Insomnia

At Las Vegas Psychiatry, Dr. Wolford has outstanding clinical experience with sleep disorders. He has even given a Grand Rounds presentation to the faculty at BronxCare Hospital in New York City on this topic. Some natural remedies such as melatonin and other over-the-counter medications can be used like Benadryl & Unisom. Pharmacological interventions will start at the least potent level for safety and selected based on side effect profile. Subjective patient reports will be taken into account the following day such as:

• Overall energy
• Productivity
• Quality of life
• Grogginess

Habit forming medications will be avoided (ie Ambien) due to FDA warnings for operating machinery/vehicles, as well as dopamine modifying medications such as Seroquel due to metabolic changes and weight gain. New Orexin medications will be considered in certain treatment resistant cases. In certain patients medical etiologies causing interruptions will be addressed such as:

• Sleep apnea (snoring and stopping breathing)
• Mass effect (obesity/breast)
• Airway problems (“Overbite”)
• Nocturia (nighttime bathroom visits)

In these cases, the appropriate referrals will be made such as to the Sleep Center of NV for a sleep study as well as to consult with urology, ob/GYN, or Dental.