Sleep Disorders

Patient Story: Sleep Disorders

Warren, a 30-year-old graduate student, saw a doctor to discuss his problems staying asleep. The trouble began four months prior when he started to wake up at 3 a.m. every morning, no matter when he went to bed, and he was unable to fall back to sleep. As a result he felt “out of it” during the day. This led him to feel more worried about how he was going to finish his thesis when he was unable to focus due to extreme fatigue. At first, he did not recall waking up with any concern on his mind. As the problem lasted, he found himself dreading the next day and wondering how he would teach his classes or focus on his writing if he was only getting a few hours of sleep. Some mornings he lay awake in the dark next to his fiancée, who was sleeping soundly. On other mornings he would cut his losses, rise from bed and go very early to his office on campus.

After a month of poor sleep, Warren went to the student health services clinic, where he received his medical care. (He had asthma, for which he sometimes used an inhaler.) The physician assistant prescribed a sleep mediation, which did not help. Falling asleep was never his problem, Warren explained. Meanwhile, he followed some of the advice he read online. Although he often relied on coffee during the day, he never drank it after 2 p.m. An avid tennis player, he chose to play on in in the early morning. He did have a glass or two of wine every night at dinner with his fiancée, however. “By dinner, I start to worry about whether I’ll be able to sleep,” he said, “and to be honest, the wine helps.”

Warren did not appear tired but told the doctor, “I made a point to see you in the morning, before I hit the wall.” He did not look sad or on edge and was not sure if he had ever felt depressed. But he was certain of nagging, low-level anxiety. “This sleep problem has taken over,” he explained. “I’m stressed about my work, and my fiancée and I have been arguing. But it’s all because I’m so tired.”

Warren was diagnosed with insomnia disorder. His sleep problem began during a period of high stress. His worries about not sleeping may have made the problem worse. Warren may also be self-medicating with caffeine to stay alert during the day and with wine to slow down during the evening.

Also noted is a past medical history of asthma, for which Warren sometimes uses an in haler. Because the inhaler mediation may be stimulating, knowing when and how much of them he uses would be helpful.