Mental status exam
Primary hypersomnia TSH
Insomnia with circadian rhythm CBC
sleep disorder Polysomnography