Evaluation and Treatment of Poor Sleep

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Mr. A, a 63-year-old man with bipolar disorder who was admitted to the hospital,was profoundly depressed and had a host of neurovegetative symptoms(including anergia, anhedonia, impaired concentration, and poor sleep [wakingup several times each night and finally arising 1-2 hours earlier than usual witha pervasive feeling of dread]). Mr. A’s medications included lithium carbonate300 mg t.i.d., duloxetine 30 mg daily, and lorazepam 1 mg t.i.d. (as needed foranxiety). An inability to sleep became a focal issue for Mr. A.