An otherwise healthy 55-year-old woman comes to the physician because of a 7-month history of insomnia. She has difficulty initiating sleep, and her sleep onset latency is normally about 1 hour. She takes melatonin most nights. The physician gives the following recommendations: leave the bedroom when unable to fall asleep within 20 minutes to read or listen to music; return only when sleepy; avoid daytime napping. These recommendations are best classified as which of the following?
ACognitive behavioral therapy
BRelaxation
CImproved sleep hygiene
DStimulus control therapy
ESleep restriction
A 17-year-old man presents to his primary care physician concerned about excessive sleepiness that has persisted his entire life. He notes that he has been having difficulty with his job as a waiter because he often falls asleep suddenly during the day. He also experiences a sensation of dreaming as he goes to sleep even though he still feels awake. He sleeps about 10 hours per day and still feels tired throughout the day. The patient has even reported driving into a tree once as he fell asleep while driving. The patient often stays up late at night working on the computer. Physical exam demonstrates an obese young man who appears tired. His oropharynx demonstrates high palatal ridges and good dental hygiene. Which of the following is the best next step in management?
ARecommend scheduling regular naps and more time for sleep at night
BStart a selective serotonin reuptake inhibitor
CBegin inhibitor of dopamine reuptake
DOrder sleep study with Multiple Sleep Latency Test
EContinuous positive airway pressure at night
A 19-year-old man is seen by his primary care physician. The patient has a history of excessive daytime sleepiness going back several years. He has begun experiencing episodes in which his knees become weak and he drops to the floor when he laughs. He has a history of marijuana use. His family history is notable for hypertension and cardiac disease. His primary care physician refers him for a sleep study, which confirms your suspected diagnosis. Which of the following is the best first-line pharmacological treatment for this patient?
AZolpidem
BLisdexamfetamine
CModafinil
DMethylphenidate
EDextroamphetamine
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