Clinical case · Insomnia
A fall at 3 a.m. and a request for a stronger tablet
A 78-year-old woman who has taken zolpidem every night for six years fell on her way to the toilet and asks for something stronger. Confirm chronic insomnia, look for other sleep disorders and plan treatment that lowers her falls risk.
Intermediate 12 minNeeds clinical review
You will learn to
- Apply the diagnostic criteria for chronic insomnia
- Choose CBT-I as first-line treatment and know which medicines are not recommended
- Weigh the falls risk of Z-drugs in older adults and plan a taper
Presentation
Step 1 of 10A 78-year-old woman fell at 3 a.m. on her way to the toilet, an hour after taking her usual zolpidem. She bruised her hip but did not break anything. "I just can't sleep," she says. "Can I have something stronger?"
References
- Riemann D, Espie CA, Altena E, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035. doi:10.1111/jsr.14035 · PubMed 38016484
- Scharner V, Hasieber L, Sönnichsen A, et al. Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing. BMC Geriatr. 2022;22(1):87. doi:10.1186/s12877-022-02757-6 · PubMed 35100976
Last updated 2026-10-24.
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