Night-Night Case Study

One concern that continues to be documented is Emily's increased social withdrawal, apparent anxiety, and tendency to stay up pacing in her bedroom at night instead of going to sleep. Overnight staff have documented many occasions where Emily has been awake in her bedroom pacing in circles at the beginning of the shift. On one occasion, overnight staff arrived and observed that Emily was pacing in her room. She was prompted to use the restroom and continued to pace around her room and changed her clothes. She began yelling and throwing her shoes. Staff prompted Emily to come to the living room to assist her with calming down and to avoid waking other housemates. Emily repeatedly asked overnight staff about fireworks and the next day's routine.

Are there going to be fireworks?" She continued to stay up pacing into the overnight shift that evening and was then observed taking strands of toilet paper off the roll and filling the commode with it as well as scattering it across her bedroom floor. Staff also noted that she had taken some of her clothes and piled them on her closet floor before finally settling down and falling asleep. Overnight staff documented several other similar instances in which Emily was up pacing in her room or going from her room to the bathroom and filling the toilet with toilet paper instead of going to bed. Staff talked with Emily's PCP (Dr. Tucker) about concerns that Emily was not getting adequate sleep due to her anxiousness and restlessness at night. He advised Emily to take Benadryl 25mg as needed if she is unable to settle down and go to bed at

For example, overnight staff have noted that Emily will be up standing next to her bed or walking around between the bathroom and her bedroom at the beginning of the shift and will require prompts that it is time for bed. Additionally, there have been occasions when Emily has seemed to be confused about the day or whether or not she had eaten dinner. Staff noted that on a Sunday evening Emily had been talking about not going to church and tomorrow being Sunday. Staff explained to Emily that it was Sunday and that the next day was Monday. On a different occasion Emily asked staff what was for dinner after she had already eaten her meal earlier in the evening. Overnight staff have also noted that Emily has been taking off her shoes in the morning while waiting on her van and required prompts to leave them on. It was also noted that she has been taking a lot of toilet paper from the bathroom in the mornings like she has been doing in the