Chapter 94. Insomnia: Assessment and Management of Sleep Disorders

A 59-year-old retired school teacher with a history of advanced ovarian cancer has been admitted for community-acquired pneumonia, responding well to appropriate antibiotic treatment. She has lost 10 pounds since her last clinic visit, and she reveals that she is having a difficult time sleeping during the night. Her husband is concerned that she has been “pretty down” recently. How should this problem be addressed?

A 48-year-old woman with obesity, hypertension, depression, and asthma, was admitted to the hospital for treatment of an exacerbation of her multiple sclerosis. Her physicians continued her home medications including lisinopril, hydrochlorothiazide, bupropion, and interferon beta. After 48 hours, her weakness improved in response to intravenous high-dose methylprednisolone, but the doctor on call has been called every night for a “sleeper.” The patient stated: “I cannot sleep at all! I feel worse than when I came in! I just feel so anxious; this happens every time I have a flare.” She has also been having trouble staying asleep because she needs to get up multiple times each night to urinate, a nurse interrupted her sleep at 2 am every night to take her blood pressure, and her roommate has been watching TV all night. Although she uses continuous positive airway pressure (CPAP) at home, she forgot to bring the machine to the hospital. What adjustments can be made to improve the sleep of patients like her?

• Sleep deprivation is associated with physiologic and psychological sequelae that may impair recovery from acute illness. Screening patients for sleep problems is the “new” sixth vital sign.