Saturday, November 22, 2008

Wake up little Suzie

A nurse at the ER stated she was getting more than enough sleep but still feeling exhausted in the am. She is also is attending school, enrolled with army and raising 4 kids. She smokes and has had an issue with constipation ok with otc softners in addition to her kids needing the same otc's. (over the counter's) My first suggestion was to get a sleep study in order to determine if an abnormal sleep waves could be causing a dangerous problem. She apparently doesnt snore, is not falling asleep at the wheel, not suffering from memory issues and not being awaken by anything in the bedroom environment. The Saguil Approach would be to first teach about sleep hygiene so she can better understand the issues that cause problems. Sometimes when patients understand the pathophysiology of and injury, they may be able to better find the reason that I can't see on the outside. After making sure no dangerous sleep issues are going on, valerian would probably help reduce her reaction to the stress of all that is going on. I would always suggest omega 3 for fighting any unseen seasonal affective disorder (later told me she is on an ssri for chronic depression that is "stable"). The cigarettes have to stop after dinner, caffeine should be tapered to nothing after lunch. I always suggest an early morning wake up alarm the same time 7 days a week. An evening ritual one hour before desired sleep time is also important to start. My experience is that grad students in the same scenario always suffer from and exacerbation of old symptoms in the last year of grad school. Best I can do is make sure nothing dangerous is occuring and provide some supportive suggestions until 3 months after graduation. This would be a complicated patient since there seems to be underlying issues, (chronic constipation, tobacco addiction and multiple endeavors with over extension of normal daily duties). Good thing is she is plugged into other specialists for each issue, bad thing is all these guys are doing there own thing without concern for the other body systems. This is typical for western medicine, treat the disease process not the patient. The brain, the body and the spirit arent considered one. This is where the spirit, would be the biggest component that if worn down would effect the normal functioning of the other body system (speaking on western terms). Truth is I could make anyone go to sleep with the right potent drug but if the true reason isnt found, more and more meds will be needed in addition to other medicines to reverse the side effects from the sleep drugs. We should just hibernate through the winter and wake up in spring, thin with grown kids.