mkdir -p /home/daytona/workspace/insomnia-pptx && ls /home/daytona/workspace/ins…

~/insomnia-pptx/insomnia.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();

pres.layout = "LAYOUT_16x9";
pres.title = "Insomnia: A Clinical Overview";
pres.author = "Orris Medical";

// ─── COLOR PALETTE ───────────────────────────────────────────────────────────
const DARK_BG   = "0D1F2D";   // deep navy  (dominant ~65%)
const MID_BG    = "1A3347";   // slate navy (supporting)
const ACCENT    = "3ABAB4";   // teal accent
const ACCENT2   = "E8734A";   // warm coral
const WHITE     = "F2F5F7";
const LIGHT_GRAY= "B8C6D1";
const YELLOW    = "F5C843";

// ─── HELPERS ─────────────────────────────────────────────────────────────────
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function iconCircle(slide, x, y, r, color) {
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function bullet(text, level, bold) {
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}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 — TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
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  // Decorative circles
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  iconCircle(s, 8.1, 0.8, 0.9, DARK_BG);
  iconCircle(s, 7.8, 3.8, 2.2, MID_BG);
  iconCircle(s, 8.5, 4.2, 1.0, DARK_BG);

  // Moon icon text
  s.addText("🌙", { x: 7.9, y: 1.0, w: 1.2, h: 1.2, fontSize: 64, align: "center" });

  s.addText("INSOMNIA", {
    x: 0.5, y: 1.2, w: 7.0, h: 1.2,
    fontSize: 54, bold: true, color: WHITE, charSpacing: 6, margin: 0
  });
  s.addText("A Clinical Overview", {
    x: 0.5, y: 2.5, w: 6.5, h: 0.55,
    fontSize: 22, color: ACCENT, italic: true, margin: 0
  });

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    x: 0.5, y: 3.15, w: 7.5, h: 0,
    line: { color: ACCENT2, width: 2 }
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  s.addText("Definition  |  Classification  |  Pathophysiology  |  Diagnosis  |  Treatment", {
    x: 0.5, y: 3.3, w: 9.0, h: 0.4,
    fontSize: 12, color: LIGHT_GRAY, italic: true, margin: 0
  });

  s.addText("Sources: Bradley & Daroff's Neurology  •  Kaplan & Sadock's Comprehensive Textbook of Psychiatry  •  Harrison's Internal Medicine", {
    x: 0.5, y: 5.15, w: 9.2, h: 0.3,
    fontSize: 8.5, color: LIGHT_GRAY, italic: true, margin: 0
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 — OVERVIEW / AGENDA
// ─────────────────────────────────────────────────────────────────────────────
{
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  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:DARK_BG}, line:{color:DARK_BG} });
  titleBar(s, "Agenda");

  const topics = [
    { num: "01", label: "Definition & Epidemiology", icon: "📋" },
    { num: "02", label: "Classification (ICSD-III & DSM-5)", icon: "🗂️" },
    { num: "03", label: "Pathophysiology & Risk Factors", icon: "🧠" },
    { num: "04", label: "Clinical Features & Comorbidities", icon: "🩺" },
    { num: "05", label: "Diagnosis & Assessment Tools", icon: "🔍" },
    { num: "06", label: "Non-Pharmacological Treatment (CBT-I)", icon: "💬" },
    { num: "07", label: "Pharmacological Treatment", icon: "💊" },
    { num: "08", label: "Special Populations & Summary", icon: "👥" },
  ];

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    topics.slice(0, 4),
    topics.slice(4, 8)
  ];

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      const y = 1.3 + ti * 0.98;
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      s.addText(`${t.icon}  ${t.num}`, {
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        fontSize: 13.5, color: WHITE, valign: "middle", margin: 0
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    });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 — DEFINITION & EPIDEMIOLOGY
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:DARK_BG}, line:{color:DARK_BG} });
  titleBar(s, "Definition & Epidemiology", "The most common sleep disorder worldwide");

  // Definition box
  accentBox(s, 0.3, 1.25, 9.4, 1.15, ACCENT);
  s.addText("DEFINITION", { x: 0.5, y: 1.28, w: 2.0, h: 0.3, fontSize: 9, color: ACCENT, bold: true, charSpacing:2, margin:0 });
  s.addText(
    "An inability to initiate, maintain sleep, or early awakening, despite an adequate opportunity for sleep, leading to poor sleep quality, lack of feeling restored, dissatisfaction with sleep and impaired daytime functioning.",
    { x: 0.5, y: 1.55, w: 9.0, h: 0.75, fontSize: 13, color: WHITE, margin: 0 }
  );

  // Stats cards
  const stats = [
    { val: "~35%", label: "of adults report\ninsomnia complaints" },
    { val: "10%",  label: "have persistent\nchronic insomnia" },
    { val: "2–5×", label: "increased risk of\nsubsequent depression" },
    { val: "#1",   label: "most common\nsleep disorder" },
  ];
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    s.addText(st.label, { x: x+0.05, y: 3.28, w: 2.08, h: 0.65, fontSize: 11, color: LIGHT_GRAY, align: "center", margin:0 });
  });

  // Health consequences
  s.addText("Key Health Consequences:", { x: 0.3, y: 4.2, w: 4.5, h: 0.3, fontSize: 12, color: ACCENT2, bold: true, margin:0 });
  s.addText([
    bullet("Increased mortality & morbidity from CAD, hypertension, obesity, DM"),
    bullet("Impaired work performance and quality of life"),
    lastBullet("Suicidal behaviour risk (2–5× higher with comorbid depression)")
  ], { x: 0.3, y: 4.5, w: 9.4, h: 0.9, fontSize: 12, color: WHITE, margin:0 });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 — CLASSIFICATION
// ─────────────────────────────────────────────────────────────────────────────
{
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  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:DARK_BG}, line:{color:DARK_BG} });
  titleBar(s, "Classification", "ICSD-III • DSM-5 • ICD-10");

  // ICSD-III column
  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.25, w:4.4, h:0.38, fill:{color:ACCENT}, line:{color:ACCENT} });
  s.addText("ICSD-III (AASM 2014)", { x:0.35, y:1.25, w:4.3, h:0.38, fontSize:13, bold:true, color:DARK_BG, valign:"middle", margin:0 });

  const icsd = [
    { label: "Short-term Insomnia Disorder", detail: "Duration < 3 months; related to identifiable stressor" },
    { label: "Chronic Insomnia Disorder", detail: "≥ 3 nights/week, ≥ 3 months; significant daytime impairment" },
    { label: "Other Insomnia Disorder", detail: "Does not meet full criteria for the above two categories" },
  ];
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    const y = 1.75 + i * 0.98;
    accentBox(s, 0.3, y, 4.4, 0.82, ACCENT);
    s.addText(`${i+1}. ${item.label}`, { x:0.5, y:y+0.04, w:4.1, h:0.35, fontSize:12.5, bold:true, color:ACCENT, margin:0 });
    s.addText(item.detail, { x:0.5, y:y+0.37, w:4.1, h:0.4, fontSize:11, color:LIGHT_GRAY, margin:0 });
  });

  // DSM-5 column
  s.addShape(pres.ShapeType.rect, { x:5.0, y:1.25, w:4.7, h:0.38, fill:{color:ACCENT2}, line:{color:ACCENT2} });
  s.addText("DSM-5 Criteria", { x:5.05, y:1.25, w:4.6, h:0.38, fontSize:13, bold:true, color:DARK_BG, valign:"middle", margin:0 });

  const dsm = [
    "Dissatisfaction with sleep quantity or quality",
    "One or more: difficulty initiating, maintaining sleep or early-morning awakening",
    "Significant distress or functional impairment",
    "Sleep difficulty ≥ 3 nights/week",
    "Present for ≥ 3 months",
    "Not explained by another sleep disorder, substance, or medical condition",
  ];
  s.addText(dsm.map((d, i) => ({
    text: `${i+1}. ${d}`,
    options: { fontSize: 12, color: i < 2 ? WHITE : LIGHT_GRAY, breakLine: i < dsm.length - 1 }
  })), { x:5.05, y:1.75, w:4.55, h:2.8, margin:6 });

  // Subtypes note
  accentBox(s, 0.3, 4.68, 9.4, 0.72, ACCENT2);
  s.addText("📌  Duration matters: Acute (<3 months) vs. Chronic (≥3 months, ≥3 nights/week). Comorbid insomnia no longer classified as 'secondary' — bidirectional relationship recognised.", {
    x:0.5, y:4.72, w:9.0, h:0.62, fontSize:11.5, color:WHITE, margin:0
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 — PATHOPHYSIOLOGY
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:DARK_BG}, line:{color:DARK_BG} });
  titleBar(s, "Pathophysiology", "Hyperarousal, Neurochemistry & the 3-P Model");

  // 3-P Model header
  s.addText("THE 3-P MODEL (Spielman)", { x:0.3, y:1.22, w:9.4, h:0.32, fontSize:11, bold:true, color:YELLOW, charSpacing:2, margin:0 });

  const threeP = [
    { title: "Predisposing", color: ACCENT, items: ["Female sex, older age", "Genetic vulnerability", "Anxious temperament", "Hyperactive HPA axis"] },
    { title: "Precipitating", color: ACCENT2, items: ["Acute stress / life events", "Medical or psychiatric illness", "Medications (MAOIs, stimulants)", "Shift work, travel (jet lag)"] },
    { title: "Perpetuating", color: YELLOW, items: ["Extended time in bed", "Daytime napping", "Conditioned arousal (bed = worry)", "Dysfunctional sleep beliefs"] },
  ];

  threeP.forEach((p, i) => {
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    s.addShape(pres.ShapeType.rect, { x, y:1.6, w:3.0, h:0.38, fill:{color:p.color}, line:{color:p.color} });
    s.addText(p.title.toUpperCase(), { x:x+0.08, y:1.6, w:2.84, h:0.38, fontSize:12, bold:true, color:DARK_BG, valign:"middle", margin:0 });
    p.items.forEach((item, j) => {
      s.addText(`• ${item}`, { x:x+0.1, y:2.05+j*0.36, w:2.8, h:0.33, fontSize:11.5, color: j===0?WHITE:LIGHT_GRAY, margin:0 });
    });
  });

  // Neurochemistry section
  s.addShape(pres.ShapeType.line, { x:0.3, y:3.68, w:9.4, h:0, line:{color:ACCENT, width:1} });
  s.addText("NEUROCHEMICAL BASIS", { x:0.3, y:3.74, w:9.4, h:0.28, fontSize:10, bold:true, color:ACCENT, charSpacing:2, margin:0 });

  const neuro = [
    { label: "GABA-A ↓", detail: "Reduced inhibitory tone → cortical & limbic hyperarousal" },
    { label: "Orexin ↑", detail: "Hypocretin over-activation maintains wake state; target of suvorexant" },
    { label: "HPA Axis ↑", detail: "Elevated cortisol & CRH; chronic activation perpetuates insomnia" },
    { label: "Glymphatic", detail: "Sleep-dependent brain waste clearance impaired in chronic insomnia" },
  ];
  neuro.forEach((n, i) => {
    const x = 0.3 + i * 2.38;
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    s.addText(n.label, { x:x+0.08, y:4.12, w:2.06, h:0.36, fontSize:13, bold:true, color:ACCENT, margin:0 });
    s.addText(n.detail, { x:x+0.08, y:4.46, w:2.06, h:0.75, fontSize:10.5, color:LIGHT_GRAY, margin:0 });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 — CLINICAL FEATURES & COMORBIDITIES
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:DARK_BG}, line:{color:DARK_BG} });
  titleBar(s, "Clinical Features & Comorbidities", "What patients report and what co-exists");

  // Night-time symptoms
  s.addShape(pres.ShapeType.rect, { x:0.3, y:1.25, w:4.3, h:0.38, fill:{color:MID_BG}, line:{color:ACCENT, width:1.5} });
  s.addText("🌙  Nocturnal Symptoms", { x:0.38, y:1.25, w:4.14, h:0.38, fontSize:13, bold:true, color:ACCENT, valign:"middle", margin:0 });
  s.addText([
    bullet("Difficulty falling asleep (sleep-onset insomnia)"),
    bullet("Frequent nocturnal awakenings (sleep-maintenance)"),
    bullet("Early-morning awakening with inability to return to sleep"),
    bullet("Unrefreshing, non-restorative sleep"),
    lastBullet("Short total sleep time (<6 hours objectively)")
  ], { x:0.3, y:1.68, w:4.3, h:2.2, margin:6, fontSize:13, color:WHITE });

  // Daytime symptoms
  s.addShape(pres.ShapeType.rect, { x:5.0, y:1.25, w:4.7, h:0.38, fill:{color:MID_BG}, line:{color:ACCENT2, width:1.5} });
  s.addText("☀️  Daytime Consequences", { x:5.08, y:1.25, w:4.54, h:0.38, fontSize:13, bold:true, color:ACCENT2, valign:"middle", margin:0 });
  s.addText([
    bullet("Fatigue and reduced energy"),
    bullet("Cognitive impairment (memory, attention, concentration)"),
    bullet("Mood disturbance (irritability, anxiety, low mood)"),
    bullet("Impaired work / school performance"),
    bullet("Increased accident risk"),
    lastBullet("Reduced quality of life")
  ], { x:5.0, y:1.68, w:4.7, h:2.2, margin:6, fontSize:13, color:WHITE });

  // Comorbidities
  s.addShape(pres.ShapeType.line, { x:0.3, y:3.98, w:9.4, h:0, line:{color:ACCENT, width:1} });
  s.addText("COMMON COMORBIDITIES", { x:0.3, y:4.04, w:9.4, h:0.28, fontSize:10, bold:true, color:ACCENT, charSpacing:2, margin:0 });
  const comorbidities = [
    { cat: "Psychiatric", items: "Depression, Anxiety, PTSD, Substance use" },
    { cat: "Medical", items: "Pain syndromes, GERD, COPD, Heart failure, DM" },
    { cat: "Sleep disorders", items: "Obstructive Sleep Apnoea (OSA), RLS, Periodic limb movements" },
    { cat: "Neurological", items: "Dementia, Parkinson's disease, Stroke" },
  ];
  comorbidities.forEach((c, i) => {
    const x = 0.3 + i * 2.38;
    accentBox(s, x, 4.38, 2.22, 1.0, i % 2 === 0 ? ACCENT : ACCENT2);
    s.addText(c.cat, { x:x+0.1, y:4.42, w:2.04, h:0.3, fontSize:11, bold:true, color: i % 2 === 0 ? ACCENT : ACCENT2, margin:0 });
    s.addText(c.items, { x:x+0.1, y:4.7, w:2.04, h:0.62, fontSize:10, color:LIGHT_GRAY, margin:0 });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 — DIAGNOSIS & ASSESSMENT
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:DARK_BG}, line:{color:DARK_BG} });
  titleBar(s, "Diagnosis & Assessment", "Clinical evaluation, questionnaires & sleep diary");

  // Clinical diagnostic criteria box
  accentBox(s, 0.3, 1.25, 9.4, 1.15, ACCENT);
  s.addText("DIAGNOSTIC CRITERIA (Chronic Insomnia Disorder — AASM 2014)", {
    x:0.5, y:1.28, w:9.0, h:0.28, fontSize:9.5, bold:true, color:ACCENT, charSpacing:2, margin:0
  });
  s.addText(
    "Sleep disturbance ≥ 3 nights/week for ≥ 3 months  |  Adequate sleep opportunity  |  Significant daytime impairment  |  Not better explained by another sleep or mental disorder",
    { x:0.5, y:1.55, w:9.0, h:0.72, fontSize:12.5, color:WHITE, margin:0 }
  );

  // Assessment tools
  s.addText("ASSESSMENT TOOLS", { x:0.3, y:2.55, w:9.4, h:0.28, fontSize:10, bold:true, color:YELLOW, charSpacing:2, margin:0 });

  const tools = [
    { name: "Sleep Diary (2 weeks)", desc: "Gold standard self-report; records bed time, wake time, sleep latency, naps, caffeine, alcohol, exercise. Identifies patterns." },
    { name: "ISI — Insomnia Severity Index", desc: "7-item validated questionnaire; score 0–28. >14 = moderate–severe clinical insomnia." },
    { name: "PSG (Polysomnography)", desc: "Not routinely required; indicated when OSA, PLMD, or parasomnias are suspected." },
    { name: "Actigraphy", desc: "Wrist-worn motion sensor; estimates sleep-wake patterns over days–weeks. Useful for circadian rhythm disorders." },
  ];
  tools.forEach((t, i) => {
    const x = 0.3 + (i % 2) * 4.9;
    const y = 2.92 + Math.floor(i / 2) * 1.22;
    accentBox(s, x, y, 4.55, 1.1, i < 2 ? ACCENT : ACCENT2);
    s.addText(t.name, { x:x+0.12, y:y+0.06, w:4.3, h:0.32, fontSize:12.5, bold:true, color: i < 2 ? ACCENT : ACCENT2, margin:0 });
    s.addText(t.desc, { x:x+0.12, y:y+0.38, w:4.3, h:0.65, fontSize:11, color:LIGHT_GRAY, margin:0 });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 — NON-PHARMACOLOGICAL TREATMENT (CBT-I)
// ─────────────────────────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625, fill:{color:DARK_BG}, line:{color:DARK_BG} });
  titleBar(s, "Non-Pharmacological Treatment", "CBT-I — First-Line Therapy");

  // CBT-I headline
  accentBox(s, 0.3, 1.25, 9.4, 0.68, ACCENT);
  s.addText("Cognitive Behavioural Therapy for Insomnia (CBT-I)", {
    x:0.5, y:1.28, w:9.0, h:0.3, fontSize:14.5, bold:true, color:ACCENT, margin:0
  });
  s.addText("Endorsed as FIRST-LINE by AASM, ACP, and multiple guideline panels. Safe, long-lasting, superior to medication alone. Typically 6–10 weekly sessions.", {
    x:0.5, y:1.56, w:9.0, h:0.3, fontSize:11.5, color:WHITE, margin:0
  });

  // CBT-I components
  const components = [
    { title: "Stimulus Control", icon: "🛏️", body: "Bed only for sleep & sex. Get out of bed if awake >20 min. Strict rise time regardless of sleep quality." },
    { title: "Sleep Restriction", icon: "⏰", body: "Temporarily reduce time in bed to match actual sleep time; increases sleep drive and efficiency." },
    { title: "Cognitive Restructuring", icon: "🧠", body: "Challenge dysfunctional beliefs: 'I need 8 h or I'll be ruined'. Reduce catastrophising about sleep loss." },
    { title: "Relaxation Therapy", icon: "🧘", body: "Progressive muscle relaxation, diaphragmatic breathing, guided imagery to lower physiologic arousal." },
  ];

  components.forEach((c, i) => {
    const x = 0.3 + (i % 2) * 4.9;
    const y = 2.08 + Math.floor(i / 2) * 1.38;
    s.addShape(pres.ShapeType.rect, { x, y, w:4.55, h:1.22, fill:{color:MID_BG}, line:{color:ACCENT, width:1} });
    s.addText(`${c.icon}  ${c.title}`, { x:x+0.12, y:y+0.06, w:4.3, h:0.36, fontSize:13, bold:true, color:ACCENT, margin:0 });
    s.addText(c.body, { x:x+0.12, y:y+0.42, w:4.3, h:0.74, fontSize:11, color:LIGHT_GRAY, margin:0 });
  });

  // Sleep hygiene footer
  s.addShape(pres.ShapeType.rect, { x:0.3, y:4.82, w:9.4, h:0.58, fill:{color:MID_BG}, line:{color:YELLOW, width:1} });
  s.addText("💡  Sleep Hygiene: No caffeine/alcohol after lunch • Avoid screens 2 h before bed • Keep bedroom dark and cool • Exercise regularly • Restrict naps to <30 min before 3 PM", {
    x:0.5, y:4.85, w:9.0, h:0.5, fontSize:11, color:WHITE, margin:0
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 — PHARMACOLOGICAL TREATMENT
// ─────────────────────────────────────────────────────────────────────────────
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  titleBar(s, "Pharmacological Treatment", "Drug classes, mechanisms & AASM recommendations");

  const drugs = [
    {
      cls: "Z-Drugs (BzRA)", color: ACCENT,
      drugs: "Zolpidem, Eszopiclone, Zaleplon",
      mech: "Non-selective GABA-A positive allosteric modulators",
      notes: "First-choice for acute insomnia. Tolerance after 1–2 months. Rebound in up to 71%. Short-term use preferred."
    },
    {
      cls: "Benzodiazepines", color: ACCENT2,
      drugs: "Temazepam, Triazolam, Flurazepam",
      mech: "GABA-A potentiation; ↓ sleep latency, ↑ TST; ↓ SWS & REM",
      notes: "Useful for acute stress/hospitalisation insomnia. Dependence risk. Avoid in elderly (Beers Criteria)."
    },
    {
      cls: "Orexin Antagonists", color: YELLOW,
      drugs: "Suvorexant, Lemborexant",
      mech: "Block hypocretin/orexin receptors → promote sleep onset & maintenance",
      notes: "Newest FDA-approved class. Approved for Alzheimer's (suvorexant). Preferred in elderly over BZDs."
    },
    {
      cls: "Melatonin Agonists", color: ACCENT,
      drugs: "Ramelteon, Tasimelteon",
      mech: "MT1 / MT2 receptor agonism; regulates circadian sleep-wake cycle",
      notes: "Safe in elderly. Limited efficacy data. Useful for circadian-component insomnia and sleep-onset issues."
    },
    {
      cls: "Low-dose Antidepressants", color: ACCENT2,
      drugs: "Doxepin (≤6 mg), Trazodone, Mirtazapine",
      mech: "Histamine H1 blockade (doxepin); 5-HT2 antagonism (trazodone)",
      notes: "Off-label except doxepin. Doxepin >6 mg avoid in elderly. Trazodone widely used, limited RCT evidence."
    },
    {
      cls: "Sedating Antipsychotics", color: YELLOW,
      drugs: "Quetiapine, Olanzapine (off-label)",
      mech: "H1, 5-HT2 antagonism",
      notes: "No systematic evidence supports routine use; risks outweigh benefits. Reserve for psychiatric comorbidity."
    },
  ];

  drugs.forEach((d, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.25 + col * 3.22;
    const y = 1.25 + row * 2.12;
    s.addShape(pres.ShapeType.rect, { x, y, w:3.05, h:2.0, fill:{color:MID_BG}, line:{color:d.color, width:1.5} });
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    s.addText(d.drugs, { x:x+0.08, y:y+0.36, w:2.9, h:0.3, fontSize:10.5, bold:true, color:WHITE, margin:0 });
    s.addText(`⚡ ${d.mech}`, { x:x+0.08, y:y+0.68, w:2.9, h:0.52, fontSize:9.5, color:LIGHT_GRAY, italic:true, margin:0 });
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  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 — SPECIAL POPULATIONS & TREATMENT ALGORITHM
// ─────────────────────────────────────────────────────────────────────────────
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    { step: "1", label: "Identify & treat underlying comorbidities", color: ACCENT },
    { step: "2", label: "Implement sleep hygiene education", color: ACCENT },
    { step: "3", label: "CBT-I (first-line for chronic insomnia)", color: ACCENT2 },
    { step: "4", label: "Pharmacotherapy if acute stress or CBT-I unavailable", color: ACCENT2 },
    { step: "5", label: "Combination CBT-I + short-term pharmacotherapy", color: YELLOW },
    { step: "6", label: "Review, taper medication, maintain CBT-I gains", color: YELLOW },
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    s.addText(st.label, { x:0.84, y:y+0.04, w:4.5, h:0.38, fontSize:12, color:WHITE, valign:"middle", margin:0 });
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  const pops = [
    { pop: "Elderly", icon: "👴", note: "Beers Criteria: avoid BZDs, Z-drugs, TCAs, antihistamines. Prefer CBT-I, suvorexant (approved in AD), ramelteon." },
    { pop: "Pregnant", icon: "🤰", note: "CBT-I first. Pharmacotherapy avoided in 1st trimester. Doxylamine + B6 considered safe for sleep-associated nausea." },
    { pop: "Psychiatric comorbidity", icon: "🧠", note: "Treat both simultaneously. Sedating antidepressants (trazodone, mirtazapine) can address both insomnia and depression." },
    { pop: "Hospitalised / Acute", icon: "🏥", note: "Short-acting benzodiazepines or Z-drugs appropriate for brief, acute insomnia. Minimise use and duration." },
  ];

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    s.addText(p.note, { x:5.68, y:y+0.36, w:4.0, h:0.44, fontSize:10, color:LIGHT_GRAY, margin:0 });
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 — SUMMARY / KEY TAKE-AWAYS
// ─────────────────────────────────────────────────────────────────────────────
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    fontSize:22, bold:true, color:WHITE, charSpacing:4, margin:0
  });
  s.addShape(pres.ShapeType.line, { x:0.5, y:0.85, w:9.0, h:0, line:{color:ACCENT, width:2} });

  const takeaways = [
    { n:"1", text:"Insomnia affects ~35% of adults; 10% have chronic insomnia with significant daytime impairment.", col:ACCENT },
    { n:"2", text:"ICSD-III classifies into Short-term and Chronic insomnia; DSM-5 requires ≥3 nights/week for ≥3 months.", col:ACCENT2 },
    { n:"3", text:"Pathophysiology centres on hyperarousal (cognitive, cortical, physiologic), maladaptive conditioning, and HPA axis dysregulation.", col:ACCENT },
    { n:"4", text:"CBT-I is endorsed as FIRST-LINE treatment — superior to pharmacotherapy alone with durable long-term benefits.", col:ACCENT2 },
    { n:"5", text:"Z-drugs and BZDs are effective short-term; orexin antagonists (suvorexant) represent the newest class and are preferred in elderly/AD.", col:ACCENT },
    { n:"6", text:"Avoid sedative hypnotics in the elderly; the 2019 AGS Beers Criteria strongly recommends against BZDs, Z-drugs, TCAs and antihistamines in older adults.", col:ACCENT2 },
  ];

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    s.addText(t.text, { x:0.98, y:y+0.04, w:8.8, h:0.52, fontSize:12.5, color:WHITE, valign:"middle", margin:0 });
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  s.addText("Sources: Bradley & Daroff's Neurology in Clinical Practice • Kaplan & Sadock's Comprehensive Textbook of Psychiatry • Harrison's 22E", {
    x:0.5, y:5.32, w:9.0, h:0.22, fontSize:8, color:LIGHT_GRAY, italic:true, margin:0
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/insomnia-pptx/Insomnia_Clinical_Overview.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/insomnia-pptx/Insomnia_Clinical_Overview.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/insomnia-pptx && node insomnia.js

ls -lh /home/daytona/workspace/insomnia-pptx/Insomnia_Clinical_Overview.pptx

~/insomnia-pptx/insomnia_mbbs.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Insomnia – Full Depth for 4th Year MBBS";

// ─── PALETTE ─────────────────────────────────────────────────────────────────
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  dark:    "0B1A27",
  green:   "52B788",
  red:     "E63946",
  yellow:  "FFD166",
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// ─── HELPERS ─────────────────────────────────────────────────────────────────
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// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════════════
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  txt(s,"🌙", 7.2,1.0, 1.6,1.6, {fontSize:72, align:"center"});

  txt(s,"INSOMNIA", 0.5,0.7, 7.0,1.6, {fontSize:58, bold:true, color:C.white, charSpacing:5});
  txt(s,"Full Clinical Depth – 4th Year MBBS", 0.5,2.38, 7.2,0.5, {fontSize:17, color:C.teal, italic:true});

  line(s, 0.5,3.0, 7.2, C.coral, 2);

  txt(s,"Department of Medicine & Psychiatry", 0.5,3.15, 6.5,0.35, {fontSize:13, color:C.lt});

  // topic pills
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                   "Clinical Features","Diagnosis","Non-Pharm Rx","Pharmacotherapy","Special Populations"];
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    txt(s, t, x+0.1,y+0.04, 2.52,0.28, {fontSize:10.5, color:C.white, valign:"middle"});
  });

  txt(s,"Sources: Harrison's 22E • Goldman-Cecil Medicine • Kaplan & Sadock's Comprehensive Psychiatry • Bradley & Daroff's Neurology • Murray & Nadel's Respiratory Medicine",
    0.5,5.38, 9.2,0.2, {fontSize:7.5, color:C.dim, italic:true});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 — SECTION DIVIDER: SLEEP PHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
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  const s = pres.addSlide();
  sectionDivider(s,"01","Sleep Physiology","Normal sleep architecture — essential foundation for understanding insomnia", C.teal);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 — NORMAL SLEEP ARCHITECTURE
// ═══════════════════════════════════════════════════════════════════════════
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  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Normal Sleep Architecture","Two-process model & NREM/REM cycles", C.teal);

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  txt(s,"THE TWO-PROCESS MODEL", 0.42,1.23, 4.06,0.28, {fontSize:9, bold:true, color:C.teal, charSpacing:2});
  txt(s,[
    {text:"Process C (Circadian):", options:{bold:true, color:C.gold, fontSize:12, breakLine:true}},
    {text:"Suprachiasmatic nucleus (SCN) → 24-h wake/sleep timing via light-dark cycle\n", options:{fontSize:11.5, color:C.white}},
    {text:"Process S (Homeostatic):", options:{bold:true, color:C.coral, fontSize:12, breakLine:true}},
    {text:"Adenosine accumulates with wakefulness → increasing sleep pressure", options:{fontSize:11.5, color:C.white}},
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    ["Stage","EEG","% Total","Function"],
    ["N1 (NREM 1)","Mixed, theta 4-8Hz","5%","Transition; easily aroused"],
    ["N2 (NREM 2)","Sleep spindles, K-complex","45%","Memory consolidation"],
    ["N3 (SWS)","Delta <2Hz, >20%","25%","Restorative, growth hormone"],
    ["REM","Mixed freq, low amp","25%","Dreams, emotional processing"],
  ];
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         bold: ri===0 || ci===0,
         color: ri===0 ? C.teal : (ci===0 ? C.gold : C.lt)});
    });
  });

  // Sleep cycle diagram (text-based)
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  txt(s,"NORMAL SLEEP HYPNOGRAM — 7-8 hours (4-5 cycles × ~90 min each, REM lengthens with each cycle)", 0.42,2.84, 9.2,0.24, {fontSize:9.5, color:C.teal, bold:true});
  
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    {label:"Cycle 1",nrem:"N3 dominant",rem:"REM ~10 min"},
    {label:"Cycle 2",nrem:"N3 moderate",rem:"REM ~20 min"},
    {label:"Cycle 3",nrem:"N2 dominant",rem:"REM ~30 min"},
    {label:"Cycle 4",nrem:"N2 only",rem:"REM ~45 min"},
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    txt(s, "NREM: "+c.nrem, x+0.08,3.44, 2.06,0.26, {fontSize:10.5, color:C.lt});
    txt(s, c.rem, x+0.08,3.7, 2.06,0.26, {fontSize:10.5, color:C.white});
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  // Key facts
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  txt(s,"⚕ Clinical pearls: Sleep latency < 20 min normal  |  NREM 75% / REM 25% of total sleep  |  Sleep efficiency > 85% normal  |  Slow-wave sleep (N3) decreases with age", 0.45,4.64, 9.1,0.66, {fontSize:11.5, color:C.white});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 — SECTION DIVIDER: DEFINITION & EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s,"02","Definition & Epidemiology","Who gets insomnia, how common, and why it matters", C.coral);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 — DEFINITION & EPIDEMIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
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  header(s,"Definition & Epidemiology","Most common sleep disorder worldwide", C.coral);

  // Definition box
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  txt(s,"DEFINITION (AASM 2014)", 0.45,1.25, 4,0.26, {fontSize:9, bold:true, color:C.teal, charSpacing:2});
  txt(s,"Inability to initiate or maintain sleep, or early morning awakening, despite adequate opportunity for sleep → poor sleep quality, unrefreshed feeling, daytime impairment, and dissatisfaction with sleep.",
    0.45,1.5, 9.1,0.68, {fontSize:13, color:C.white});

  // Epidemiology stat cards
  const stats = [
    {v:"~35%",  l:"Adults with\ninsomnia complaints",  c:C.teal},
    {v:"10%",   l:"Have chronic\npersistent insomnia",  c:C.coral},
    {v:"2–5×",  l:"Increased risk of\ndepression",       c:C.gold},
    {v:"F > M", l:"Female sex\nmore affected",           c:C.purple},
  ];
  stats.forEach((st,i) => tagBox(s, 0.3+i*2.38, 2.38, st.l, st.v, st.c));

  // Risk factors
  rect(s,0.3,3.6, 4.55,1.78, C.panel, C.gold,1);
  txt(s,"RISK FACTORS", 0.45,3.63, 4.3,0.26, {fontSize:9, bold:true, color:C.gold, charSpacing:2});
  bulletList(s,[
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    "Lower socioeconomic status / poor education",
    "Psychiatric disorders (depression, anxiety)",
    "Chronic medical illness (pain, cardiac, neuro)",
    "Obsessive-compulsive traits, frequent rumination",
    "Shift work, jet lag, poor sleep hygiene",
  ], 0.42,3.92, 4.3, C.white, 11.5);

  // Consequences
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  txt(s,"HEALTH CONSEQUENCES", 5.25,3.63, 4.3,0.26, {fontSize:9, bold:true, color:C.red, charSpacing:2});
  bulletList(s,[
    "Impaired cognition, memory, concentration",
    "Occupational dysfunction, accidents",
    "↑ Risk CAD, hypertension, diabetes, obesity",
    "↑ Mortality (esp. men with short sleep + insomnia)",
    "2–5× risk of developing MDD; suicidal behaviour",
    "Reduced quality of life and social functioning",
  ], 5.25,3.92, 4.3, C.white, 11.5);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 6 — SECTION DIVIDER: CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s,"03","Classification","ICSD-III • DSM-5 • Subtypes", C.gold);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 7 — CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Classification of Insomnia","ICSD-III (AASM 2014) | DSM-5 | Clinical Subtypes", C.gold);

  // ICSD-III
  rect(s,0.3,1.2, 3.0,0.34, C.teal);
  txt(s,"ICSD-III — 3 Types", 0.38,1.2, 2.84,0.34, {fontSize:12, bold:true, color:C.dark, valign:"middle"});
  const icsd = [
    {t:"Short-term Insomnia", d:"Duration < 3 months; identifiable stressor; resolves with stressor", c:C.teal},
    {t:"Chronic Insomnia Disorder", d:"≥ 3 nights/wk for ≥ 3 months; significant daytime impairment", c:C.coral},
    {t:"Other Insomnia Disorder", d:"Does not meet full criteria; used rarely as a category", c:C.gold},
  ];
  icsd.forEach((it,i) => {
    const y = 1.6 + i*0.95;
    rect(s,0.3,y, 3.0,0.88, C.panel, it.c,1);
    txt(s,`${i+1}. ${it.t}`, 0.42,y+0.04, 2.76,0.3, {fontSize:11.5, bold:true, color:it.c});
    txt(s,it.d, 0.42,y+0.34, 2.76,0.5, {fontSize:10.5, color:C.lt});
  });

  // DSM-5 Criteria
  rect(s,3.55,1.2, 3.0,0.34, C.coral);
  txt(s,"DSM-5 Criteria", 3.63,1.2, 2.84,0.34, {fontSize:12, bold:true, color:C.white, valign:"middle"});
  const dsm5 = [
    "Dissatisfaction with sleep quality/quantity",
    "≥ 1 of: difficulty initiating, maintaining sleep, or early awakening with inability to return",
    "Clinically significant distress or functional impairment",
    "≥ 3 nights per week",
    "≥ 3 months duration",
    "Adequate opportunity for sleep",
    "Not explained by another sleep or mental disorder, substances",
  ];
  rect(s,3.55,1.6, 3.0,3.0, C.panel, C.coral,1);
  dsm5.forEach((item,i) => {
    const y = 1.66 + i*0.4;
    ellipse(s, 3.62,y+0.06, 0.18,0.18, i<2?C.coral:C.dim);
    txt(s,item, 3.86,y+0.01, 2.6,0.36, {fontSize:10.5, color:i<2?C.white:C.lt});
  });

  // Subtypes (Goldman-Cecil)
  rect(s,6.8,1.2, 2.9,0.34, C.gold);
  txt(s,"Clinical Subtypes", 6.88,1.2, 2.74,0.34, {fontSize:12, bold:true, color:C.dark, valign:"middle"});
  const subtypes = [
    {t:"Psychophysiologic", d:"Conditioned arousal; bed = wakefulness; sleeps better away from home"},
    {t:"Idiopathic", d:"Onset in childhood; lifelong; impaired inherent sleep mechanisms"},
    {t:"Paradoxical\n(Sleep-state misperception)", d:"Normal PSG but patient believes they did not sleep"},
    {t:"Adjustment insomnia", d:"Acute stressor; usually self-limiting"},
  ];
  subtypes.forEach((it,i) => {
    const y = 1.6 + i*0.98;
    rect(s,6.8,y, 2.9,0.9, C.panel, C.gold,0.8);
    txt(s,it.t, 6.9,y+0.04, 2.7,0.3, {fontSize:11, bold:true, color:C.gold});
    txt(s,it.d, 6.9,y+0.36, 2.7,0.5, {fontSize:9.8, color:C.lt});
  });

  // Note
  rect(s,0.3,4.6, 9.4,0.78, C.panel, C.green,1);
  txt(s,"📌 Important shift: 'Secondary insomnia' is OBSOLETE — comorbid insomnia is now used because causation cannot always be proven. Insomnia has a bidirectional relationship with depression, anxiety, and pain.", 0.45,4.63, 9.1,0.7, {fontSize:11.5, color:C.white});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 8 — SECTION DIVIDER: PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s,"04","Pathophysiology","Hyperarousal model • Neurochemistry • 3-P model", C.purple);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 9 — PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Pathophysiology of Insomnia","Hyperarousal is the central unifying concept", C.purple);

  // Hyperarousal central concept
  rect(s,0.3,1.2, 9.4,0.58, C.panel, C.purple,1.5);
  txt(s,"CORE MECHANISM: HYPERAROUSAL STATE",0.45,1.22, 5,0.26, {fontSize:9,bold:true,color:C.purple,charSpacing:2});
  txt(s,"Patients with insomnia show elevated brain metabolic rates during NREM sleep — cognitive, cortical, and physiologic hyperarousal prevents normal sleep-promoting processes.", 0.45,1.48, 9.1,0.26, {fontSize:12, color:C.white});

  // 3P Model
  txt(s,"THE 3-P MODEL (Spielman)", 0.3,1.9, 9.4,0.28, {fontSize:10, bold:true, color:C.yellow, charSpacing:2});
  const threeP = [
    {h:"PREDISPOSING",  c:C.teal, items:["Female sex, older age, genetics","Anxious/obsessive temperament","Hyperactive HPA axis; ↑ CRH","First-degree relative with insomnia"]},
    {h:"PRECIPITATING", c:C.coral, items:["Acute life stressor (bereavement, job loss)","Medical/surgical illness, hospitalisation","Medications (MAOIs, stimulants, steroids)","Jet lag, shift work, travel"]},
    {h:"PERPETUATING",  c:C.gold, items:["Extended time in bed (↓ sleep efficiency)","Daytime napping (↓ sleep drive)","Conditioned arousal — bed = wakefulness","Dysfunctional beliefs about sleep (catastrophising)"]},
  ];
  threeP.forEach((p,i) => {
    const x = 0.3+i*3.18;
    rect(s,x,2.22, 3.0,0.32, p.c);
    txt(s,p.h, x+0.08,2.22, 2.84,0.32, {fontSize:11,bold:true,color:C.dark,valign:"middle"});
    p.items.forEach((it,j) => {
      const y = 2.58+j*0.36;
      rect(s,x+0.08,y+0.06, 0.12,0.12, p.c);
      txt(s,it, x+0.26,y+0.01, 2.64,0.3, {fontSize:11,color:j===0?C.white:C.lt});
    });
  });

  // Neurochemical mechanisms
  line(s,0.3,4.06, 9.4, C.purple,1);
  txt(s,"NEUROCHEMICAL BASIS", 0.3,4.1, 9.4,0.26, {fontSize:9,bold:true,color:C.purple,charSpacing:2});
  const neuro = [
    {k:"GABA-A ↓", v:"Reduced GABAergic inhibition → cortical & limbic hyperexcitability. Benzodiazepines and Z-drugs act here.", c:C.teal},
    {k:"Orexin/Hypocretin ↑", v:"Excess orexin maintains wakefulness. Suvorexant/lemborexant block OX1/OX2 receptors to promote sleep.", c:C.coral},
    {k:"HPA Axis ↑", v:"↑ CRH, cortisol, ACTH. Chronic stress perpetuates insomnia via hypothalamic activation.", c:C.gold},
    {k:"Adenosine ↓", v:"Insufficient adenosine accumulation (caffeine blocks A1/A2A) → inadequate homeostatic sleep drive.", c:C.purple},
  ];
  neuro.forEach((n,i) => {
    const x = 0.3+i*2.38;
    rect(s,x,4.4, 2.22,1.0, C.panel, n.c,1);
    txt(s,n.k, x+0.08,4.44, 2.06,0.28, {fontSize:11.5,bold:true,color:n.c});
    txt(s,n.v, x+0.08,4.72, 2.06,0.64, {fontSize:9.5,color:C.lt});
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 10 — CLINICAL FEATURES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Clinical Features","Nocturnal complaints • Daytime consequences • Timing patterns", C.green);

  // Nocturnal
  rect(s,0.3,1.2, 4.4,0.32, C.mid);
  txt(s,"🌙  NOCTURNAL SYMPTOMS", 0.42,1.2, 4.2,0.32, {fontSize:12,bold:true,color:C.teal,valign:"middle"});
  bulletList(s,[
    "Sleep-onset insomnia — difficulty falling asleep (latency >20-30 min)",
    "Sleep-maintenance insomnia — frequent awakenings (WASO >30 min)",
    "Terminal insomnia — early morning awakening (>30 min before desired)",
    "Non-restorative, unrefreshing sleep",
    "Short total sleep time (objective <6 h)",
    "Mixed pattern — any combination of the above",
  ], 0.3,1.56, 4.4, C.white, 12);

  // Daytime
  rect(s,5.2,1.2, 4.5,0.32, C.mid);
  txt(s,"☀️  DAYTIME CONSEQUENCES", 5.32,1.2, 4.3,0.32, {fontSize:12,bold:true,color:C.coral,valign:"middle"});
  bulletList(s,[
    "Fatigue, low energy",
    "Impaired attention, concentration & memory",
    "Mood disturbance: irritability, anxiety, dysphoria",
    "Occupational/academic impairment",
    "Increased accident risk (driving, machinery)",
    "Somatic symptoms: headache, GI complaints",
    "Social withdrawal & reduced QoL",
  ], 5.2,1.56, 4.5, C.white, 12);

  // Timing clue box
  rect(s,0.3,3.78, 9.4,0.28, C.mid);
  txt(s,"TIMING OF INSOMNIA → DIAGNOSTIC CLUES", 0.42,3.79, 9.2,0.26, {fontSize:9,bold:true,color:C.yellow,charSpacing:2});
  const timing = [
    {t:"Sleep-onset", d:"Suggests: delayed sleep phase disorder, sleep phobia, anxiety, poor sleep hygiene"},
    {t:"Sleep-maintenance", d:"Suggests: depression, OSA, RLS, PLMD, pain, nocturia, cardiac/respiratory disease"},
    {t:"Early morning awakening", d:"Strongly suggests: MDD, advanced sleep phase syndrome"},
    {t:"Non-restorative sleep", d:"Suggests: fibromyalgia, undiagnosed OSA, mood disorders"},
  ];
  timing.forEach((ti,i) => {
    const x = 0.3+i*2.38;
    rect(s,x,4.1, 2.22,1.28, C.panel, [C.teal,C.coral,C.gold,C.purple][i],1);
    txt(s,ti.t, x+0.08,4.13, 2.06,0.28, {fontSize:11,bold:true,color:[C.teal,C.coral,C.gold,C.purple][i]});
    txt(s,ti.d, x+0.08,4.42, 2.06,0.9, {fontSize:10,color:C.lt});
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 11 — COMORBIDITIES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Comorbidities & Differential Diagnosis","What co-exists with insomnia and what to rule out", C.coral);

  // Comorbidities 2 columns
  rect(s,0.3,1.2, 4.55,0.3, C.coral);
  txt(s,"PSYCHIATRIC COMORBIDITIES", 0.42,1.2, 4.3,0.3, {fontSize:11,bold:true,color:C.white,valign:"middle"});
  const psych = [
    {c:"Major Depressive Disorder", d:"50–80% of MDD have insomnia; early-morning awakening hallmark"},
    {c:"Anxiety Disorders", d:"GAD, PTSD — hyperarousal, rumination at bedtime"},
    {c:"Bipolar Disorder", d:"Insomnia during mania; hypersomnia in depression"},
    {c:"Schizophrenia", d:"Circadian disruption; medication side effects"},
    {c:"Substance Use Disorders", d:"Alcohol → suppresses REM; rebound insomnia on withdrawal"},
  ];
  psych.forEach((it,i) => {
    const y = 1.54+i*0.72;
    rect(s,0.3,y, 4.55,0.65, C.panel, C.dim,0.5);
    txt(s,it.c, 0.42,y+0.04, 4.3,0.26, {fontSize:12,bold:true,color:C.coral});
    txt(s,it.d, 0.42,y+0.3, 4.3,0.32, {fontSize:10.5,color:C.lt});
  });

  // Medical comorbidities
  rect(s,5.1,1.2, 4.6,0.3, C.gold);
  txt(s,"MEDICAL COMORBIDITIES & DDx", 5.22,1.2, 4.3,0.3, {fontSize:11,bold:true,color:C.dark,valign:"middle"});
  const medical = [
    {c:"Obstructive Sleep Apnoea (OSA)", d:"Fragments sleep; snoring, witnessed apnoeas, obesity — PSG to differentiate"},
    {c:"Restless Legs Syndrome (RLS)", d:"Sleep-onset insomnia + irresistible urge to move legs at rest"},
    {c:"Periodic Limb Movement Disorder", d:"Involuntary leg jerks → repeated arousals → sleep-maintenance insomnia"},
    {c:"Chronic Pain Syndromes", d:"Fibromyalgia, arthritis, cancer pain — pain → arousal cycle"},
    {c:"Cardiac/Respiratory Disorders", d:"Heart failure (orthopnoea), COPD (nocturnal hypoxia), asthma"},
  ];
  medical.forEach((it,i) => {
    const y = 1.54+i*0.72;
    rect(s,5.1,y, 4.6,0.65, C.panel, C.dim,0.5);
    txt(s,it.c, 5.22,y+0.04, 4.35,0.26, {fontSize:12,bold:true,color:C.gold});
    txt(s,it.d, 5.22,y+0.3, 4.35,0.32, {fontSize:10.5,color:C.lt});
  });

  // Drugs causing insomnia
  rect(s,0.3,5.1, 9.4,0.38, C.panel, C.red,1);
  txt(s,"💊 Drugs causing insomnia: SSRIs/SNRIs (activating), MAOIs, corticosteroids, stimulants (amphetamines, methylphenidate), theophylline, beta-agonists, decongestants (pseudoephedrine), caffeine, levodopa", 0.45,5.13, 9.1,0.32, {fontSize:10.5,color:C.white});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 12 — DIAGNOSIS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Diagnosis & Clinical Assessment","History • Questionnaires • Investigations • Sleep Diary", C.teal);

  // Diagnostic criteria box
  rect(s,0.3,1.22, 9.4,0.68, C.panel, C.teal,1.5);
  txt(s,"CHRONIC INSOMNIA DISORDER — DIAGNOSTIC CRITERIA (AASM / DSM-5)", 0.45,1.24, 8,0.26, {fontSize:9,bold:true,color:C.teal,charSpacing:2});
  txt(s,"Sleep difficulty ≥ 3 nights/week   |   Duration ≥ 3 months   |   Adequate sleep opportunity   |   Significant daytime impairment   |   Not explained by another primary sleep disorder, medical condition, or substance", 0.45,1.5, 9.1,0.34, {fontSize:12, color:C.white});

  // History checklist
  rect(s,0.3,2.02, 3.08,0.28, C.mid);
  txt(s,"CLINICAL HISTORY", 0.42,2.02, 2.9,0.28, {fontSize:10,bold:true,color:C.gold,valign:"middle"});
  bulletList(s,[
    "24-h sleep-wake schedule & diary",
    "Onset, duration, frequency",
    "Precipitating events",
    "Daytime functioning (work, driving)",
    "Medications (present & recent)",
    "Psychiatric & medical history",
    "Bed-partner history (snoring, kicks)",
    "Substance: caffeine, alcohol, nicotine",
  ], 0.3,2.34, 3.08, C.white, 11);

  // Assessment tools
  rect(s,3.6,2.02, 3.0,0.28, C.mid);
  txt(s,"ASSESSMENT TOOLS", 3.72,2.02, 2.8,0.28, {fontSize:10,bold:true,color:C.coral,valign:"middle"});
  const tools = [
    {n:"Sleep Diary (2 weeks)", d:"Gold standard self-report — records TST, SOL, WASO, SE, naps, substances"},
    {n:"ISI (Insomnia Severity Index)", d:"7 items; 0–28 score; >14 = clinically significant; widely used"},
    {n:"PSQI (Pittsburgh Sleep Quality Index)", d:"19 items; 7 components; score >5 = poor sleeper"},
    {n:"ESS (Epworth Sleepiness Scale)", d:"Daytime sleepiness; if high → suspect OSA/narcolepsy"},
    {n:"Actigraphy", d:"Wrist-worn; 7–14 days; estimates sleep-wake patterns objectively"},
  ];
  tools.forEach((t,i) => {
    const y = 2.34+i*0.6;
    rect(s,3.6,y, 3.0,0.54, C.panel, C.coral,0.5);
    txt(s,t.n, 3.72,y+0.04, 2.76,0.22, {fontSize:11,bold:true,color:C.coral});
    txt(s,t.d, 3.72,y+0.27, 2.76,0.24, {fontSize:9.5,color:C.lt});
  });

  // PSG indications
  rect(s,6.82,2.02, 2.88,0.28, C.mid);
  txt(s,"POLYSOMNOGRAPHY", 6.94,2.02, 2.7,0.28, {fontSize:10,bold:true,color:C.teal,valign:"middle"});
  rect(s,6.82,2.34, 2.88,1.2, C.panel, C.teal,1);
  txt(s,"⚠️ NOT routinely indicated\nfor uncomplicated insomnia\n\nINDICATIONS for PSG:", 6.94,2.38, 2.66,0.82, {fontSize:10.5,color:C.white});
  bulletList(s,[
    "Suspected OSA or PLMD",
    "Paradoxical insomnia",
    "Treatment-refractory cases",
    "Safety-sensitive occupation",
  ], 6.94,3.22, 2.66, C.lt, 10.5);

  // Key definitions
  rect(s,0.3,4.55, 9.4,0.85, C.panel, C.yellow,1);
  txt(s,"KEY PARAMETERS TO DOCUMENT:", 0.45,4.58, 5,0.26, {fontSize:9,bold:true,color:C.yellow,charSpacing:2});
  const params = [
    "SOL (Sleep Onset Latency): normal <20 min",
    "TST (Total Sleep Time): target 7–9 h adults",
    "WASO (Wake After Sleep Onset): normal <30 min",
    "SE (Sleep Efficiency = TST/TIB × 100): normal >85%",
    "TIB (Time in Bed)",
  ];
  params.forEach((p,i) => {
    const x = i < 3 ? 0.35 : 5.15;
    const y = i < 3 ? 4.85+i*0.0 : 4.85+(i-3)*0.0;
    // column layout
  });
  txt(s,[
    {text:"SOL < 20 min normal  |  TST 7–9 h adults  |  WASO < 30 min  |  SE = TST/TIB × 100% (normal >85%)  |  TIB = Time in Bed", options:{fontSize:11.5,color:C.white}},
  ], {x:0.45,y:4.86, w:9.1,h:0.45, margin:0});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 13 — SECTION DIVIDER: NON-PHARMACOLOGICAL
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s,"05","Non-Pharmacological Treatment","CBT-I: the evidence-based first-line therapy", C.green);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 14 — CBT-I IN DEPTH
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Cognitive Behavioural Therapy for Insomnia (CBT-I)","First-line for chronic insomnia — superior to pharmacotherapy alone", C.green);

  // Evidence box
  rect(s,0.3,1.22, 9.4,0.56, C.panel, C.green,1.5);
  txt(s,"EVIDENCE BASE: AASM, ACP, British Sleep Society all endorse CBT-I as FIRST-LINE for chronic insomnia. RCTs show effects are durable (maintained at 12-month follow-up) vs. medication where benefits are lost on discontinuation. CBT-I + medication > medication alone.",
    0.45,1.26, 9.1,0.48, {fontSize:11.5,color:C.white});

  // 5 core components
  txt(s,"FIVE CORE COMPONENTS OF CBT-I", 0.3,1.88, 9.4,0.28, {fontSize:9.5,bold:true,color:C.yellow,charSpacing:2});

  const components = [
    {
      n:"1. Stimulus Control",
      c:C.teal,
      b:"Pavlovian reconditioning — break the bed-wakefulness association",
      rules:[
        "Use bed ONLY for sleep and sex",
        "Get out of bed if awake >20 min",
        "Return only when sleepy",
        "Same wake time 7 days/week",
        "No daytime napping",
      ]
    },
    {
      n:"2. Sleep Restriction",
      c:C.coral,
      b:"Temporarily restrict TIB to actual TST → builds homeostatic sleep pressure",
      rules:[
        "Calculate mean TST from sleep diary",
        "Set TIB = TST (minimum 5.5 h)",
        "Increases sleep efficiency to >85%",
        "Then gradually extend TIB by 15–20 min",
        "Caution: daytime sleepiness, driving risk",
      ]
    },
    {
      n:"3. Cognitive Restructuring",
      c:C.gold,
      b:"Identify and challenge dysfunctional beliefs about sleep",
      rules:[
        '"I must sleep 8 h or tomorrow is ruined"',
        '"I have no control over my sleep"',
        "Reframe: sleep variability is normal",
        "Reduce catastrophising about lost sleep",
        "Worry postponement technique",
      ]
    },
    {
      n:"4. Relaxation Therapy",
      c:C.purple,
      b:"Reduce physiologic and cognitive arousal",
      rules:[
        "Progressive muscle relaxation (PMR)",
        "Diaphragmatic breathing (4-7-8 method)",
        "Guided imagery / mindfulness",
        "Paradoxical intention (try to stay awake)",
        "Biofeedback in specialised centres",
      ]
    },
  ];

  components.forEach((comp,i) => {
    const col = i % 2;
    const row = Math.floor(i/2);
    const x = 0.3+col*4.9;
    const y = 2.22+row*1.55;
    rect(s,x,y, 4.55,1.45, C.panel, comp.c,1);
    rect(s,x,y, 4.55,0.3, comp.c);
    txt(s,comp.n, x+0.1,y+0.02, 4.35,0.26, {fontSize:12,bold:true,color:C.dark});
    txt(s,comp.b, x+0.1,y+0.33, 4.35,0.24, {fontSize:10,color:C.lt,italic:true});
    comp.rules.slice(0,4).forEach((r,ri) => {
      txt(s,`• ${r}`, x+0.1,y+0.6+ri*0.2, 4.3,0.2, {fontSize:10.5,color:C.white});
    });
  });

  // Sleep hygiene table
  rect(s,0.3,5.12, 9.4,0.36, C.panel, C.yellow,1);
  txt(s,"⚡ SLEEP HYGIENE (adjunct, not sufficient alone): No caffeine/alcohol after lunch • No screens 2 h before bed • Regular exercise • Keep bedroom dark & cool (18–20°C) • Naps < 30 min before 3 PM • Consistent sleep-wake schedule", 0.45,5.15, 9.1,0.3, {fontSize:10.5,color:C.white});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 15 — SECTION DIVIDER: PHARMACOTHERAPY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  sectionDivider(s,"06","Pharmacotherapy","Drug classes, mechanisms, doses & clinical selection", C.coral);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 16 — PHARMACOTHERAPY — GABA-ACTING DRUGS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Pharmacotherapy — GABA-Acting Agents","Benzodiazepines & Z-drugs (BzRAs)", C.coral);

  // Header bar
  rect(s,0.3,1.22, 9.4,0.28, C.mid);
  txt(s,"MECHANISM: Positive allosteric modulation of GABA-A receptors → ↑ chloride influx → neuronal inhibition → ↓ arousal systems (VLPO pathway)", 0.42,1.24, 9.1,0.24, {fontSize:11.5,color:C.white});

  // BZD drugs table
  rect(s,0.3,1.58, 4.6,0.28, C.coral);
  txt(s,"BENZODIAZEPINES", 0.42,1.58, 4.5,0.28, {fontSize:11.5,bold:true,color:C.white,valign:"middle"});
  const bzds = [
    ["Drug","Dose","T½ (h)","Indication / Notes"],
    ["Triazolam","0.125–0.25 mg","1.5–5.5","Sleep onset; short T½; amnesia risk at high dose"],
    ["Temazepam","15–30 mg","8–20","Sleep maintenance; intermediate T½; preferred"],
    ["Lorazepam","0.5–2 mg","10–20","Acute insomnia; also anxiety; dependence risk"],
    ["Flurazepam","15–30 mg","47–100","Active metabolite >1 day; daytime sedation; avoid elderly"],
    ["Clonazepam","0.5–2 mg","20–50","RLS/PLMD; long T½; accumulates"],
  ];
  bzds.forEach((row,ri) => {
    const bg = ri===0 ? C.mid : (ri%2===0 ? C.panel : C.bg);
    rect(s,0.3,1.88+ri*0.38, 4.6,0.36, bg);
    const widths = [1.0,0.7,0.72,2.1];
    let xc = 0.32;
    row.forEach((cell,ci) => {
      txt(s,cell, xc,1.9+ri*0.38, widths[ci],0.32, {fontSize:ri===0?9:10.5, bold:ri===0||ci===0, color:ri===0?C.coral:(ci===0?C.gold:C.lt)});
      xc += widths[ci]+0.04;
    });
  });

  // Key BZD effects
  rect(s,0.3,4.02, 4.6,0.26, C.mid);
  txt(s,"EFFECTS ON SLEEP ARCHITECTURE", 0.42,4.02, 4.4,0.26, {fontSize:9.5,bold:true,color:C.gold,charSpacing:1});
  bulletList(s,[
    "↓ Sleep latency, ↑ TST, ↑ sleep efficiency",
    "↓ REM sleep (suppress dream sleep)",
    "↓ Slow-wave sleep (N3) — non-restorative",
    "Tolerance after 1–2 months; rebound insomnia 71%",
  ], 0.3,4.3, 4.6, C.white, 11);

  // Z-drugs
  rect(s,5.1,1.58, 4.6,0.28, C.teal);
  txt(s,"Z-DRUGS (Non-BZD BzRAs)", 5.22,1.58, 4.5,0.28, {fontSize:11.5,bold:true,color:C.dark,valign:"middle"});
  const zdrugs = [
    ["Drug","Dose","T½","Notes"],
    ["Zolpidem","5–10 mg","2–4 h","Most prescribed; α1-selective; complex sleep behaviours"],
    ["Zaleplon","5–20 mg","1–2 h","Shortest T½; sleep onset only; safe mid-night dose"],
    ["Eszopiclone","1–3 mg","5–8 h","Longest-approved (6-month studies); metallic taste"],
    ["Zopiclone","3.75–7.5 mg","5 h","Widely used outside US; similar to eszopiclone"],
  ];
  zdrugs.forEach((row,ri) => {
    const bg = ri===0 ? C.mid : (ri%2===0 ? C.panel : C.bg);
    rect(s,5.1,1.88+ri*0.4, 4.6,0.38, bg);
    const widths = [1.0,0.7,0.7,2.12];
    let xc = 5.12;
    row.forEach((cell,ci) => {
      txt(s,cell, xc,1.9+ri*0.4, widths[ci],0.34, {fontSize:ri===0?9:10.5, bold:ri===0||ci===0, color:ri===0?C.teal:(ci===0?C.gold:C.lt)});
      xc += widths[ci]+0.04;
    });
  });

  rect(s,5.1,4.02, 4.6,0.26, C.mid);
  txt(s,"Z-DRUGS vs BZDs", 5.22,4.02, 4.4,0.26, {fontSize:9.5,bold:true,color:C.teal,charSpacing:1});
  bulletList(s,[
    "α1-selective → less muscle relaxation/amnesia vs BZDs",
    "No reduction in REM or delta sleep (zolpidem)",
    "Complex sleep behaviours: sleep-walking, sleep-eating, sleep-driving",
    "Recommended max 2–4 weeks; rebound on stopping",
  ], 5.1,4.3, 4.6, C.white, 11);

  // Warning box
  rect(s,0.3,5.08, 9.4,0.38, C.panel, C.red,1);
  txt(s,"⚠️ BEERS CRITERIA 2019 (AGS): Strong recommendation AGAINST benzodiazepines, Z-drugs, TCAs (>6 mg doxepin), and first-generation antihistamines for sleep in OLDER ADULTS (↑ fall, confusion, cognitive impairment risk)", 0.45,5.11, 9.1,0.32, {fontSize:11,color:C.white});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 17 — PHARMACOTHERAPY — NOVEL AGENTS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Pharmacotherapy — Novel & Alternative Agents","Orexin antagonists • Melatonin agonists • Antidepressants", C.gold);

  // Orexin antagonists
  rect(s,0.3,1.22, 9.4,0.26, C.mid);
  txt(s,"OREXIN (HYPOCRETIN) RECEPTOR ANTAGONISTS — Newest FDA-approved class for insomnia", 0.42,1.24, 9.1,0.22, {fontSize:11.5,bold:true,color:C.gold});

  const orexinDrugs = [
    {n:"Suvorexant",d:"10–20 mg",h:"OX1+OX2 block (dual)",note:"Approved insomnia incl. AD patients; needs 7 h after dosing; morning sedation", c:C.gold},
    {n:"Lemborexant",d:"5–10 mg",h:"OX1+OX2 block (faster dissociation)",note:"Better kinetics than suvorexant; ↓ morning sedation; no head-to-head studies", c:C.coral},
    {n:"Daridorexant",d:"25–50 mg",h:"Dual orexin antagonist",note:"Newest; improves next-day functioning; approved 2022", c:C.teal},
  ];
  orexinDrugs.forEach((d,i) => {
    const x = 0.3+i*3.18;
    rect(s,x,1.52, 3.0,1.52, C.panel, d.c,1.2);
    rect(s,x,1.52, 3.0,0.3, d.c);
    txt(s,d.n, x+0.1,1.54, 2.8,0.26, {fontSize:13,bold:true,color:C.dark});
    txt(s,`Dose: ${d.d}`, x+0.1,1.86, 2.8,0.26, {fontSize:11,bold:true,color:d.c});
    txt(s,`MOA: ${d.h}`, x+0.1,2.12, 2.8,0.26, {fontSize:10.5,color:C.lt,italic:true});
    txt(s,d.note, x+0.1,2.38, 2.8,0.6, {fontSize:10,color:C.white});
  });
  txt(s,"Side effects: morning sedation, hypnagogic hallucinations, sleep paralysis (rare — similar to narcolepsy symptoms)", 0.3,3.08, 9.4,0.26, {fontSize:11,color:C.lt,italic:true});

  // Melatonin agonists
  line(s,0.3,3.38, 9.4, C.teal,0.8);
  txt(s,"MELATONIN AGONISTS", 0.3,3.42, 4,0.26, {fontSize:9.5,bold:true,color:C.teal,charSpacing:2});
  const melat = [
    {n:"Ramelteon 8 mg",note:"MT1/MT2 agonist; no abuse potential; best for sleep-onset/circadian; approved AD patients"},
    {n:"Tasimelteon",note:"Circadian rhythm disorders in blind patients; non-24-h sleep-wake disorder"},
  ];
  melat.forEach((m,i) => {
    rect(s,0.3+i*4.9,3.72, 4.55,0.58, C.panel, C.teal,1);
    txt(s,m.n, 0.42+i*4.9,3.76, 4.3,0.26, {fontSize:12,bold:true,color:C.teal});
    txt(s,m.note, 0.42+i*4.9,4.0, 4.3,0.26, {fontSize:10.5,color:C.lt});
  });

  // Antidepressants & others
  line(s,0.3,4.38, 9.4, C.purple,0.8);
  txt(s,"ANTIDEPRESSANTS & OTHER SEDATING AGENTS", 0.3,4.42, 9,0.26, {fontSize:9.5,bold:true,color:C.purple,charSpacing:2});
  const antideps = [
    {n:"Trazodone 25–100 mg",m:"5-HT2 antagonist, H1 block",note:"Off-label; widely used; T½ 5–9 h; no abuse potential"},
    {n:"Doxepin ≤6 mg",m:"H1 antagonism",note:"FDA-approved at low dose; sleep maintenance; Beers: avoid >6 mg, avoid in delirium risk"},
    {n:"Mirtazapine 7.5–15 mg",m:"H1+5HT2 antagonism",note:"Off-label; useful with comorbid depression + insomnia; weight gain"},
    {n:"Diphenhydramine (OTC)",m:"H1 antagonist",note:"Tolerance within days; anticholinergic; AVOID in elderly"},
  ];
  antideps.forEach((a,i) => {
    const x = 0.3+(i%2)*4.9;
    const y = 4.72+(Math.floor(i/2)*0.0);
    if (i<2) {
      rect(s,x,4.72, 4.55,0.64, C.panel, C.purple,0.8);
      txt(s,a.n, x+0.1,4.76, 4.3,0.24, {fontSize:11.5,bold:true,color:C.purple});
      txt(s,`MOA: ${a.m} | ${a.note}`, x+0.1,5.0, 4.3,0.3, {fontSize:10,color:C.lt});
    }
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 18 — DRUG SELECTION & TREATMENT ALGORITHM
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Drug Selection & Treatment Algorithm","Matching the drug to the patient's insomnia type", C.teal);

  // Algorithm
  txt(s,"STEP-BY-STEP TREATMENT ALGORITHM", 0.3,1.22, 6,0.28, {fontSize:9.5,bold:true,color:C.yellow,charSpacing:2});
  const steps = [
    {n:"Step 1", t:"Treat underlying cause", d:"Address comorbid depression, anxiety, pain, OSA, medications before adding hypnotics", c:C.teal},
    {n:"Step 2", t:"Sleep hygiene education", d:"Implement for ALL patients regardless of severity", c:C.teal},
    {n:"Step 3", t:"CBT-I (first-line)", d:"Chronic insomnia: 6–10 sessions. BBTI (4 sessions) if resources limited", c:C.green},
    {n:"Step 4", t:"Pharmacotherapy", d:"Acute insomnia or while awaiting CBT-I: short-acting BzRA or orexin antagonist", c:C.coral},
    {n:"Step 5", t:"Combination therapy", d:"CBT-I + short-term medication superior to either alone", c:C.gold},
    {n:"Step 6", t:"Taper & maintain", d:"Gradual taper of medication; maintain CBT-I strategies", c:C.purple},
  ];
  steps.forEach((st,i) => {
    const col = i < 3 ? 0 : 1;
    const row = i < 3 ? i : i-3;
    const x = 0.3+col*4.9;
    const y = 1.54+row*1.04;
    rect(s,x,y, 4.55,0.96, C.panel, st.c,1);
    ellipse(s,x+0.14,y+0.3, 0.38,0.38, st.c);
    txt(s,st.n, x+0.14,y+0.3, 0.38,0.38, {fontSize:9.5,bold:true,color:C.dark,align:"center",valign:"middle"});
    txt(s,st.t, x+0.62,y+0.06, 3.8,0.3, {fontSize:13,bold:true,color:st.c});
    txt(s,st.d, x+0.62,y+0.38, 3.8,0.52, {fontSize:11,color:C.lt});
  });

  // Drug selection guide
  txt(s,"DRUG CHOICE BY INSOMNIA TYPE (AASM)", 0.3,4.62, 9.4,0.26, {fontSize:9.5,bold:true,color:C.teal,charSpacing:2});
  rect(s,0.3,4.9, 9.4,0.56, C.panel, C.dim,0.5);
  txt(s,[
    {text:"Sleep ONSET: ", options:{bold:true,color:C.coral,fontSize:11}},
    {text:"Zaleplon, triazolam, ramelteon  |  ", options:{color:C.white,fontSize:11}},
    {text:"  Sleep MAINTENANCE: ", options:{bold:true,color:C.gold,fontSize:11}},
    {text:"Eszopiclone, zolpidem CR, temazepam, suvorexant, lemborexant  |  ", options:{color:C.white,fontSize:11}},
    {text:"  BOTH: ", options:{bold:true,color:C.teal,fontSize:11}},
    {text:"Eszopiclone, zolpidem CR, suvorexant", options:{color:C.white,fontSize:11}},
  ], {x:0.42,y:4.93, w:9.0,h:0.5, margin:0});
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 19 — SPECIAL POPULATIONS
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  header(s,"Special Populations","Elderly • Pregnancy • Paediatric • Psychiatric comorbidity", C.purple);

  const pops = [
    {
      icon:"👴", title:"ELDERLY", c:C.gold,
      x:0.3, y:1.2, w:4.55, h:2.0,
      points:[
        "Most susceptible to drug side effects",
        "↑ fall risk, confusion, cognitive impairment",
        "Beers Criteria: AVOID BZDs, Z-drugs, TCAs (>6 mg), antihistamines",
        "PREFER: CBT-I (first-line), suvorexant (approved in AD), ramelteon (safe, low efficacy)",
        "Doxepin ≤6 mg: FDA-approved for sleep maintenance in elderly",
        "Treat comorbid depression, pain, OSA first",
      ]
    },
    {
      icon:"🤰", title:"PREGNANCY", c:C.teal,
      x:5.1, y:1.2, w:4.6, h:2.0,
      points:[
        "CBT-I: safe and recommended first-line",
        "Pharmacotherapy: AVOID in 1st trimester if possible",
        "Common causes: nocturia, foetal movements, heartburn, anxiety",
        "Doxylamine + B6: safe for sleep-associated nausea in 1st trimester",
        "Short-term zolpidem if essential (lowest dose, 3rd trimester preferred)",
        "Avoid BZDs (neonatal withdrawal, 'floppy infant syndrome')",
      ]
    },
    {
      icon:"🧠", title:"PSYCHIATRIC COMORBIDITY", c:C.coral,
      x:0.3, y:3.3, w:4.55, h:2.06,
      points:[
        "Treat both disorders simultaneously — bidirectional",
        "MDD + insomnia: sedating antidepressant (mirtazapine, trazodone)",
        "Treating insomnia → ↑ antidepressant response, ↓ relapse",
        "Anxiety: CBT-I + SSRI; avoid BZDs long-term",
        "PTSD: prazosin for nightmares; CBT-I for sleep disruption",
        "Schizophrenia: low-dose quetiapine (off-label); address medications",
      ]
    },
    {
      icon:"🏥", title:"HOSPITALISED / ACUTE ILLNESS", c:C.green,
      x:5.1, y:3.3, w:4.6, h:2.06,
      points:[
        "Non-pharmacological first: sleep hygiene, light control, noise reduction",
        "Short-acting BZDs or Z-drugs for brief, severe insomnia",
        "ICU: melatonin for circadian realignment (low evidence)",
        "Avoid long-acting BZDs (↑ delirium risk)",
        "Delirium risk: reassess medications, treat pain, orient patient",
        "Discharge planning: taper hypnotics started in hospital",
      ]
    },
  ];

  pops.forEach(p => {
    rect(s,p.x,p.y, p.w,p.h, C.panel, p.c,1);
    rect(s,p.x,p.y, p.w,0.32, p.c);
    txt(s,`${p.icon}  ${p.title}`, p.x+0.1,p.y+0.02, p.w-0.2,0.28, {fontSize:12,bold:true,color:C.dark});
    bulletList(s, p.points, p.x+0.1, p.y+0.36, p.w-0.2, C.white, 10.5);
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 20 — EXAM HIGH-YIELD SUMMARY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s,0,0,10,5.625, C.bg);
  rect(s,0,0, 0.22,5.625, C.teal);
  txt(s,"HIGH-YIELD EXAM POINTS", 0.45,0.1, 9.2,0.52, {fontSize:22,bold:true,color:C.white,charSpacing:3});
  line(s,0.45,0.68, 9.1, C.teal, 2);

  const points = [
    {n:"1", t:"Definition", d:"Inability to initiate/maintain sleep + adequate opportunity + daytime impairment", c:C.teal},
    {n:"2", t:"Chronic vs Acute", d:"Chronic = ≥3 nights/wk for ≥3 months; Acute = <3 months (short-term)", c:C.coral},
    {n:"3", t:"Most common sleep disorder", d:"35% intermittent; 10% chronic; F > M; ↑ with age, psychiatric illness", c:C.gold},
    {n:"4", t:"Pathophysiology", d:"Hyperarousal (cognitive + cortical + physiologic) + 3-P model + ↓GABA / ↑Orexin / ↑HPA", c:C.purple},
    {n:"5", t:"Early-morning awakening", d:"Hallmark of Major Depressive Disorder — key clinical clue", c:C.teal},
    {n:"6", t:"First-line treatment", d:"CBT-I (cognitive behavioural therapy) — all guidelines; superior & more durable than drugs", c:C.green},
    {n:"7", t:"First-line drug (acute)", d:"Z-drugs (zolpidem, zaleplon, eszopiclone) or short-acting BZD for acute/short-term", c:C.coral},
    {n:"8", t:"Newest drug class", d:"Orexin receptor antagonists: suvorexant, lemborexant, daridorexant — block wake-promoting orexin", c:C.gold},
    {n:"9", t:"AVOID in elderly", d:"BZDs, Z-drugs, TCAs >6 mg, antihistamines (Beers 2019) — ↑ falls, confusion, cognitive impairment", c:C.red},
    {n:"10", t:"Rebound insomnia", d:"Occurs in up to 71% after BZD discontinuation — taper slowly", c:C.purple},
  ];

  points.forEach((p,i) => {
    const col = i < 5 ? 0 : 1;
    const row = i < 5 ? i : i-5;
    const x = 0.3+col*4.9;
    const y = 0.78+row*0.92;
    rect(s,x,y, 4.55,0.84, C.panel, p.c,0.8);
    ellipse(s,x+0.1,y+0.2, 0.44,0.44, p.c);
    txt(s,p.n, x+0.1,y+0.2, 0.44,0.44, {fontSize:13,bold:true,color:C.dark,align:"center",valign:"middle"});
    txt(s,p.t, x+0.64,y+0.06, 3.8,0.28, {fontSize:12.5,bold:true,color:p.c});
    txt(s,p.d, x+0.64,y+0.36, 3.8,0.42, {fontSize:11,color:C.lt});
  });

  txt(s,"Sources: Harrison's 22E (p.259-261) • Goldman-Cecil Medicine • Kaplan & Sadock's Comprehensive Textbook of Psychiatry • Murray & Nadel's Respiratory Medicine • Bradley & Daroff's Neurology in Clinical Practice",
    0.3,5.42, 9.4,0.18, {fontSize:7.5,color:C.dim,italic:true});
}

// ═══════════════════════════════════════════════════════════════════════════
// WRITE
// ═══════════════════════════════════════════════════════════════════════════
pres.writeFile({fileName:"/home/daytona/workspace/insomnia-pptx/Insomnia_MBBS_FullDepth.pptx"})
  .then(()=>console.log("DONE"))
  .catch(e=>{console.error(e);process.exit(1);});