Sleep disorders can disrupt an individual’s sleep patterns and have an impact on the body’s circadian rhythm. The circadian rhythm refers to the inherent 24-hour cycle of physiological, behavioral, and cognitive changes in the body (Riemann et al., 2022). The decline in this cognitive ability can lead to a deterioration in the patient’s overall well-being, including their health, safety, and overall quality of life. Insomnia is a sleep disorder characterized by difficulty falling asleep or staying asleep. Common aetiologies of insomnia include stress, lifestyle-induced disruptions to sleep patterns, anxiety, melancholy, pain, medication use, neurological disorders, and inadequate sleep hygiene.
The individual in question is a 31-year-old male who is currently experiencing worsening insomnia over six months, indicating a chronic condition. The problem started when the patient’s fiancé passed away, which also had an impact on how well he performed at work using a forklift. In addition, the patient reports using diphenhydramine as a sleep aid, having a history of opiate abuse (acetaminophen) for pain relief, and consuming alcohol.
When treating insomnia in this individual, it is important to take into account the patient’s alcohol use, as it may be a potential factor contributing to the sleeping disorder. While alcohol can promote deeper sleep in individuals without health issues, it has negative effects on Rapid Eye Movement (REM) sleep. The patient’s opiate misuse history and usage of diphenhydramine are other considerations to consider during therapy since it is critical to avoid medicine that creates tolerance and dependency. Additionally, it is important to take into account the patient’s mental state as it could potentially be a contributing factor if the issue is psychological. The onset of the patient’s insomnia symptoms after the demise of his fiancée suggests that the disorder could potentially be attributed to stress or depression. This paper delves into the decision-making process and the legal and ethical considerations associated with prescribing medication for the management of insomnia in the patient mentioned above.
Decision Point One
Selected Decision and Rationale
The chosen course of action was to initiate Trazodone at a dosage of 50 mg orally, to be taken before bedtime. Trazodone has been approved by the FDA for the treatment of insomnia, as stated by Riemann et al. (2022). Trazodone is a medication that acts as a serotonin modulator. It is commonly prescribed for the treatment of depression, as it helps to elevate serotonin levels in the brain, leading to improved moods and emotional stability (Ferini‐Strambi et al., 2021). In addition, the drug is highly effective in treating insomnia as a sedative when taken in low doses. The desired effects typically manifest around 30 minutes after oral ingestion (Madari et al., 2021). As is the case with the patient, the medication is most effective in managing insomnia that is associated with anxiety or depression (Gonçalo & Vieira-Coelho, 2021). Trazodone enables individuals to address sleep disruptions while maintaining their concentration on tasks effectively.
Zolpidem 10 mg every night before bed was not chosen because of the bad effects that come with it. The drug induces lethargy, migraines, vertigo, an unpleasant sensation of being intoxicated, and impaired balance upon administration (Hassinger et al., 2020). In addition, the drug may cause sleepwalking and memory loss. Hydroxyzine 50 mg every night before bed was not chosen because it is an antihistamine that makes people sleepy. The drug can lead to anticholinergic adverse reactions, which can cause discomfort the following morning (Madari et al., 2021).
Expected Outcome
The patient will likely return to the hospital after four weeks with markedly better sleeping habits (Riemann et al., 2022). The individual should rest sufficiently for the night and demonstrate enhanced concentration and vitality upon awakening.
Ethical Considerations
The ethical concepts of beneficence and nonmaleficence are crucial in guiding treatment options and fostering effective communication between patients and healthcare providers. According to Ferini-Strambi et al. (2021), it is essential to prioritize the patient’s well-being and reduce the risk of damage to uphold the moral principle of beneficence. Without any malice intended, the pharmacological medication with the lowest incidence of side effects was given in the scenario.
Decision Point Two
Selected Decision and Rationale
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