ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

  Examine Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult. You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #3 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Conclusion (1 page) Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.    
Introduction to the case The patient in this case study is a 25-year-old female who presents with insomnia. She has been having difficulty falling asleep and staying asleep for the past 6 months. She reports that she is averaging 5-6 hours of sleep per night, and that she often wakes up feeling tired and groggy. She has tried over-the-counter sleep aids, but they have not been effective. The patient has no significant medical history and does not take any medications. She is a healthy, active individual who works full-time. She does not smoke or drink alcohol. Decision #1 The first decision point in this case study is whether to prescribe a medication for the patient's insomnia. There are several factors to consider when making this decision, including the patient's age, medical history, and lifestyle. The patient in this case is a young, healthy adult. She does not have any significant medical conditions that would make her a poor candidate for medication. However, she is a busy professional who works long hours. This suggests that she may be more likely to experience side effects from medication, such as drowsiness and impaired judgment. After considering all of the factors, I have decided to prescribe a medication for the patient's insomnia. I will start her on a low dose of zolpidem, a non-benzodiazepine hypnotic. Zolpidem is a short-acting medication that is well-tolerated by most people. It is also less likely to cause dependence than benzodiazepines. Why did I not select the other two options provided in the exercise? The other two options provided in the exercise were to:
  • Prescribe a benzodiazepine, such as temazepam or lorazepam.
  • Recommend cognitive-behavioral therapy for insomnia (CBT-I).
I did not select the first option because benzodiazepines have a higher risk of dependence and withdrawal symptoms. They can also cause side effects such as drowsiness, dizziness, and impaired judgment. I did not select the second option because CBT-I is a longer-term treatment approach. It is also not always effective for people who have severe insomnia. What were I hoping to achieve by making this decision? I hope to achieve several things by prescribing a medication for the patient's insomnia. First, I hope to improve her sleep quality and quantity. Second, I hope to reduce her daytime fatigue and improve her overall well-being. Third, I hope to minimize the risk of side effects and dependence. Explain how ethical considerations may impact my treatment plan and communication with patients. Ethical considerations are important to keep in mind when making treatment decisions for patients. In this case, it is important to respect the patient's autonomy and to provide her with accurate information about the risks and benefits of medication. It is also important to monitor the patient for side effects and to adjust the dose of medication as needed. Decision #2 The second decision point in this case study is whether to recommend cognitive-behavioral therapy for insomnia (CBT-I) in conjunction with medication. CBT-I is a non-pharmacological treatment approach that has been shown to be effective for insomnia. It is based on the principles of cognitive-behavioral therapy and teaches patients how to change their thinking and behavior patterns that contribute to insomnia. I have decided to recommend CBT-I in conjunction with medication for the patient. I believe that CBT-I will help the patient to address the underlying causes of her insomnia and to develop long-term strategies for managing her sleep. Why did I select this decision? I selected this decision because I believe that CBT-I is an effective treatment for insomnia. It is also a safe and non-pharmacological treatment, which is important for the patient in this case. Why did I not select the other two options provided in the exercise? The other two options provided in the exercise were to:
  • Continue with medication only.
  • Discontinue medication and refer the patient to a sleep specialist.
I did not select the first option because I believe that CBT-I would be beneficial for the patient. I also believe that medication alone is not always effective for people who have severe insomnia. I did not select the second option because I believe that the patient would benefit from continuing with medication while she also receives CBT-I. This will help her to achieve better sleep quality and quantity more quickly. What were I hoping to achieve by making this decision? I hope to achieve several things by recommending CBT-I in conjunction with medication for the patient. First, I hope to improve her sleep quality and quantity. Second, I hope to reduce her daytime fatigue and improve her overall well-being. Third, I hope to help her to develop long-term strategies    

Sample Solution

The patient in this case study is a 25-year-old female who presents with insomnia. She has been having difficulty falling asleep and staying asleep for the past 6 months.