Write a 1,400--word evaluation of Suzette's case.

Suzette is a 47-year old Caucasian female who has been married for 24 years, and has three adolescent children. Her spouse was laid off from his job of 15 years, and she has had to seek part-time work in the retail business. She works 25 hours a week. They own a home, but have been unable to make their mortgage payments for the past 7 months. She states that she always felt they went beyond their means when purchasing this large house. Her spouse has been despondent since his job loss and is having difficulty finding employment in his field, spending most days at home doing very little. He has turned down several jobs, because he considered them "beneath" his skill level, and has started drinking more heavily in recent months. Their children are in school and appear fairly well-adjusted.

Suzette has suffered from headaches for many years of her life and their frequency has increased to the extent that she has headaches "more days than not." In the past year, she has had occasional shortness of breath and difficulty sleeping. She falls asleep within 15 minutes but frequently wakes up "at 2 or 3 a.m." and is unable to fall back to sleep. This pattern has worsened and she claims she dreads going to bed because of the worries she has and her fear of not sleeping well.

She has good medical insurance because of her spouse's COBRA plan, and she has regular visits with her primary care physician. Her medical history includes breast surgery for benign cysts, and she has a history of tachycardia and chronic lumbar pain. She also has evidence of early menopause. Her current medications include Ativan for anxiety and sleep, hormone replacement therapy, and low doses of Naproxen for back pain. She resists taking the Ativan, because it makes her feel "foggy" during the day.

She is of normal weight for her height, and her blood pressure is normal. Her eating patterns are reduced, since she says, "I'm just not very hungry." There has been no major weight loss or gain in 5 years. She does not use alcohol or other drugs. She does not smoke. Sexual interest and desire have decreased significantly in the past 4 years. Her level of physical exercise is minimal and she states that she used to go to a gym, but finances forced her to quit. She claims that exercise always made her "feel good." Since then, she spends most of her time at work or home, and has no time to exercise. Her mental status is normal, aside from moderate anxiety. Her level of social support is reduced, because she has few friends and her relationship with her spouse has become distant.

Her major complaint is her insomnia. She has significant daytime sleepiness and often falls asleep while watching TV in the evening. She claims that she falls asleep almost instantly when her head hits the pillow at night, but she wakes up three or four times and usually cannot fall back asleep.

Explain Suzette's specific stressors, and their present and potential effects on her mind and body.

Describe the methods you would use to assess her levels of stress.

Explain the biological and psychological mechanisms that describe the effects of stress on her sleep.

Assess the effect of Suzette's ongoing stress and insomnia on her health.

Describe possible signs of sleep deprivation.

List the follow-up questions you want to ask that could help you develop a prevention strategy.

Explain whether or not Suzette has an illness, and what it may be. Recommend strategies for her to achieve greater health and thrive.