A 40-year-old man with difficulty falling asleep and maintaining sleep!!
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A 40-year-old man presents with difficulty falling asleep and staying asleep. The problem started after the death of his sister 2 months previously. He is unable to fall sleep until at least an hour after going to bed. He has no previous sleep problems. A general practitioner (GP) he consulted had prescribed low-dose dothiepin (tricyclic antidepressant) as sedation but he was unable to tolerate the drowsiness and dry mouth caused by the medication. He consumes 4 cups of coffee during the day and lately takes alcohol at night to aid sleep. The patient’s wife has noted that his legs jerk occasionally during the sleep though Mr. Tan is not aware of these movements. What are the causes of this condition?
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@aagami This is insomnia related to acute stress, conflict, or recent environmental change. The precipitating event in this case is the death of his sister. Adjustment sleep disorder is usually a self-limiting disorder, often resolving once the patient comes to terms and copes with the stressor. The course is usually transient lasting from a few days to less than 2 weeks. However, the sleep difficulty may last up to 3 months. He has had no previous sleep problems and the onset of his sleep problem after a major stressful event makes adjustment sleep disorder the likely diagnosis.