Insomnia

Question 1

Key history in insomnia

Answer 1

Duration
Description (trouble falling asleep, staying asleep, multiple awakenings, early-morning rises)
Daytime sleepiness
Other medical problems (arthritis, diabetes)
Loud snoring, nightmares, depression
Caffeine, alcohol, medication, drug use
Jet lag, shift work
Stressors, sleep hygiene
Psychiatric symptoms (irritability, grandiose delusions)

Question 2

Key physical exam in insomnia

Answer 2

Vital signs, MMSE, thyroid exam

Question 3

25 yo F with 3-week Hx of difficulty falling asleep but sleeps 7 hours without snoring or nightmares
+ recently began college
+ trouble with boyfriend
+ drinks 3-4 cups of coffee per day

Answer 3

Stress-induced insomnia
Caffeine-induced insomnia
Insomnia related to circadian rhythm sleep disorder

Polysomnography
MMSE
Urine toxicology
CBC
TSH

Question 4

55 yo obese M with several months of poor sleep, daytime fatigue, morning headaches
+ snores loudly

Answer 4

Obstructive sleep apnea
Daytime fatigue in primary hypersomnia
Insomnia with circadian rhythm sleep disorder

CBC, TSH, polysomnography, ECG

Question 5

33 yo F with three weeks of fatigue and trouble sleeping
+ falls asleep easily but wakes up in early morning and cannot fall asleep again
+ 8 pound weight loss
+ ahedonia

Answer 5

Insomnia related to major depressive disorder
Primary hypersomnia
Insomnia with circadian rhythm sleep disorder

MMSE, TSH, CBC, polysomnography