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A 27 yr teacher comes to a physician for sleep medication. She is unable to fall asleep until 2 or 3 Am since the start of the school year 3 months ago. When she awakens at 6 am, she feel tired throughout the morning. Last week, she fell asleep at her desk. She believes that her job is in jeopardy. Drinking one glass of wine before going to bed has not helped her. She recently took one of her mother’s zolpidem tablets, she only slept for 2 hours and was then awake until 3 or 4 am. During vacations and on weekends, she typically sleeps from 3 am until noon and feels energetic and well rested. She currently does not take any meds or drink alcohol. P/E- NAD. M/E-tired and teary. She can recall two of three objects after 5 mins. Which is most likely Dx
A. Adjustment disorder with depressed mode
B. Circadian rhythm sleep disorder
C. Dysthymic disorder
D. MDD
E. Narcolepsy
F. Primary insomnia
G. REM sleep behavior disorder.
A tiny explanation will help all.(pls)
thanks
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F. Primary insomnia
1)A 1-month or longer history of at least one of the following: a) difficulty initiating or maintaining sleep or b) nonrestorative sleep.
2)Sleep disturbance (or associated daytime fatigue) causing significant distress or impairment in social, occupational, or other important areas of functioning.
3)To be considered primary insomnia, the sleep disturbance must not occur exclusively during the course of narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or a parasomnia.
4)The sleep disturbance does not occur as a result of another mental disorder.
5)The sleep disturbance does not occur as a result of drug or alcohol dependence or any medical condition
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i think B
poor sleep hygiene..going to bed at 3 am on vacations/weekend set her normal sleep cycle from 3am tilll noon but if asked to get up at 6 am it distrubs her circadian rythym
but if allowed to sleep b/w 3 am till noon she has no problem.tats why even BZ dont help her
..these q are so confusing....
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Could be BBB.
Primary Insomnia is sleeplessness that is not attributable to a medical, psychiatric, or environmental cause.
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yes q says she cant sleep till 2-3 am specific time is another clue for B
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thank you !lost that point
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thanks everyone for participation...
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B-Delayed sleep phase syndrome
During vacations and on weekends, she typically sleeps from 3 am until noon and feels energetic and well rested.
