Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders.
Persistent insomnia continues to plague individuals, wreaking havoc on their daily lives. Its detrimental effects are far-reaching, leading to a diminished quality of life in adults and even fatal consequences or impairments among young adults. Insomnia manifests as a relentless struggle to fall asleep or remain asleep, resulting in a dearth of restful nights and hampering daily functioning due to the burden of stress and exhaustion. Extensive research has linked insomnia to an array of illnesses, encompassing anxiety, post-traumatic stress disorder (PTSD), addictive behaviors, depression, diabetes, suicidal ideation, and hypertension (Gaffey et al., 2020). Additionally, diagnostic criteria for insomnia focus on various factors, including sleep initiation and maintenance difficulties, disrupted sleep-wake patterns, abrupt awakenings, and the consequent inability to perform optimally during the day. Notably, socio-economic stressors such as low-income levels, limited education, and relationship strife further compound the complexity of insomnia.
In evaluating insomnia, it is imperative to conduct comprehensive mental and physical examinations. These assessments entail a thorough evaluation of key indicators, such as neck circumference, airway examination for potential sleep apnea, and body mass index. Such evaluations serve a dual purpose, as they not only aid in diagnosing insomnia but also offer insights into the presence of other underlying disorders and concomitant conditions (Gaffey et al., 2020).
Presently, a 31-year-old male patient seeks medical assistance due to his ongoing battle with insomnia. The severity of his condition has escalated over the past six months, significantly disrupting his ability to initiate and sustain sleep. While he admits to having never been a sound sleeper, his difficulties have intensified following the tragic loss of his fiancée. The debilitating impact of his sleep deprivation is acutely felt in his job performance as a forklift operator at a chemical plant. Distressed by the undesired side effects of diphenhydramine, a sleep aid he has previously utilized, the patient is reluctant to resort to its use. Lamentably, his struggle with sleeplessness has led to instances of unintentional dozing off during work hours. It is important to note that the patient has a documented history of opioid dependence stemming from an ankle fracture years ago, which was managed with hydrocodone/adrenaline phosphate for acute pain relief. Although pain management prescriptions have ceased for the past four years, the patient has resorted to alcohol consumption—four bottles of beer—to facilitate sleep. Notwithstanding these challenges, the patient’s mental examination reveals a lucid and alert individual who is well-oriented to person, place, and time. He maintains appropriate eye contact and exhibits suitable attire for the circumstances. His cognitive faculties, including perception, reasoning, and grasp of reality, are intact, and he denies experiencing auditory or visual hallucinations, as well as any suicidal or homicidal thoughts.
Decision # 1: Trazodone 50–100 mg daily at bedtime
In selecting Trazodone as a treatment option, I took into consideration the patient’s difficulty sleeping and staying asleep, which has been exacerbated by the recent death of his fiancée. Trazodone is not only FDA-approved for depression but also used off-label for insomnia. Its advantages outweigh the risks, as it has shown efficacy in managing insomnia by regulating cortisol repression in the adrenal, pituitary, and hypothalamic axis (Vgontzas et al., 2020). Additionally, its short half-life of three to six hours allows for initiating and maintaining sleep without excessive drowsiness.
Other medications like zolpidem and hydroxyzine were not chosen for this particular client’s therapy. Zolpidem, authorized for short-term insomnia, has a shorter half-life and is not suit
Order this paper