USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 24-year-old woman comes to the clinic because of insomnia. She says she has suffered from insomnia intermittently for many years, but it did not bother her in college very much since she mostly took night classes. It has become problematic with her new career which requires her to wake up at 6am to get to work on time. She has been late to work on several occasions recently, which resulted in a missed opportunity for a pay raise. She goes to bed at 10pm every night but often lies awake in her dark room unable to sleep until 2am. She reports feeling more refreshed on the weekends when she can sleep until 10am. She drinks 2-3 cups of coffee most mornings, but she often still wishes to nap and struggles to keep herself awake sometimes. Which of the following treatment methods is this patient most likely to benefit from?
Contributors:Brooke Miller, PhD
Have you ever had one of those nights where you just can’t seem to fall asleep?
While that happens to everyone every occasionally, people with insomnia have to deal with these symptoms night after night.
Some people with insomnia have trouble falling asleep, whereas others wake up throughout the night, and struggle to fall back asleep.
These disturbances typically happen at least 3 times each week.
Acute insomnia lasts less than a month, whereas chronic insomnia lasts over a month.
Insomnia affects both the quantity and quality of sleep, which makes it hard for individuals to reach restorative levels of sleep, leading to daytime sleepiness and fatigue, and over time, feelings of irritability, anxiety, and depression.
This can cause professional and personal problems, as make day-to-day activities like driving more challenging and dangerous, with people struggling to stay awake on the road.
Although insomnia can happen without an underlying cause, it can also accompany and worsen other problems like pulmonary diseases, psychiatric conditions, and a whole variety of conditions that might cause pain.
Finally, and probably most commonly, insomnia can be the result of daily stresses from work or relationships as well environmental factors such as having to work a night shift, or having a newborn baby.
There are a number of biological factors associated with insomnia.
People with insomnia are also more sensitive to the effects of cortisol, typically waking up at much lower levels of cortisol compared to the general population.
Some individuals with insomnia resort to self-medicating with alcohol and benzodiazepines which can be extremely dangerous.