Case Study: Insomnia

👨‍⚕️ What brings you to us today?

👨 I just can’t fall asleep in the evenings. During the day I’m tired and can’t concentrate properly at work.

👨‍⚕️ Since when has it been like this?

👨 I’ve had sleep problems now and then. But for about four months it’s been really bad.

👨‍⚕️ Do you have trouble every night, or are there nights when you sleep well?

👨 Most nights it’s bad. Occasionally it’s better, but I never know in advance how the night will be.

👨‍⚕️ What is particularly stressful for you?

👨 That I already feel anxious about going to bed in the evening. I keep thinking that I won’t be able to fall asleep again and won’t be able to get anything done the next day.

👨‍⚕️ When do you usually go to bed?

👨 Usually around half past ten. Sometimes I go earlier because I think I’ll then have more time to sleep.

👨‍⚕️ Are you already sleepy at that time?

👨 I am tired. But as soon as I lie in bed, I’m suddenly wide awake again.

👨‍⚕️ How long does it take approximately for you to fall asleep?

👨 Often one and a half or two hours. Sometimes even longer. I then constantly look at the clock.

👨‍⚕️ What goes through your mind during this time?

👨 First I think about work and my wife. Then it’s only about needing to sleep at last. I calculate how many hours I have left.

👨‍⚕️ How do you feel physically during that?

👨 I’m really tense. Especially my shoulders and legs. I also can’t find a comfortable position.

👨‍⚕️ What do you do when you can’t fall asleep for a long time?

👨 At first I stay lying and keep trying. Eventually I can’t stand it anymore. Then I get up, smoke a cigarette and walk around the apartment.

👨‍⚕️ Can you sleep better once you finally fall asleep?

👨 Mostly yes. Sometimes I wake up briefly, but falling asleep at the beginning is the biggest problem.

👨‍⚕️ When do you get up in the morning?

👨 When I was still working, I had to get up around half past six. Right now it’s sometimes eight or half past eight, because I have a hard time getting out of bed.

👨‍⚕️ How much do you sleep in total approximately?

👨 Hard to say. Maybe four to five hours on a bad night. Sometimes a bit more.

👨‍⚕️ Do you feel rested in the morning?

👨 No. I feel like I hardly slept.

👨‍⚕️ Are there situations in which you fall asleep more easily?

👨 Yes, that’s the strange thing. When I’m watching a film on the sofa, I sometimes just fall asleep.

👨‍⚕️ Do you then try consciously to fall asleep?

👨 No, not at all. I watch the film and at some point I notice I’ve missed a bit.

👨‍⚕️ What happens when you go to bed afterwards?

👨 Then I’m often awake again. As soon as I lie in bed, the brooding starts again.

👨‍⚕️ How do you sleep when you stay somewhere else?

👨 I recently stayed at a friend’s place. It was much better there. It’s almost as if I’ve developed a problem with my own bed.

👨‍⚕️ Do you sleep during the day?

👨 Sometimes I doze off briefly on the sofa in the afternoon. But I don’t lie down to sleep every day.

👨‍⚕️ You said it got worse about four months ago. Did anything change in your life at that time?

👨 Yes, quite a lot. At work it was pointed out that I’m making more mistakes. Around the same time my wife moved to New York.

👨‍⚕️ What kind of mistakes at work were they?

👨 I also forgot simple things. Once I didn’t give a customer the guarantee certificate. He was pretty angry, and then there was an argument.

👨‍⚕️ Have you noticed such difficulties in everyday life as well?

👨 Sometimes I forget what I was about to do. But it was mainly noticeable at work.

👨‍⚕️ Why did your wife move to New York?

👨 She really wanted to go there because she hoped for better earning opportunities and more prospects. Eventually she carried out her plan.

👨‍⚕️ How do you feel about that?

👨 It preoccupies me a lot. Especially in the evenings when I’m alone at home. We talk on the phone, but of course it’s different than before.

👨‍⚕️ When did you previously have difficulties sleeping?

👨 Mostly when something changed in the family or at work. That happened from time to time.

👨‍⚕️ How long did these phases last?

👨 Sometimes a few days, sometimes several weeks. Eventually it got better again.

👨‍⚕️ What helped you back then?

👨 Sometimes it went away on its own. Once I was given tablets.

👨‍⚕️ Do you still remember what they were called?

👨 No, unfortunately not. I only roughly remember what they looked like.

👨‍⚕️ Do you still have those tablets at home or are you currently taking them?

👨 No, I don’t have any left and I’m not taking anything to sleep at the moment.

👨‍⚕️ How is your mood during the day?

👨 Actually quite normal. I’m mainly tired and annoyed about the sleep.

👨‍⚕️ Do you still enjoy things that usually give you pleasure?

👨 Yes. I like meeting friends and also going for walks. I just often have less energy for that.

👨‍⚕️ Has your appetite changed?

👨 No, I eat as usual.

👨‍⚕️ Do you feel that everything is hopeless or that nothing can improve?

👨 No. I do hope that I can sleep better again.

👨‍⚕️ Do you also worry frequently aside from sleep issues?

👨 Yes, I quickly worry about all kinds of things. About work, money or family. It has been like that before.

👨‍⚕️ Have you ever had a period lasting several weeks in which you felt very low and had little interest in anything?

👨 No, not like that.

👨‍⚕️ Conversely, have there been times when you were unusually keyed up, needed very little sleep and still felt full of energy?

👨 No. If I sleep little, I’m always tired.

👨‍⚕️ Do you sometimes have thoughts that you have to repeat over and over against your will, or do you have to check certain things repeatedly?

👨 No.

👨‍⚕️ Have you ever heard voices when no one was there, or felt that others were persecuting you?

👨 No, never.

👨‍⚕️ Have you had thoughts of harming yourself?

👨 No.

👨‍⚕️ Did your wife previously notice that you snore loudly or temporarily stop breathing during sleep?

👨 No, she never said anything about that.

👨‍⚕️ Has she noticed unusual movements, for example strong kicking or hitting during sleep?

👨 No, not that either.

👨‍⚕️ Do you sometimes wake up because you can’t breathe?

👨 No.

👨‍⚕️ Do you have an unpleasant sensation in your legs in the evening and have to move them to make it better?

👨 No. They sometimes feel tense, but I don’t have such an urge to move.

👨‍⚕️ Do you fall asleep suddenly during the day without being able to prevent it, for example while eating or during a conversation?

👨 No. I’m tired, but that doesn’t happen to me.