A 40-Year-Old Man Comes to the Office Due to Sleep

question 498

Multiple Choice

A 40-year-old man comes to the office due to sleep difficulties over the past 2 years.  He regularly goes to bed at 11:00 PM but is unable to fall asleep until 12:30 AM.  As bedtime approaches, he typically becomes tense, watches the clock, and worries about the prospect of another sleepless night.  The patient eventually falls asleep and awakens by alarm at 6 AM in order to arrive at his office by 8 AM.  During the day he feels fatigued and is concerned that his insomnia is negatively affecting his work performance.  The patient does not take naps during the day.  His wife has not noticed any snoring or unusual limb movements during sleep.  His general health has been good and he takes no medication.  He would like to exercise but feels too tired.
Which of the following is the most appropriate next step in management of this patient?

• A)Advise daytime naps to replenish sleep debt
• B)Advise remaining in bed doing a relaxing activity even if unable to sleep
• C)Recommend aerobic exercise before going to bed
• D)Recommend going to bed only when feeling sleepy
• E)Recommend restricting time in bed to 5-6 hours a night

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