Insomnia :: PLAB 2 Symptomatic Differential Stations

• Insomnia (grief after spouse death/chronic disease/poor sleep hygiene(playing video games/smoking cannabis))

  • Other presenting symptoms: 

    • Old lady with Long term insomnia history (Husband died few months ago but mood is okay)

    • Young guy with cannabis and anxiety history (mother takes sleeping pills)

    • Problem initiating sleep

  • Past history and PMAFTOSA: 

    • Rule out suicide

  • Social:

    • Life effects

    • Work

    • Mood, relationships

  • Exam and Invs:

    • GPE, vitals

    • Hands examination

  • Referral:

    • None

  • Treatment: 

    • General advice:

      • Sleep hygiene

      • Avoid daytime naps

      • Avoid alcohol, caffiene before sleep

      • Support groups, exercise

    • Offer sleeping pills (benzodiazepines) (offer first for the old ladies)

  • Warning signs:

    • Side effects of benzodiazepines (drowsiness/falls/amnesia/dependence)

    • Worsening symptoms

    • Suicidal thoughts