08-19-2008, 03:45 AM
39. A 67-year-old man comes to the physician because of insomnia for 2 years. He goes to bed at 11:00 PM after taking a
bath but does not fall asleep until midnight. He usually wakes up twice each night: once around 3:00 AM to void and again at 6:00 AM. He stays in bed until his alarm goes off at 7 AM. He is concerned because he used to sleep 8 hours daily. He recently retired from his job as an attorney. He takes no medications. He drinks one beer with lunch 3 days each week and one glass of wine with dinner each evening. He walks 1 mile daily after dinner. Physical examination shows no abnormalities. His mood is neutral, and cognition is intact. Urine toxicology screening is negative. Which of the following is the most likely cause of this patient's symptoms?
A) Advanced sleep phase syndrome
B) Alcohol abuse
C) Delayed sleep phase syndrome
D) Major depressive disorder
E) Melatonin deficiency
F) Poor sleep hygiene
G) Normal aging
bath but does not fall asleep until midnight. He usually wakes up twice each night: once around 3:00 AM to void and again at 6:00 AM. He stays in bed until his alarm goes off at 7 AM. He is concerned because he used to sleep 8 hours daily. He recently retired from his job as an attorney. He takes no medications. He drinks one beer with lunch 3 days each week and one glass of wine with dinner each evening. He walks 1 mile daily after dinner. Physical examination shows no abnormalities. His mood is neutral, and cognition is intact. Urine toxicology screening is negative. Which of the following is the most likely cause of this patient's symptoms?
A) Advanced sleep phase syndrome
B) Alcohol abuse
C) Delayed sleep phase syndrome
D) Major depressive disorder
E) Melatonin deficiency
F) Poor sleep hygiene
G) Normal aging