A patient reports going to bed at 10:00 pm every night but often lays awake until midnight. The primary care NP instructs the patient to practice good sleep hygiene and to avoid caffeine in the evening
After 1 week of this regimen, the patient reports still lying awake until 11:00 PM. The NP should: a. order a sleep study.
b. consider short-term zolpidem.
c. order ramelteon for several weeks.
d. reassure the patient and re-evaluate in 1 week.
D
Treatment of patients with insomnia begins with sleep hygiene. It is important that the patient have reasonable expectations and understand that the time of onset of sleep can be moved up only by 15 minutes every 3 or 4 days. This patient is showing improvement, which means the measures are working. When these measures are ineffective, medications may be considered.
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