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After completing this case study, the reader should be able to:

  • Identify the psychosocial, disease-related, and drug-induced causes of insomnia.

  • Explain the impact of poor medication adherence on chronic illnesses.

  • Educate a patient regarding nonpharmacologic treatments for insomnia.

  • Design a therapeutic plan for the treatment of insomnia.


Chief Complaint

“I can’t sleep.”


Jenny Moore is a 42-year-old woman who is referred by her family medicine physician to a Pharmacotherapy Clinic for medication therapy management for insomnia. She receives help paying for her medications from medication assistance programs. She reports that she is unable to sleep at all during the week and then sleeps all day on Sunday. Ms Moore is currently taking temazepam 30 mg daily at bedtime that was recently increased from 15 mg. She is also experiencing depression due to an abusive relationship with her boyfriend as well as lack of current employment. Her most recent Patient Heath Questionnaire-9 (PHQ-9) result was 20. She admits to being nonadherent to her medication regimen. She reports that she is no longer able to see her psychiatrist due to cost of the visits.


  • Insomnia for many years

  • COPD

  • Depression

  • Migraine headaches

  • GERD

  • Allergic rhinitis


Mother is alive and well and lives nearby. Father died of an MI at age 65.


Single, lives with her abusive boyfriend. Unemployed, but receives some money from her mother. She smokes approximately five cigarettes per day, but has smoked up to two ppd in the past. She denies alcohol use. She sees a deacon at her church for counseling. She receives medication assistance for several of her medications from a local agency.


  • Temazepam 30 mg PO QHS PRN sleep

  • Fluticasone/salmeterol DPI 250/50, one inhalation BID

  • Albuterol MDI, two puffs Q 6 H PRN SOB

  • Tiotropium Handihaler, one inhalation daily

  • Citalopram 20 mg PO Q AM

  • Olanzapine 3 mg/fluoxetine 25 mg PO Q PM

  • Sumatriptan 100 mg PO PRN migraine

  • Atenolol 25 mg PO Q AM for migraine prophylaxis

  • Dexlansoprazole 60 mg PO Q AM

  • Ibuprofen 200–400 mg PO Q 6 H PRN pain

  • Tramadol 50 mg PO Q 6 H PRN pain

  • Pseudoephedrine 30 mg PO Q 6 H PRN allergies




Patient reports that she does not sleep during the week and only sleeps on Sunday. She reports poor sleep hygiene, because she reads and watches television in bed. She drinks six to eight cups of coffee throughout the day and really ...

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