BACKGROUND This week, we examine a 31-year-old male who presents to the office w
BACKGROUND This week we examine a 31-year-old male who presents to the office with a chief complaint of insomnia. SUBJECTIVE Patient is a 31-year-old male. He states that his insomnia has gotten progressively worse over the past 6 months. Per the patient he has never been a great sleeper but is now having difficulty both falling asleep and staying asleep at night. The problem began approximately 6 months ago after the sudden loss of his fiancÃ©. The patient states this is affecting his ability to perform his job which is a forklift operator at a local chemical company. The patient states he has used diphenhydramine in the past to sleep but does not like the way it makes him feel the morning after. He states he has fallen asleep on the job due to lack of sleep from the night before. The patients medical record from his previous physician states that he has a history of opiate abuse which began after he broke his ankle in a skiing accident and was prescribed hydrocodone/apap (acetaminophen) for acute pain management. The patient has not received a prescription for an opiate analgesic in 4 years. The patient states recently he has been using alcohol to help him fall asleep approximately four beers prior to bed.