1294 A Nightly Pour, a Dangerous Fall: A Case of Daily Alcohol Use for Insomnia Preceding a Traumatic Intracranial Bleed

Abstract Introduction Sleep disturbances are common in older adults, with aging being associated with decreased total sleep time and a delayed circadian phase. Though there are fewer self-reported complaints of insomnia rates in older adults than in younger individuals, they remain more vulnerable to worse mental health outcomes and decline in cognitive function. Depression and anxiety can be both risk factors and morbidities with sleep difficulties, leading to poorer sleep efficiency in this population. Untreated insomnia and its psychiatric comorbidities can lead to misuse of alcohol as a form of self-medication. This case highlights a case of an alcohol use disorder (AUD) patient with depression and anxiety in an outpatient setting, leading to hospitalization with a traumatic fall. Report of case(s) An 82-year-old male, with a longstanding history of alcohol abuse up to 13 years, presented to the clinic with complaints of nighttime coughing and difficulty sleeping. He reported being under stress due to financial and housing instability and has been drinking a bottle of wine daily to cope with stress and insomnia. Acute coughing has worsened his ability to fall asleep, prompting him to request sleep aid medication. After initial evaluation for aspiration pneumonia, follow-up for the AUD was arranged, but the patient declined intervention. Four months later, the patient presented to the hospital after multiple falls over 3-4 months and 4 weeks of acute dysphagia. Imaging revealed chronic stable subdural hematoma, internal carotid artery dissection, and cervical spine osteophytes displacing the esophagus. No surgical intervention was performed for intracranial bleeding. A PEG tube was placed for dysphagia, and alcohol cessation counseling was performed at the hospital. At the 1-month post-hospitalization visit, the patient reported abstinence from alcohol, improvement in sleep quality, dysphagia, and cognitive function. Conclusion This case illustrates the interplay between insomnia, psychiatric comorbidities, and maladaptive coping behaviors in elderly. This patient's chronic reliance on alcohol as a sleeping aid and anxiety aid has masked a progressive functional decline, culminating in multiple falls that resulted in neurologic and structural traumas. Early recognition and intervention for insomnia and alcohol use, especially in geriatric patients with psychosocial stressors, may prevent escalation into severe morbidity. Support (if any)