, i-Human Case Study: “I Just Can’t Sleep” –
Insomnia in a 65-Year-Old Female week 9
Week 9: Advanced Primary Care of the Older Adult (NURS 6531)
Walden University | Fall 2026 | Simulation Encounter
Patient Demographics: 65-year-old female | Height: 5'4" (163 cm) | Weight: 168 lb (76.2 kg) |
BMI: 28.8 (overweight) |
Reason for encounter: “I have terrible trouble sleeping – it’s been months and I’m exhausted all
day.”
Setting: Outpatient primary care clinic (self-referred, brought by daughter).
1. Case Overview & Learning Objectives
This i-Human case presents a 65-year-old female with a 6-month history of progressive difficulty
falling asleep and staying asleep, leading to daytime fatigue, mood disturbances, and reduced
quality of life. The case challenges advanced practice nursing students to differentiate between
primary insomnia, insomnia secondary to medical/psychiatric conditions, sleep-disordered
breathing (obstructive sleep apnea), restless legs syndrome (RLS), circadian rhythm disorders,
and medication-induced sleep disturbances. Learners will perform a focused sleep history
(including the use of sleep diaries, Insomnia Severity Index, STOP-BANG questionnaire, and
Epworth Sleepiness Scale), order and interpret appropriate diagnostic studies (polysomnography,
actigraphy, laboratory tests), and develop an evidence-based, multimodal treatment plan
incorporating cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene education, and
judicious use of pharmacotherapy. The primary diagnosis is chronic insomnia disorder
(ICSD-3 criteria) with features of sleep maintenance insomnia and early morning
awakening, complicated by mild obstructive sleep apnea (AHI 12) and possible
contribution from perimenopausal vasomotor symptoms. The case emphasizes
non-pharmacologic first-line treatment and shared decision-making.
Learning Objectives: Upon completion of this case, the student will be able to: (1) obtain a
comprehensive sleep history using validated instruments; (2) recognize common medical and
psychiatric comorbidities that perpetuate insomnia in older adults; (3) interpret polysomnography
and home sleep apnea test results; (4) prescribe cognitive behavioral therapy for insomnia
(CBT-I) as first-line treatment; (5) appropriately select and monitor pharmacologic agents (e.g.,
low-dose doxepin, melatonin, ramelteon) while avoiding high-risk medications
(benzodiazepines, Z-drugs); and (6) develop a longitudinal follow-up plan that includes sleep
hygiene, stimulus control, and sleep restriction.
2. Chief Complaint (CC)
“I’ve been sleeping terribly for the last six months. I fall asleep okay, but then I wake up at 2 or 3
AM and can’t fall back asleep. I’m tired all day and my memory is getting bad.”
3. History of Present Illness (HPI) – Detailed Chronology
Insomnia in a 65-Year-Old Female week 9
Week 9: Advanced Primary Care of the Older Adult (NURS 6531)
Walden University | Fall 2026 | Simulation Encounter
Patient Demographics: 65-year-old female | Height: 5'4" (163 cm) | Weight: 168 lb (76.2 kg) |
BMI: 28.8 (overweight) |
Reason for encounter: “I have terrible trouble sleeping – it’s been months and I’m exhausted all
day.”
Setting: Outpatient primary care clinic (self-referred, brought by daughter).
1. Case Overview & Learning Objectives
This i-Human case presents a 65-year-old female with a 6-month history of progressive difficulty
falling asleep and staying asleep, leading to daytime fatigue, mood disturbances, and reduced
quality of life. The case challenges advanced practice nursing students to differentiate between
primary insomnia, insomnia secondary to medical/psychiatric conditions, sleep-disordered
breathing (obstructive sleep apnea), restless legs syndrome (RLS), circadian rhythm disorders,
and medication-induced sleep disturbances. Learners will perform a focused sleep history
(including the use of sleep diaries, Insomnia Severity Index, STOP-BANG questionnaire, and
Epworth Sleepiness Scale), order and interpret appropriate diagnostic studies (polysomnography,
actigraphy, laboratory tests), and develop an evidence-based, multimodal treatment plan
incorporating cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene education, and
judicious use of pharmacotherapy. The primary diagnosis is chronic insomnia disorder
(ICSD-3 criteria) with features of sleep maintenance insomnia and early morning
awakening, complicated by mild obstructive sleep apnea (AHI 12) and possible
contribution from perimenopausal vasomotor symptoms. The case emphasizes
non-pharmacologic first-line treatment and shared decision-making.
Learning Objectives: Upon completion of this case, the student will be able to: (1) obtain a
comprehensive sleep history using validated instruments; (2) recognize common medical and
psychiatric comorbidities that perpetuate insomnia in older adults; (3) interpret polysomnography
and home sleep apnea test results; (4) prescribe cognitive behavioral therapy for insomnia
(CBT-I) as first-line treatment; (5) appropriately select and monitor pharmacologic agents (e.g.,
low-dose doxepin, melatonin, ramelteon) while avoiding high-risk medications
(benzodiazepines, Z-drugs); and (6) develop a longitudinal follow-up plan that includes sleep
hygiene, stimulus control, and sleep restriction.
2. Chief Complaint (CC)
“I’ve been sleeping terribly for the last six months. I fall asleep okay, but then I wake up at 2 or 3
AM and can’t fall back asleep. I’m tired all day and my memory is getting bad.”
3. History of Present Illness (HPI) – Detailed Chronology
