ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

Walden University ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University  ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS  assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

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Whether one passes or fails an academic assignment such as the Walden University   ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for  ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

The introduction for the Walden University   ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for  ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS 

After the introduction, move into the main part of the  ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for  ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for  ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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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

            The dosage of trazodone was subsequently reduced to 25 mg, to be taken before bedtime. The intervention is being conducted in response to the patient’s report of notable adverse effects of Trazodone. Specifically, the patient has experienced a prolonged penile erection for two weeks. It is advised to start trazodone at a lower dose of 25 mg and gradually increase it to 100 mg, closely monitoring the patient’s response (Ferini‐Strambi et al., 2021). Trazodone has a half-life of six to seven hours, which aids in maintaining sleep and reducing side effects, particularly at lower doses (Hassinger et al., 2020). Commonly observed temporary side effects include a decrease in sleep quality and duration. Therefore, the researchers concluded that the most effective approach would be to decrease the Trazodone dosage to 25mg and carefully monitor the patient’s progress over two weeks (Madari et al., 2021).

Due to the patient’s positive response to Trazodone, the alternatives Suvorexant or Hydroxyzine are deemed unsuitable for substitution. Lowering the dosage can help mitigate undesired effects. There are potential risks associated with the use of suvorexant and hydroxyzine for treating insomnia, including the possibility of addiction and likely decline in physical or mental health (Roach et al., 2020). A decrease in the patient’s cognitive and physical capacities could potentially occur, posing a risk to their well-being. Adverse effects such as hallucinations and drowsiness may occur when initiating therapy with Suvorexant or Hydroxyzine (Hassinger et al., 2020).

Expected Outcome

By reducing the dosage of trazodone, the adverse effects of priapism can be alleviated, leading to an enhancement in the patient’s sleep quality. Trazodone’s efficacy in treating insomnia can be enhanced by administering lower doses, which also helps minimize the occurrence of unwanted reactions (Riemann et al., 2022). The patient is anticipated to exhibit enhanced focus and reduced fatigue throughout the day, leading to increased efficiency in the workplace.

Ethical Considerations

            Beneficence requires healthcare staff to prioritize their patients’ well-being, aggressively advocating for and safeguarding them from harm. Consequently, the dosage was reduced to mitigate the risk of priapism and ensure the patient’s safety. In addition, Roach et al. (2020) emphasize that obtaining informed consent before treatment is crucial, underscoring the importance of autonomy. Helping patients understand the potential outcomes of reducing their medication dosage is vital. The patient demonstrated high trust in the provided information and was given informed consent.

Decision Point Three

Selected Decision and Rationale

            The final decision was to maintain administering a 25mg dose of trazodone before bedtime and implement strategies to improve sleep hygiene. The dose had to be lowered because the patient was getting good sleep and having priapism side effects. To enhance overall well-being and establish healthy sleep patterns, it is crucial to incorporate psychotherapy treatments and adopt effective sleep hygiene techniques (Hassinger et al., 2020). Furthermore, patients should implement lifestyle changes, such as limiting their coffee and alcohol use (Roach et al., 2020). Psychotherapy and other specialized therapies play a vital role in addressing these demands. Integrating non-pharmacological strategies alongside pharmaceutical interventions can improve patient outcomes and safety profiles (Gonçalo & Vieira-Coelho, 2021).

Administering Trazodone at a lower dosage resulted in improved sleep quality for the patient and a decrease in priapism. In this context, discontinuing the medication was deemed unnecessary (Madari et al., 2021). Ramelteon and Hydroxyzine may cause tiredness and withdrawal symptoms that impede daily life (Hassinger et al., 2020).

Expected Outcome

Based on the ongoing treatment and adherence to sleep hygiene protocols, there is an anticipated improvement in the patient’s sleep patterns and overall sleep quality (Ferini‐Strambi et al., 2021). To optimize the efficacy of Trazodone and foster the development of a regular sleep schedule, a follow-up consultation might encompass an evaluation of the patient’s sleeping hygiene.

Ethical Consideration

The ethical concept of autonomy in therapy is essential since it mandates getting informed permission before starting any treatment. Assessing and supporting the patient’s sleep habits is crucial for improving adherence to the suggested treatment plan (Hassinger et al., 2020). To improve a person’s general well-being, it is important to advocate for alcohol abstinence.

Conclusion

A 31-year-old man is currently dealing with insomnia and needs medical attention. Insomnia is typically identified by a shortage of sleep, frequent disruptions during sleep, and difficulty initiating sleep. For optimal therapeutic results, starting treatment by administering a nightly dose of 50 mg of Trazodone is recommended. Trazodone has been authorized by the FDA as a therapy for insomnia, according to a study conducted by Riemann et al. in 2022. This treatment effectively addresses insomnia by blocking the serotonin 5-HT2A receptor, as demonstrated in a study conducted by Ferini‐Strambi et al. in 2021. Reducing the amount of trazodone taken before bedtime from 50 mg to 25 mg was the second intervention. Despite the advantageous effects of Trazodone, the patient encountered priapism as a contraindication, which significantly impairs their quality of life in general (Roach et al., 2020). One possible approach is to continue administering the patient’s current trazodone dosage while guiding sleep hygiene.

Zolpidem and hydroxyzine were rejected as therapy alternatives for insomnia due to their recognized link with sleep-related eating disorders and their antihistamine properties (Gonçalo & Vieira-Coelho, 2021). Furthermore, studies have indicated that using zolpidem causes negative side effects such as forgetfulness, hallucinations, reduced self-control, dizziness, vertigo, and stomach pain (Hassinger et al., 2020). Urine retention has been linked to the sedative effects of hydroxyzine. The treatment plan and communication between the patient and healthcare provider are influenced by ethical principles such as beneficence, autonomy, and non-maleficence (Madari et al., 2021). It was important to prioritize actions promoting the patient’s well-being and preventing potential harm, in line with the principle of beneficence. Before commencing treatment, the concept of autonomy holds significant importance in the context of informed consent.

References

Ferini‐Strambi, L., Auer, R., Bjorvatn, B., Castronovo, V., Franco, O. H., Gabutti, L., Galbiati, A., Hajak, G., Khatami, R., Kitajima, T., McEvoy, D., Nissen, C., Perlis, M. L., Pevernagie, D., Randerath, W., Riemann, D., Rizzo, G., Van Someren, E. J., Vgontzas, A. N., . . . Bassetti, C. (2021). Insomnia disorder: clinical and research challenges for the 21st century. European Journal of Neurology, 28(7), 2156–2167. https://doi.org/10.1111/ene.14784

Gonçalo, A. M. G., & Vieira-Coelho, M. A. (2021). The effects of trazodone on human cognition: a systematic review. European Journal of Clinical Pharmacology, 77(11), 1623–1637. https://doi.org/10.1007/s00228-021-03161-6

Hassinger, A., Bletnisky, N., Dudekula, R., & El-Solh, A. (2020). Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert Opinion on Pharmacotherapy, 21(9), 1035–1043. https://doi.org/10.1080/14656566.2020.1743265

Madari, S., Golebiowski, R., Mansukhani, M. P., & Kolla, B. P. (2021). Pharmacological management of insomnia. Neurotherapeutics, 18(1), 44–52. https://doi.org/10.1007/s13311-021-01010-z

Riemann, D., Benz, F., Dressle, R. J., Espie, C. A., Johann, A. F., Blanken, T. F., Leerssen, J., Wassing, R., Henry, A. L., Kyle, S. D., Spiegelhalder, K., & Van Someren, E. J. (2022). Insomnia disorder: State of the science and challenges for the future. Journal of Sleep Research, 31(4). https://doi.org/10.1111/jsr.13604

Roach, M., Juday, T., Tuly, R. A., Chou, J. W., Jena, A. B., & Doghramji, P. P. (2020). Challenges and opportunities in insomnia disorder. International Journal of Neuroscience, 131(11), 1058–1065. https://doi.org/10.1080/00207454.2020.1773460

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

Trazodone 50 mg P.O. at bedtime.

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 trazodone dose was not lowered to 25 mg because a higher dose is more reasonable because it is associated with better outcomes than low doses (Zheng et al., 2022).

What I Was Hoping To Achieve By Making This Decision

The practitioner hoped that continuing the dose and explaining to the patient about trazodone-associated priapism would promote medication adherence and continuously improve sleep quality (Krystal et al., 2019). Earl et al. (2020) explain that clinicians should be aware that trazodone can cause a rare but potentially serious adverse effect of priapism that may need urgent care.

How Ethical Considerations May Impact the Treatment Plan

The principles of nonmaleficence and informed consent may impact treatment and communication with this patient. The provider upheld nonmaleficence by assessing Trazodone’s side effects and addressing them. Informed consent as to the risk of priapism with trazodone is essential.

Decision Point Three

Continue the dose and explain to the patient that he may split the 50 mg tablet in half. Follow up in 4 weeks.

Why I Selected This Decision

Splitting the Trazodone dose by half was selected to lower the severity of the reported drowsiness. Trazodone is linked with dose-dependent daytime somnolence, and reducing the dose is recommended to alleviate the side effect (Madari et al., 2021). A follow-up after four weeks is important to examine if the side effect has abated and assess improvement in insomnia (Zheng et al., 2022).

Why I Did Not Select the Other Two Options Provided

It was not ideal to change therapy to Sonata because it is also associated with side effects of dizziness and somnolence, as well as strange and dangerous sleep-related behaviors (Madari et al., 2021). Hydroxyzine was not also a good choice due to its strong sedative properties that cause side effects of drowsiness, daytime sedation, and involuntary motor activity (Krystal et al., 2019).

What I Was Hoping To Achieve By Making This Decision

            The practitioner hoped that reducing the Trazodone dose would lower the patient’s reported drowsiness but still improve sleep quality and lower nighttime awakenings (Earl et al., 2020). Low Trazodone doses are linked with decreased side effects (Madari et al., 2021).

How Ethical Considerations May Impact the Treatment Plan

            The practitioner must uphold nonmaleficence by taking measures that will reduce patient safety risks. In this case, the dose was reduced to alleviate the dose-dependent side effects. The principle of confidentiality may impact communication. The practitioner cannot share the patient’s information without seeking consent.

Conclusion

The patient complained of insomnia, trouble falling asleep, and nighttime awakening. Factors impacting treatment decisions include his previous treatment response, insomnia pattern, and history of opiate abuse. The first treatment decision was to initiate the patient on Trazodone 50 mg. It is widely used off-label to treat insomnia. It improves insomnia symptoms by reducing the frequency of awakenings and aiding in initiating sleep (Zheng et al., 2022). Zolpidem and Hydroxyzine were not selected because of their side effects like abuse potential, complex sleep behaviors, and drowsiness (Krystal et al., 2019)

The patient reported improved sleep with Trazodone. However, he complained of an erection that lasted 15 minutes. The provider reassured the patient about this side effect by explaining that an erection lasting 15 minutes is not considered a priapism. The Trazodone dose was maintained since the patient demonstrated a positive response. Patient education on the side effect of erection and priapism is important for patients initiated on Trazodone (Krystal et al., 2019). The patient’s priapism abated with time, but he came after four weeks with complaints of next-day drowsiness. This was attributed to dose-dependent sedation that occurs with Trazodone. As a result, the provider informed the patient to divide the Trazodone tablet to alleviate the side effect while improving sleep quality (Earl et al., 2020).

References

Earl, D. C., & Van Tyle, K. M. (2020). New pharmacologic agents for insomnia and hypersomnia. Current Opinion in Pulmonary Medicine, 26(6), 629–633. doi:10.1097/mcp.0000000000000722

Hassinger, A. B., Bletnisky, N., Dudekula, R., & El-Solh, A. A. (2020). Selecting a pharmacotherapy regimen for patients with chronic insomnia. Expert opinion on pharmacotherapy, 21(9), 1035–1043. https://doi.org/10.1080/14656566.2020.1743265

Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World Psychiatry: official journal of the World Psychiatric Association (WPA), 18(3), 337–352. https://doi.org/10.1002/wps.20674

Madari, S., Golebiowski, R., Mansukhani, M. P., & Kolla, B. P. (2021). Pharmacological Management of Insomnia. Neurotherapeutics: the journal of the American Society for Experimental NeuroTherapeutics, 18(1), 44–52. https://doi.org/10.1007/s13311-021-01010-z

Pagel, J. F., Pandi-Perumal, S. R., & Monti, J. M. (2018). Treating insomnia with medications. Sleep Science and Practice, 2(1), 1-12. https://doi.org/10.1186/s41606-018-0025-z

Zheng, Y., Lv, T., Wu, J., & Lyu, Y. (2022). Trazodone changed the polysomnographic sleep architecture in insomnia disorder: A systematic review and meta-analysis. Scientific Reports, 12(1), 14453. https://doi.org/10.1038/s41598-022-18776-7

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