Case Studies

A 40 year old male patient came on his own to the Psychiatric OPD at Nair Hospital, with chief complaints of:

• difficulty in falling asleep – since last 2 to 3 years
• cannot initiate sleep
• no day time sleep
• sleep only for 1 to 2 hours at night

Sandeep a ward-boy at a Municipal hospital, experienced difficulty in falling asleep for 2 to 3 years. He would lie in bed for hours together waiting to fall asleep. Inspite of taking no day time sleep (or afternoon naps) he found it difficult to initiate sleep at night. He ultimately would sleep for only one to two hours at night. But this lack of sleep did not have any effect on his day to day activities. During this period Sandeep claimed to lead a normal active life.

On noting his case history no depressive, anxiety or psychotic symptoms were observed. Sandeep also did not have a history of any psychiatric illness, and there were no significant stresses prior to this problem nor was there any general medical condition which could be accountable for this episode. His alcohol consumption was also not significant (social drinker).

Management :

Sandeep was initially started on T zopiclone (7.5mg) 1 HS. No improvement was perceived after taking this medication for three weeks. The patient was then shifted to T zolpidem (10mg).

Discussion :

After a detailed interview with the patient and psychological testing, Sandeep was diagnosed to be suffering from ‘chronic insomnia’. As sleep problems are not considered as important symptoms, this patient may not have approached the Psychiatric OPD earlier. In such cases of chronic insomnia sleep restoring agents are generally prescribed.