A middle-aged woman presents with difficulty falling asleep and increasing day-time fatigue. She reports taking over an hour to fall asleep, and frequent waking throughout the night. She is perimenopausal and her history is significant for anxiety. Her physical exam and laboratory tests are normal. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out sleep apnea, psychiatric disorders and neurological disorders (dementia, Parkinson’s Huntington’s, myotonic dystrophy).

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This post was written by Omar Rifai