Insomnia is a sleep illness in which a patient suffers from falling asleep, remaining asleep, or even obtaining restorative sleep. This problem persists even when the patient has the right environment to rest. Stress is the leading cause of short-term Insomnia. Long-term Insomnia can cause the patient to lack sleep three or more nights a week and even last for months (Edinger et al., 2021). Lack of sleep means the patient suffers from some health conditions requiring medical attention. This case study evaluates Insomnia in a 31-year-old patient who has Insomnia which has been worsening for the last six months. He states that he has never had good sleep patterns, but at the time, he does not fall or stay asleep all night. According to the patient, his condition rose after the passing aware of his fiancé six months ago. It has affected his work since he experiences excessive daytime fatigue due to poor sleep quality. He has been using diphenhydramine which has helped improve his sleep patterns, but it has affected how he feels in the morning once he wakes up.
The patient also has opiate abuse, traced to 4 years ago when he had a skiing accident and was recommended hydrocodone/ apap (acetaminophen). For four years, his medications have not been defined. The patient further reveals that he uses alcohol to induce sleep. These factors from the patient are essential in making decisions for their treatment. The patient requires a prescription to help him get better sleep without affecting his health. Psychopharmacologic therapies can help treat the patient though some drugs can have adverse side effects. This essay analyzes the patient’s case, the history of Insomnia, and the factors contributing to their sleep disorder. The PMHNP’s decisions regarding pharmacotherapy, including medication selection, dosage, and duration of treatment, will also be discussed in detail. This paper aims to provide insight into managing patients with Insomnia and how medication can be used as part of a comprehensive treatment plan.
Decision #1
Prescribing the patient with Zolpidem: 10mg daily at bedtime would be the best decision. It is the best decision to take at this stage of his health condition. The medication can make the patient go to sleep and even get ample sleep. However, in a few circumstances, the patient might lack sleep and end up working at night hungry (Edinger et al., 2021). These cases are not persistent, and they do not affect the patient’s way to recovery. The patient is also able to reduce their rate of drinking alcohol which is healthy for their condition.
The other two decisions would be inappropriate at this stage of patient treatment. They are halting Zolpidem and introducing therapy with eszopiclone 1 mg every day at sleep time. This decision would lead to unwanted side effects on erections in the morning, affecting their morning routine (Krystal et al., 2019). Discontinuing Zolpidem and initiating treatment with trazodone 50–100 mg daily at sleep time would help the patient get to sleep but would have a negative side effect of the patient feeling dizziness the following day.
Deciding to prescribe the patient Zolpidem: 10mg daily at bedtime helps initiate the treatment plan for the patient. Zolpidem slows down the activities of the brain (Ong et al., 2021). This action allows the body to sleep since the prescription aims to help the patient get enough sleep, which would help give the next step for his medication. It is ethical that the patient is made aware of the medication they are receiving since it helps them avoid tension when side effects arise during the prescription period (Edinger et al., 2021). Ethically, it is right to consider the drug’s role in the patient’s healing process. Prescribing the right medicines ensures that the patient can recover within the shortest time possible.
Decision #2
Discontinuing Zolpidem and introducing therapy with eszopiclone 1 mg every day at sleep time is the best prescription for the patient at this stage of the treatment. Eszopiclone helps the patient sleep (Krystal et al., 2019). It does not cause any side effects on the patient. The patient should take it two hours before going to sleep since the medicine makes them feel well until they fall asleep. It does not cause any disturbing effects on the patient. The patient’s decision-making is not affected by the medication. Prescribing trazodone at 50 mg is not the perfect decision at this stage of the treatment. Though priapism would have diminished, the patient would suffer from drowsiness when the next day (Ong et al., 2021). Halting hydroxyzine and introducing therapy with temazepam 15 mg daily at sleep time would also not be the most appropriate dose. Taking this drug, especially under the influence of alcohol, would even cause more harm to the patient.
This stage of treatment helps the patient overcome most of the challenges and symptoms that have been persistent. These are symptoms that the first dose was not able to treat. If the patient successfully surpasses this stage, they are close enough to the final stages of treating their illness (Edinger et al., 2021). That would signify that the prescription that the Psychiatric nurse offered was right. The biggest aim of the treatment is to ensure that the patient would not develop any further complications that would harm the patient. It would be ethical to offer the patient counseling at this stage (Pavlova & Latreille, 2019). Considering the patient has been taking alcohol for a long time, guiding him and ensuring that he knows the possible effects of alcohol at this stage would be helpful. At this stage, the patient should not consume alcohol because it would complicate their prescription (Krystal et al., 2019). The Psychiatric nurse should ensure the patient knows that that is the right decision.
Decision #3
Continuing with the therapeutic dose of eszopiclone 1 mg daily is the more appropriate treatment for the patient. Eszopiclone is a long-term hypnotic more suitable for treating chronic, long-term Insomnia (Edinger et al., 2021). Instructing the patient to take the medication 30 minutes before bed for four weeks is necessary to ensure that the patient can sleep without relying on alcohol. Prompting therapy with Sonata 10 mg every night with a follow-up in four weeks is not the suitable prescription at this stage of the treatment because Sonata (zaleplon) is a short-acting hypnotic, meaning that it has a shorter half-life and can cause rebound insomnia (a period of increased Insomnia after discontinuing use) when used for long term (Cruz et al., 2021). It means it is not an ideal treatment for this patient’s chronic and long-term Insomnia, and it may not be the best option for his current situation. Furthermore, long-term use of Sonata can be habit-forming and potentially lead to the patient developing a dependency.
On the contrary, it has anticholinergic side effects like Xerostomia and Xerophthalmia (Edinger et al., 2021). Discontinuing temazepam and initiating therapy with trazodone 50–100 mg every night with a follow-up in 4 weeks would also not be the right decision. Trazodone would cause weakness and dizziness in the patient. This final stage is meant to complete the treatment since the patient has undergone several guidance and counseling sessions and has foregone taking alcohol (Edinger et al., 2021). The goal main of this stage is to allow the patient to achieve enough sleep without medication. It is important to ensure that the patient understands the stage of their treatment and the risks associated with taking alcohol or other substances that could complicate their health or treatment (Krystal et al., 2019). The patient will be monitored regularly to ensure they can achieve enough sleep without medication.
Conclusion
Insomnia is a disease that can affect anyone of any age. It is treatable when the patient receives suitable treatment and medications. A Psychiatric nurse needs to provide the patient with the appropriate medication to help the patient recover within the shortest time possible. This medicine should not cause harm or complications to patients as they are provided with essential instructions and information in their treatment processes.
The case study of the 31 years old male shows the steps through the treatment of Insomnia. It highlights the best medications offered to the patient from the first day. The nurse keeps a record of the treatment and monitors the patient’s progress through the different stages of the treatment. At the various stages, the patient receives medication that aims at helping health improve. In the first stage, the patient has prescribed Zolpidem: 10mg daily at bedtime, while in the second, the nurse discontinued Zolpidem and initiated therapy with eszopiclone 1 mg daily at rest. Lastly, the patient continues the therapy dose of eszopiclone 1 mg daily. This timeline of treatment, which progresses from the first dose of Zolpidem to the initiation of eszopiclone therapy to the final stage of maintenance therapy, aims to help the patient’s health improve.
Guidance and counseling strive to help to overcome the intake of alcohol that would have affected their treatment process. The nurse ensures that the patient is fully briefed on every step that is being undertaken. This treatment helps the patient up to his full recovery. Insomnia is a severe medical condition that needs to be treated with the utmost care and attention. With the proper medication and counseling, the patient can fully recover. The nurse can successfully help the patient reach the desired results by following the steps outlined in the case study. Furthermore, the nurse must provide guidance and support to the patient to ensure that the medications are taken correctly and that there are no complications from the intake of alcohol. Finally, the patient can look forward to a better quality of life with the proper care and treatment.
References
Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Lichstein, K. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255-262. https://doi.org/10.5664/jcsm.8986
Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of Insomnia: an update. World Psychiatry, 18(3), 337–352. https://doi.org/10.1002/wps.20674
Ong, J. C., Crawford, M. R., & Wallace, D. M. (2021). Sleep apnea and Insomnia: emerging evidence for effective clinical management. Chest, 159(5), 2020-2028. https://doi.org/10.1016/j.chest.2020.12.002
Pavlova, M. K., & Latreille, V. (2019). Sleep disorders. The American Journal of Medicine, 132(3), 292-299. https://doi.org/10.1016/j.amjmed.2018.09.021
Cruz, M. M., Kryger, M. H., Salles, C., & Gozal, D. (2021). Comorbid Insomnia and Sleep Apnea: Mechanisms and implications of an underrecognized and misinterpreted sleep disorder. Sleep Medicine, 84, 283-288. https://doi.org/10.1016/j.sleep.2021.05.043
write