This delightful woman in her early fifties from western Ohio experienced the onset of sleepiness and severe insomnia one year prior to referral to our Center. She could not turn off her racing thoughts when attempting to sleep. Her sleep became physically restless and she developed nightmares. She worsened rapidly to the point of physical collapse with nausea and vomiting such that she had to be hospitalized. During her hospital stay, she was recorded overnight in their sleep laboratory and was started on CPAP for sleep apnea. She was discharged on an antidepressant that provoked severe hypertension (179/122) and a sedative that worsened her daytime sleepiness.
During her first office visit at our Center, she was tremulous and tearful, crying over her desperate plight. She told us that she had been unable to fall asleep until the early morning hours and then would sleep through her alarm clock such that she had remained unable to work and on a leave of absence. She was using CPAP faithfully, but her exhaustion and poor sleep were no better.
We changed her medications to zaleplon (a short acting sleeping pill that does not worsen sleep apnea) and a different antidepressant with fewer side effects. We also referred her to a consultant for relaxation training.
We checked her serum ferritin level which revealed low body iron stores and then started her on oral iron tablets for restless legs symptoms.
We also performed overnight polysomnography and found that she required a higher CPAP pressure than had been prescribed during her hospitalization.
Her response to the treatment changes we instituted has been nothing short of dramatic. She now falls asleep quickly and sleeps through the night, awakening refreshed. She is particularly excited by the fact that after visiting our Center, she has returned to her profession and did not miss a single day of work throughout the past year.
COMMENTS:
We are convinced that a comprehensive approach is vital whenever patients suffer from severe insomnia. Simply giving sleeping pills is both frequently ineffective and potentially dangerous.
If this patient's story reminds you of your own--or that of a loved one--please do not hesitate to contact us at flamenco@netexp.net with any questions that you may have. We are here to help.
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