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Introduction
The client in the provided case study presented with insomnia complaints. The client reported that the condition had worsened for the last 6 months after he suddenly lost his fiancé. He reported that insomnia has impacted his ability to work. he sometimes falls asleep while at work. He has used diphenhydramine but he reports it has some bad effects afterward. Assessing and Treating Patients with Sleep/Wake
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The client has a history of opiate abuse but had not used opiate in the last 4 years. He further reports that he has been drinking alcohol to assist him to fall asleep. The MSE indicates that he is alert and well oriented. He is well-groomed and maintains good eye contact throughout the interview. His judgment, reality, and insight are intact. He denies any suicidal thoughts. Insomnia is characterized by symptoms such as difficulty initiating sleep, difficulty maintaining sleep, and inability to return to sleep after awakening. Assessing and Treating Patients with Sleep/Wake Disorders.The sleep difficulty should have been there for a minimum of 3 months and should significantly impact aspects such as education, work, social life, and other areas of functioning (Vargas et al., 2020). The client has all these symptoms and hence his symptoms meet the DSM-5 criteria of insomnia. Therefore, the purpose of this paper is to discuss the available treatment choices and select the most suitable medication for the patient. The appropriate ethical principles will be used to guide each treatment decision.Assessing and Treating Patients with Sleep/Wake Disorders.
Decision Point One
The available treatment choices are zolpidem 10 mg; trazodone 50-100 mg; and hydroxyzine 50 mg. Zolpidem is a sedative (benzodiazepine receptor agonist (BzRA) that is used to treat insomnia. The medication works by increasing GABA activity which is a body chemical that causes sleepiness (Vargas et al., 2020). Therefore, increasing the activity of GABA helps a person fall asleep. Trazodone is an off-label medication for the treatment of insomnia, but it is approved by the FDA to treat depression (Jaffer et al., 2017). On the other hand, hydroxyzine is an antihistamine that is an off-label medication in the treatment of insomnia, but it is FDA approved to treat anxiety (Patel et al., 2018). Trazodone was selected for this patient as it is an SSRI that is associated with minimal effects, when compared to zolpidem and hydroxyzine medications, which are associated with many serious side effects, including negative side effects for zolpidem.Assessing and Treating Patients with Sleep/Wake Disorders.
The targeted treatment outcome with Trazodone is that that the symptoms of insomnia for this patient will improve as manifested by the ability to initiate and maintain sleep. This is due to the medication’s efficacy in the treatment of insomnia (Jaffer et al., 2020). It is also expected that the patient will tolerate Trazodone, without any side effects because the medication is well tolerated.Assessing and Treating Patients with Sleep/Wake Disorders.
As expected, after two weeks the client reported that the medication was working well. However, he reported that he was experiencing a prolonged erection, which was making him uncomfortable. A change in sexual interest/ability is one of the side effects of trazodone (Ilgın et al., 2018).Assessing and Treating Patients with Sleep/Wake Disorders.
Beneficence and non-maleficence guided the selection of trazodone because the medication is likely to bring the best care outcomes for the client, and also the medication is associated with minimal side effects when compared to other available treatment choices. Informed consent was obtained from the client before initiating the treatment (Anderson & Anderson, 2018).Assessing and Treating Patients with Sleep/Wake Disorders.
Decision Point Two
The available treatment choices in decision point two include continuing with the same trazodone dose but explain to the patient that priapism is a common side effect with trazodone but the side effect reduces over time; discontinue trazodone and start suvorexant 10 mg; and reduce trazodone to 25 mg daily. Sharma & Sharma (2019) explain that priapism is a very serious side effect associated with trazodone. Suvorexant is an orexin receptor antagonist that is used in the treatment of insomnia. Suvorexant works by hindering the action of substance within the brain associated with wakefulness (Tampi et al., 2018).Assessing and Treating Patients with Sleep/Wake Disorders. Order this paper