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22-Nov-2015 08:59 posted by green281 | Leave a comment

For example, I would ask your patient to do the following: 1) get plenty of exercise during the day, (usually this means walking), preferably in direct sunlight, but do not exercise in the evening; 2) avoid fluids during the last several waking hours and void before going to bed; 3) avoid alcohol or caffeine during evening hours; 4) read or do whatever seems to help with relaxation and sleep induction before turning the lights out; 5) leave window shades up so that morning sunlight can enter the bedroom; 6) get up at approximately the same hour each a.m.even if nighttime sleep had been poor, and do not nap during the day; 7) get a comfortable mattress and sleep in an uncluttered bedroom.

Duński BC Aabyhoj Aarhus wśród dziewcząt i BC Raplamaa Rapla z Estonii wśród chłopców, okazały się najlepsze podczas rozgrywanego w Człuchowie Super Finału ligi EYBL i EGBL w kategoriach U15 dziewcząt i U14 chłopców.Biuro POZKosz nieczynne - do końca lipca Mecz Gwiazd: Znamy pełne składy zespołów70 lat Pomorskiej Koszykówki Kadra Pomorza zagra o Puchar Wójta Gminy ... Biuro POZKosz nieczynne - 27 maja Mecz Gwiazd: Rozpoczynamy głosowanie! Would you increase the dose of SSRI or add an additional medication for sleep, or what else would you choose to do?If so, I would not hesitate to increase Paxil® to 40 mg.daily, which for some-even for frail, elderly patients-would be a more optimal dose. This could be done in one step without any tapering of the Paxil®.

Since she seems to respond to and tolerate SSRI antidepressants, another option would be to switch to a more potent SSRI, namely Lexapro®(Escitalopram), starting at 10 mg. Whether you increase the Paxil® dose or switch to Lexapro®, the presumption here is that your patient's ongoing sleep difficulties reflect residual depression.

By the term 'sleep hygiene' I refer to a few very basic and obvious measures.

The medication is being tolerated and her mood is improved, but her sleep remains a problem.

In this case you say that your patient is tolerating Paxil® at 30 mg.

daily and her mood has improved, but sleep is still problematic.

This leaves the impression that, despite overall improvement, she is not quite in full remission from the depressive picture.

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