Case study - Insomnia
Albert, 22-years old pharmacy student came to your pharmacy with a 7-day prescription for
diazepam 10 mg tablets, one to be taken at night.
It was prescribed to him because 5 weeks ago he started suffering from insomnia. He cannot sleep till
the morning; he wakes up at 4 am although he could sleep till 7am to attend his lectures. When he
wakes up he is fully awake. He doesn’t have any difficulty to fall sleep, nor does he wake up during
the night. During the day he feels very tired, anxious and tearful.
It is now 3 days since you dispensed him his prescription and the patient has returned to you because
he claims he is still not able to sleep properly.
Tasks:
1. How is insomnia defined?
2. What are the risk factors for its development? Does Albert have any risk factors for
development of insomnia?
3. What group of medicines does diazepam belong to? What are the main pharmacokinetic
differences between the components of this class of medicines?
4. What is the mechanism of action of diazepam in the treatment of insomnia? What are the
side effects of diazepam? What formulations are available for diazepam?
5. What are other pharmacological options of management of insomnia? (other drugs)
6. What alternative preparation(s) could you recommend to Albert? (herbal, homeopathy, ...)
7. What counselling could you give Albert to help try and resolve the issue (nonpharmacological
advice)?
8. What are the rules/recommendations of sleeping hygiene?
9. What is a sleep diary, sleep laboratory and sleep monitoring?