Posted: September 7th, 2022

Assessing and Treating Patients with Sleep/Wake Disorders

Assessing and Treating Patients with Sleep/Wake Disorders
Introduction
The case examine entails a 31-year previous male with insomnia and has begotten progressively during the last six months. In response to the affected person, he has by no means been a better sleeper, however now he has challenges sleeping (Walden College, 2021). The sleeping issues began after the lack of the fiancé. The signs are detrimental to each day actions and work. She is utilizing diphenhydramine as a sleep support, however the drug triggers an undesirable feeling. He falls asleep at work. The affected person has a historical past of opiate abuse. He makes use of alcohol to make him go to sleep, roughly 4 beers earlier than mattress (Walden College, 2021).
The primary choice is to begin Trazodone 50 mg to 100 mg each day at bedtime. The remedy is the perfect among the many choices obtainable because it has fewer negative effects (Vgontzas et al., 2020). The second choice is to proceed with the drug for the reason that affected person studies the drug is efficient in serving to him sleep. The one precaution is to scale back Trazodone 25 mg to decrease the chance of priapism (Vgontzas et al., 2020). The third choice is to proceed with Trazodone 25 mg since it’s serving to scale back insomnia. Moral concerns promote professionalism within the healthcare observe. The observe ought to adhere to the moral necessities, together with knowledgeable consent, beneficence, maleficence, confidentiality, integrity, and belief.
Resolution One
The primary choice is to prescribe Trazodone 50 mg to 100 mg each day at bedtime. The prescription choice ought to accompany the Assessment of the affected person’s alcohol use. Alcohol use can have an effect on the drug’s adherence and restoration (Vgontzas et al., 2020). Though the drug is within the off-label class, it’s the only option in comparison with different choices. Trazodone is best in treating insomnia because it generates high quality outcomes, in contrast to benzodiazepines (Vgontzas et al., 2020).
I didn’t choose Zolpidem 10 mg at bedtime for the reason that drug has antagonistic negative effects which might be dangerous for the affected person and his work. As an example, Zolpidem causes daytime drowsiness, lightheadedness, lack of coordination, tiredness, and weak point (Oggianu et al., 2020). The negative effects would have an effect on the affected person on the office, similar to growing the chance of inflicting an accident (Oggianu et al., 2020). If the affected person realizes the drug is unfriendly, there’s a threat of non-adherence. One more reason for not deciding on Zolpidem is that the drug is habit-forming, resulting in dependancy (Caraci et al., 2020). The drug needs to be used for few weeks since sufferers could expertise hassle sleeping with out it. Therapy of sleep or wake problems could take eight to 12 weeks, growing the chance of dependancy (Caraci et al., 2020). The affected person is already struggling with alcohol which he makes use of to Help him sleep.
I dominated out Hydroxyzine 50 mg each day at bedtime for the reason that drug has negative effects associated to diphenhydramine. Hydroxyzine makes an individual groggy, drained, and sleepy the next day (Albrecht et al., 2019). The remedy is just not the perfect for the remedy of insomnia as a result of excessive non-adherence charges. The consumer can cease taking the drug if he realizes that it makes him sleepy and unable to carry out his job as a forklift operator.
The anticipated consequence upon prescribing the remedy is to enhance the affected person’s high quality of sleep with minimal negative effects. For instance, it is going to be important to eradicate grogginess as a facet impact (Albrecht et al., 2019). The facet impact can have an effect on the affected person’s job and result in non-adherence. One other expectation is to keep away from the chance of habit-forming remedy as a result of his present alcohol dependancy (Albrecht et al., 2019). Dependancy can complicate his situation and have an effect on his well being.

Resolution Two
When the affected person studies again to the clinic after two weeks, he explains that the remedy is working nicely to scale back insomnia. He complains that regardless of the efficacy of the drug, it makes him expertise priapism. The extended erection makes it difficult to go downstairs to have breakfast with his girlfriend and daughter or prepare for work. Priapism can last as long as 15 minutes. The affected person denies visible and auditory hallucinations and is future-oriented.
The second choice is to teach the affected person that priapism is a facet impact of Trazodone and proceed with the dose. The dose helps the affected person to generate high quality outcomes regardless of the facet impact. It is going to be important to scale back the dosage to decrease the chance of priapism. I’ll prescribe Trazodone 25mg each day at bedtime. The potent remedy has a half-life of three to 9 hours (Vgontzas et al., 2020). The aim of decreasing the dosage is to make sure there’s a minimal quantity of drug circulating within the blood upon waking up (Vgontzas et al., 2020). One more reason for persevering with with the drug is that the evidence-based observe reveals that the negative effects put on off roughly after 4 weeks. Trazodone 25mg PO QHS is a normal prescription for sufferers taking SSRI, which generates insomnia as a big facet impact (Vgontzas et al., 2020). Research point out that Trazodone 25mg is efficient in decreasing insomnia (Oggianu et al., 2020).
I dominated Suvorexant 10mg for the reason that drug could cause negative effects similar to drowsiness, affecting the consumer on the office (Kuriyama & Tabata, 2017). One more reason is that suvorexant is a managed substance, in response to the U.S. Drug Enforcement Administration (DEA) (Kuriyama & Tabata, 2017). My remedy goal is to keep away from prescribing managed substances except the choice is important and no alternate options can be found. Altering a drug in the course of the remedy of sleep or wake problems can have an effect on the restoration course of (Kuriyama & Tabata, 2017).
The anticipated consequence is that the affected person’s negative effects will scale back considerably. One other anticipated objective is to maintain compliance with the drug. Decreasing the dose will decrease the chance of priapism and promote adherence (Kuriyama & Tabata, 2017).
Resolution Three
The affected person comes again to the clinic after two weeks. He studies the remedy is efficient in serving to him sleep. His solely grievance is that the dosage is just not sufficient to maintain him asleep all through the evening. He denies visible and auditory hallucinations and is future-oriented.
The third choice is to proceed with the drug since it’s working to scale back insomnia. I might encourage the consumer to observe sleep hygiene to deal with the problem of sleeping all through the evening (Morin et al., 2020). I’ll comply with up with the affected person within the subsequent clinic after 4 weeks for additional analysis. It’s important to ask about actions that will undermine his sleep, similar to noise, pets, or girlfriend.
It’s not prudent to change the drug for the reason that affected person is already responding to the drug and experiencing important enchancment in his sleep. A sleep hygiene Assessment can be important earlier than the subsequent clinic (Morin et al., 2020). If the end result reveals the affected person is just not training sleep hygiene, it might be good to encourage him to vary and proceed with the remedy. If the affected person is already training sleep hygiene, it might be prudent to change to hydroxyzine (Morin et al., 2020). Regardless of the negative effects of Xerostomia and Xerophthalmia, hydroxyzine is secure in comparison with ramelteon (Matheson & Hainer, 2017).
Hydroxyzine pamoate is dominated out since it isn’t a main drug for treating insomnia (Matheson & Hainer, 2017). Ramelteon is dominated out since it’s a melatonin agonist. The remedy is efficient in serving to individuals sleep and to not hold them sleep all through the evening (Matheson & Hainer, 2017). If different choices should not efficient, ramelteon could be a greater remedy because it has a low threat of abuse and is just not listed by U.S. Drug Enforcement Administration (DEA) (Matheson & Hainer, 2017).
The anticipated consequence is to scale back the negative effects, promote high quality sleep, optimize sleep environment, and keep adherence to the drug.
Moral Issues
Knowledgeable consent is an important moral consideration for the grownup affected person. It entails explaining to the affected person the prognosis and acceptable remedy. The affected person has the autonomy to say no remedy (Lyles et al., 2017). Beneficence and maleficence are essential concerns to make sure the affected person’s greatest curiosity whereas decreasing the chance of hurt. For instance, decreasing the dosage is important to decrease the chance of priapism (Lyles et al., 2017). Honesty and integrity are moral concerns to boost belief and communication. Confidentiality of the affected person info in response to the HIPPA legal guidelines is important to keep away from exposing the data to unauthorized events (Lyles et al., 2017).
Conclusion
Therapy of sleep and wake problems entails a sequence of selections. Therapy choices within the present case examine contain balancing between drug efficacy and negative effects. Trazodone is an efficient remedy, however a excessive dose causes priapism. Decreasing the dosage is important to keep away from priapism whereas selling adherence. I’ll observe varied moral concerns, together with knowledgeable consent, beneficence, maleficence, confidentiality, integrity, and belief. Therapy of the affected person is profitable for the reason that drug reduces insomnia.

References
Albrecht, J. S., Wickwire, E. M., Vadlamani, A., Scharf, S. M., & Tom, S. E. (2019). Traits in insomnia prognosis and remedy amongst Medicare beneficiaries, 2006–2013. The American Journal of Geriatric Psychiatry, 27(three), 301-309.
Caraci, F., Cuomo, A., & Fagiolini, A. (2020). Personalised remedy of despair phenotypes: function of trazodone in despair with insomnia. Rivista di Psichiatria, 55(6), 371-379.
Kuriyama, A., & Tabata, H. (2017). Suvorexant for the remedy of main insomnia: a scientific Assessment and meta-analysis. Sleep Medication Opinions, 35, 1-7.
Lyles, C. R., Fruchterman, J., Youdelman, M., & Schillinger, D. (2017). Authorized, sensible, and moral concerns for making on-line affected person portals accessible for all. American Journal of Public Well being, 107(10), 1608-1611.
Matheson, E., & Hainer, B. L. (2017). Insomnia: pharmacologic remedy. American Household Doctor, 96(1), 29-35.
Morin, C. M., Edinger, J. D., Beaulieu-Bonneau, S., Ivers, H., Krystal, A. D., Guay, B., … & Busby, M. (2020). Effectiveness of sequential psychological and remedy therapies for insomnia dysfunction: a randomized medical trial. Jama Psychiatry, 77(11), 1107-1115.
Oggianu, L., Ke, A. B., Chetty, M., Picollo, R., Petrucci, V., Calisti, F., … & Tongiani, S. (2020). Estimation of an Acceptable Dose of Trazodone for Pediatric Insomnia and the Potential for a Trazodone–Atomoxetine Interplay. CPT: Pharmacometrics & Techniques Pharmacology, 9(2), 77-86.
Vgontzas, A. N., Puzino, Ok., Fernandez-Mendoza, J., Krishnamurthy, V. B., Basta, M., & Bixler, E. O. (2020). Results of trazodone versus cognitive behavioral remedy within the insomnia with quick sleep period phenotype: a preliminary examine. Journal of Medical Sleep Medication, 16(12), 2009-2019.
Walden College (2021). Insomnia 31-year previous male. Retrieved April 20, 2021, from https://mym.cdn.laureate-medica.com/2dett4d/WaldenNURS/6630/DT/week_11/index.html

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