Mr. Smith is a 40-year-old married man

Mr. Smith is a 40-year-old married man who presents to the PMHNP with a chief complaint of “I can’t fall asleep. I’ve tried everything. Nothing works! That medication the doctor gave me made me feel worse. It made me feel really anxious. I’m exhausted! I can’t function. I’m going to lose my job.” Mr. Smith states his primary care provider has prescribed various sleeping medications, including zolpidem, eszopiclone, and lorazepam which have all caused a worsening of his insomnia. His physical exam and routine labs, performed by his primary care provider, have all been within normal limits. To participate in this discussion, please answer the following questions. Be sure to provide a rationale and references to support your responses. What would you do first? What pharmocological interventions would you recommend and why?

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