Insomnia is a sleep disorder characterized by poor sleep quantity or quality. Sleep disorders impair various aspects of individuals, including quality of life and cognition. They contribute to interpersonal difficulties, work-related problems, risk of psychiatric disease, substance abuse, and increased proneness to accidents. The purpose of this paper is to describe treatment interventions for a patient with a sleep/wake disorder.
Introduction to the Case
The case study portrays a 31-year-old man presenting with insomnia. He mentions that insomnia has increasingly worsened in the past six months. He currently experiences trouble falling asleep and remaining asleep at night. The sleep disturbance started roughly six months ago after his fiancé’s death. It affects his job performance because he often falls asleep when at work since he did not have adequate sleep the previous night. He had used diphenhydramine to aid sleep, but it has a morning after-effect. The patient has an opiate abuse history. He states that he has not been given an opioid prescription for the past four years. He reports taking four beers before bed to aid in falling asleep. His MSE is unremarkable.
Both pharmacological and psychotherapy interventions are indicated in managing insomnia in adult patients. When the pharmacotherapy option is selected, the choice of the drug should be directed by: Insomnia symptom pattern; Patient’s past treatment response; Treatment goals; Patient preference; Medication cost; Comorbid conditions; Drug contraindications; Concurrent medication interactions; Potential adverse effects (Pagel et al., 2018). Therefore, the factors that may impact treatment decisions for this patient include his insomnia pattern, past response to diphenhydramine, and opiate abuse history.
Decision Point One
Why I Selected This Decision
Trazodone was selected because it is widely prescribed off-label to manage insomnia. It is a sedative antidepressant that wields its antidepressant effect by antagonizing and inhibiting serotonin reuptake (Madari et al., 2021). Zheng et al. (2022) found that trazodone markedly improved total sleep time (TST) and non-rapid eye movement stage 3 (N3). It also markedly reduces latency to the onset of persistent sleep, frequency of awakenings, and waking time following persistent sleep onset.
Why I Did Not Select the Other Two Options Provided
Zolpidem was not ideal due to its associated abuse potential, psychomotor impairment, and complex sleep behaviors (Earl et al., 2020). Hydroxyzine was not also ideal due to its strong sedative properties that cause drowsiness, which causes intolerance to the drug (Krystal et al., 2019). Besides, limited data support Zolpidem’s efficacy and safety in treating insomnia.
What I Was Hoping To Achieve By Making This Decision
The practitioner hoped that Trazodone would improve the patient’s reported sleep quality by reducing nighttime awakenings and aiding in sleep (Hassinger et al., 2020). Zheng et al. (2022) explain that trazodone plays an essential role in improving the internal structure of sleep, such as reducing non-rapid eye movement stage 1 and the number of awakenings and increasing non-rapid eye movement stage 3.
How Ethical Considerations May Impact the Treatment Plan
Ethical factors of beneficence may affect treatment since the practitioner had to select the medication established to have the most benefits in improving insomnia. Respect for patient autonomy may affect communication since the practitioner must involve the patient in treatment decisions.
Decision Point Two
Explain that an erection lasting 15 minutes is not considered a priapism and should diminish over time, continue with the current dose.
Why I Selected This Decision
Priapism is a known side effect of Trazodone. It is reported that prolonged, dysfunctional penile erection is most likely to happen within the first 28 days of trazodone treatment, typically 150 mg/day or less (Earl et al., 2020). The current dose was maintained because it led to a positive response in reducing insomnia. Continuing the dose would likely improve the patient’s sleep quality (Hassinger et al., 2020).
Why I Did Not Select the Other Two Options Provided
Changing the drug to Suvorexant was not ideal since it has side effects of daytime somnolence, motor and driving impairment, abnormal dream pattern, and unconscious nighttime activity like sleepwalking (Earl et al., 2020). The trazodo
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