insomnia

How do you counsel an older patient about the risks of benzodiazepines?  

Mr. Davis is a 75-year-old man with a history of hypertension, type 2 diabetes (A1c 6.8), and insomnia. He recently moved to be closer to his grandchildren and is establishing primary care with you. His medications are amlodipine 10 mg daily, metformin 500 mg twice daily, semaglutide 1 mg weekly, atorvastatin 40 mg daily, and …

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How do you treat insomnia with medications if CBTi doesn’t help?

Part 2 of “When the sheep are gone, how do you treat insomnia?” In a prior PsychSnap, we met Ms. Rose, a 65 year old woman with diabetes who is the primary caregiver for her adult son. She has been struggling with sleep maintenance, waking up multiple times in the middle of the night and taking 30-90 …

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What change could reduce anxiety in a patient with partial benefit from an SNRI?

A 62 yo woman has a history of chronic pain from osteoarthritis, severe sciatica, recurrent major depression, generalized anxiety, and insomnia. She takes chronic low-dose opioids for pain and an SNRI (duloxetine, titrated to 60mg BID) for pain, depression, and anxiety, with moderate improvement in pain and depression and mild improvement in anxiety.   She currently …

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