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Insomnia
- Presentation:
- Physical Exam:
- DDX:
- Work-up:
- Treatment:
- Self Care
- Medication
- Sedative – Zolpidem, Temazepam, Lorazepam, Eszopiclone, Trazodone
- Antihistamine – Diphenhydramine, Doxylamine
- Antidepressant – Mirtazapine, Trazodone
- Therapy
- Cognitive behavioral therapy and Light therapy
Insomnia related to Major Depressive Disorder
- Presentation:
- DDX:
- Work-up:
- Specialist:
- Clinical psychologist
- Psychiatrist
- Primary care provider (PCP)
- Treatments:
- Therapy
- CBT, Behavioral Therapy, Psychotherapy
- Medication
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Antidepressant, Anxiolytic
- Antipsychotic
- Electroconvulsive therapy
Obstructive Sleep Apnea (OSA)
- Presentation:
- several months of poor sleep and daytime fatigue. spouse reports that he snores loudly.
- – fatigue and daytime sleepiness. snores heavily and naps 3-4 times per day but never feels refreshed. Hx of hypertension.
- – Sleep apnea is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep.
- – Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.
- – Cessation for >10 seconds → ↓ O2 saturation → Episodes of breathing cessation for 10 seconds during sleep, 10 – 15 events per hour with ↓ O2 saturation
- – Associated signs → Snoring, gasping, GI reflux (GERD), nocturia, excessive moving, night sweats, morning headaches, daytime sleepiness, sleep attacks
- – Psychological: Slow thought process, memory impairment, inattention
- DDX:
- Work-up:
- Specialist:
- Primary care provider (PCP)
- Sleep medicine
- Otolaryngologist
- Treatment:
- Self Care
- Sleeping on side, Avoid alcohol, and Weight loss
- Supportive Care
- Continuous positive airway pressure (CPAP) and BiPap
- Surgery
- Tonsillectomy and Adenoid removal
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