Reference no: EM133815446

Question

Patient case: A 66-year-old white female college professor presents to you with the complaint of difficulty getting to sleep (and once she gets to sleep, staying asleep) for the last 6 months. She wakes up at about 3 am every morning and has difficulty getting back to sleep. She is easily fatigued throughout the day and states, "my fuse is shorter than usual." She has just been given a big assignment at work and says, "I can't afford to be crabby." She recently moved to a new home, and she had several deaths in her family in the last year. She is in counseling with an LMFT (licensed marriage and family therapist) biweekly for her anxious symptoms, which has only helped a little. Her past med history is significant for intermittent episodes of insomnia during stressful life experiences. Melatonin 3 to 6 mg has worked in the past, but it has not helped this time, and she believes it causes her daytime grogginess. She is postmenopausal and taking bioidentical hormone therapy prescribed by her physician; her hormone levels are optimal and do not require adjustment. She has cut out caffeine; she does not smoke tobacco or drink alcohol. She walks.