Case 1 :
Mrs X, a 40 -year-old lady with difficulty falling asleep. PuanSuraya, a 40 year old schoolteacher complains of inability to sleep well for more than 2 years. She regularly goes to bed at 10 pm but is unable to sleep until 1 am. She experiences about 3-5 awakenings every night and with each awakening requires about 30 minutes to fall asleep again. Mrs x, also experiences daytime fatigue and is unable to concentrate in her work. She does not take naps during the day. She does not snore and has no usual limb movements during sleep (history from husband). Her general health has been good. She vaguely recalls being involved in a stressful family property dispute just prior to onset of her sleep difficulty. As bedtime approaches, she becomes very tense and worries about the prospect of another sleepless night. “Sleep has become a real frustration. Every night, when I lie in bed, I have to try very hard to sleep. I keep watching the clock”. She does not take any sleeping pills and has no symptoms of depression. There is no marital conflict. On further questioning, she surprising admits that she sleeps well while on vacations and relatives houses.
Case 2 :
Mr. X a 40-year-old man with difficulty falling asleep and maintaining sleep. Mr. Tan, a 45-year-old man presents with difficulty falling asleep and staying asleep. The problem started after the death of his sister 2 months previously. He is unable to fall sleep until at least an hour after going to bed. He has no previous sleep problems. A general practitioner he consulted had prescribed low-dose tricyclic antidepressant as sedation but Mr. X was unable to tolerate the drowsiness and dry mouth caused by the medication. He consumes 4 cups of coffee during the day and lately takes alcohol at night to aid sleep. The patient’s wife has noted that his legs jerk occasionally during the sleep though Mr. Tan is not aware of these movements.