1. Use the following CASE to answer questions 1 and 2 EH is a 71-year-old-woman with difficulty falling asleep for the past 6 months. She complains of daytime sleepiness but states that when she tries to fall asleep at night, it can take hours. Some nights, she feels that she has barely fallen asleep before it is time to wake up the next day. On average, she feels that she sleeps approximately 4 hours a night. EH owns a small business and employees have commented several times that she has become more irritable. Usually well organized, EH has recently forgotten to complete several orders and billing statements. Last week, she accidently failed to stop at intersections while driving to work and at least once, felt that she might fall asleep while driving. EH is overall very healthy for her age. She uses saline ophthalmic drops for dry macular degeneration and acetaminophen for occasional osteoarthritis pain. EH lives at home by herself but sleeps in the living room on the couch with the television on because it allows her to better focus on payroll or other work that she often does in the evening. EH smokes 1 pack of cigarettes per day, drinks a “few” caffeinated diet sodas throughout the day, and denies use of alcohol or illicit drugs.

EH’s insomnia is best characterized as:

2. On the basis of her current clinical presentation, what is the most appropriate treatment approach for EH?

3. Which medication would be best for a 70-year-old otherwise healthy woman with good sleep hygiene but trouble falling asleep and who prefers to try an over-the-counter agent before using a prescription medication?

4. Which of the following medications may be taken with an evening snack?

5. Which of the following medications would be most appropriate for a 68-year-old woman with difficulty falling asleep and multiple awakenings each night despite appropriate nonpharmacologic therapy?

6. PT is a 50-year-old man who reports waking up unintentionally at 3:30 am and has difficulty falling back asleep at least 5 nights per week for the past 4 months. He maintains a regular bedtime at 10:00 pm and reports adequate sleep hygiene. Which of the following medications could be initiated to improve PT's sleep difficulties?

7. Which of the following assessment instruments provides an objective measure of sleep latency?

8. Which of the following medications is an OTC agent that causes a clinically significant drug-drug interaction with lemborexant?

9. Patients taking which of the following medications for insomnia should be counseled to be cautious and move slowly to minimize potential orthostatic hypotension when changing position from lying to sitting or from sitting to standing?

10. Tapered discontinuation is not required to prevent rebound insomnia with which of the following medications?

Evaluation Questions

11. How confident are in your treatment choices for the patients in the above questions?

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