NURS 6670 Ron D. is a 67-year-old man who has been referred by his primary care provider for management of sleep disorder

Ron D. is a 67-year-old man who has been referred by his primary care provider for management of sleep disorder


Ron D. is suffering from what you know as a paradoxical insomnia which is characterized by recurrent complaints of difficulty initiating or maintaining sleep, despite adequate opportunity and circumstances for sleep. Typically paradoxical insomnia has an environmental risk factor where the patient may not be given the chance to sleep or experiences a smaller window of time in bed for sleep.

This is known as paradoxical insomnia. Hypersomnia means oversleeping on the other end of the sleep spectrum. Paradoxical insomnia is described as an individual who stays awake for long periods of time (sometimes more than an hour) during the night, followed by brief periods of very rapidly falling asleep. This can cause a feeling of not having slept because they wake up and feel unrefreshed. This is a diagnosis that I would give if someone was coming to me with this type of complaint, and I would refer them to a psychiatrist or psychologist in my area to get further help with this issue.

Ron comes to the clinic after getting up from his naps with a residual sleepiness that has prevented him from feeling alert and functional during the day. His history reveals multiple prescriptions, including Ambien and Sonata. Ron’s symptoms are classic for those in the midst of a hypnogogic-hypnopompic syndrome that is symptomatic upon awakening. This often goes untreated because it is so subtle.

Insomnia is a subjective report of sleep difficulty, most commonly consisting of difficulty falling asleep, frequent nocturnal awakenings, and/or nonrestorative sleep. It is the most common sleep complaint and can be caused by a medical disorder or psychological factors.

A. Sleep onset insomnia B. Sleep maintenance insomnia C. Co-Morbid sleep apnea

Polysomnography is a sleep study conducted in a sleep lab that includes electroencephalographic, electromyographic, and electro-oculographic recordings; anterior tibialis muscle recordings; oximetry; airflow nasopharyngeal pneumogram; airflow tracheal pneumogram; and body movement recordings. Positron emission tomography (PET) of the brain can also be done during a sleep study.

A. Paradoxical insomnia; B. Sleep state misperception; C. Sleep apnea; D. None of the above

Insomnia is characterized by an inability to fall asleep, or remain asleep, or both. It is a chronic disorder that can have many etiologies.

An example of the second type of error was given with the fallacious conclusion that early onset insomnia is the most common type of insomnia.


Ron D. is a 67-year-old man who has been referred by his primary care provider for management of sleep disorder. He has seen his PCP many times complaining of insomnia. He reports that he lays in bed for “hours” every night before falling asleep and then often wakes up every 90 minutes, sometimes staying awake for more than an hour before he goes back to sleep. He has been trialed on both zolpidem (Ambien) and zaleplon (Sonata) without improvement. Polysomnography did not support the pattern of sleep described by Ron D. During his sleep study, he reported the same complaints, while the objective test results indicated that he fell asleep in < 15 minutes with a total sleep time > 7 hours and 93% sleep efficiency. This is known as:

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