March 1st 2007
Once again your patient, an accountant and tax specialist, is complaining about his sleep. More nights than not he awakens at about 2 am. An hour goes by, sometimes 2, before he returns to sleep. You've prescribed 4 different hypnotics. Each gave the same unsatisfactory result. For 2 weeks, your patient got the 8 hours of uninterrupted sleep he-and you-seek, but then the old pattern returned. Following your instructions, he avoids caffeine, doesn't exercise after 6 pm, and confines his activities in bed to sleep, but to no avail. You refer him to a sleep laboratory, and the results there are entirely consistent with what he's been telling you. In the sleep lab he falls asleep at 11 pm, awakens at 2:30 am, returns to sleep at 4 am, and awakens for good at 7:30 am. He does not have sleep apnea, restless legs syndrome, or depression.