Therapy For Patients With Sleep/Wake Disorders From negative ✓ Solved

Sleep/wake disorders can have a tremendous impact on patients’ lives, leading to negative changes in mood and difficulties in concentration. When individuals suffer from these disorders, they often seek medical interventions, primarily involving medications to manage symptoms. However, many prescribed medications for sleep/wake disorders carry a risk of addiction, necessitating thorough patient assessments and vigilant follow-up care. Understanding the pathophysiology of these disorders and the pharmacologic agents used in their treatment is crucial to providing safe and effective therapy.

This assignment will focus on assessing and treating patients with sleep/wake disorders, taking into account the ethical and legal implications of these therapies. The goals include synthesizing concepts related to psychopharmacologic treatment, analyzing patient factors that influence pharmacokinetic and pharmacodynamic processes, and understanding the clinical guidelines for managing sleep/wake disorders.

Introduction to the Case

This assignment examines the case of a 31-year-old male who presents with a chief complaint of insomnia. The patient reports a progressive worsening of insomnia over the past six months, particularly after the loss of his fiancé. Such significant life events often contribute to the development of sleep disorders. His insomnia affects his performance at work as a forklift operator, leading to dangerous situations due to lack of sleep. Additionally, he has a history of opiate abuse and has resorted to using alcohol to aid in falling asleep, which poses additional risks. Therefore, a comprehensive assessment of his medical and psychiatric history will guide the selection of psychopharmacologic treatment options.

Decision #1

For the first decision, I selected trazodone at a dosage of 50–100 mg daily at bedtime. The reason for this choice is rooted in trazodone's effectiveness as a sleep aid, particularly for patients with a history of substance abuse. Unlike opioids and benzodiazepines, trazodone is less addictive and has a favorable safety profile (Sateia et al., 2017). While both Zolpidem and hydroxyzine are viable options, Zolpidem can cause dependence over time, and hydroxyzine may not address underlying issues effectively.

The rationale for not selecting the other options includes Zolpidem's higher potential for addiction, which is particularly concerning given the patient's history of substance abuse. Hydroxyzine, while useful for anxiety and inducing sleep, may not provide a sustained solution for insomnia (Winkleman, 2015). My goal in selecting trazodone is to achieve consistent sleep without exacerbating the patient's risk for substance dependence.

Ethical considerations are paramount, as prescribing a medication that is less likely to lead to addiction aligns with principles of beneficence and non-maleficence. It is crucial to communicate openly with the patient about potential side effects and the importance of monitoring their response to treatment.

Decision #2

The second decision involved decreasing the trazodone dosage to 25 mg daily at bedtime. This adjustment was made after the patient reported an initial satisfactory response but also experienced an unpleasant side effect of prolonged erection. By lowering the dosage, we aim to manage side effects while maintaining the medication's effectiveness. This approach aligns with best practices in clinical pharmacology, which emphasize tailoring treatment to individual patient needs (Levenson et al., 2015).

The rationale for not selecting to maintain the higher dosage is centered on balancing efficacy and side effects. While reducing the dosage might lead to insufficient sleep, it is essential to initiate this cautious approach to minimize adverse effects. The hope is that a lower dose will enhance his quality of life by reducing side effects while still providing sufficient sleep.

Ethically, the patient’s concerns about side effects must be acknowledged and addressed responsibly. Ensuring the patient's comfort and reducing discomfort contribute to a therapeutic alliance that is vital for compliance and satisfaction with treatment.

Decision #3

The third decision focused on maintaining the reduced dose of trazodone while emphasizing sleep hygiene practices. Encouraging sleep hygiene is critical, as it can enhance the effects of pharmacologic treatments and support the patient's overall well-being. If sleep hygiene measures are not adequately implemented, we risk compromising the efficacy of the medication (Morgenthaler et al., 2007).

Continuing the same dosage is a balanced approach as trazodone has already shown effectiveness at a reduced level. Switching medications again could destabilize the progress made thus far. The objective is to achieve optimal sleep while minimizing the potential risks associated with pharmacotherapy.

Ethical considerations in this decision revolve around patient education and advocacy for healthy practices. Engaging in a discussion about sleep hygiene empowers the patient and helps build self-efficacy in managing his sleep disorder independently.

Conclusion

In summary, the decisions made throughout this case study center on the careful selection and adjustments of trazodone therapy, coupled with a robust emphasis on sleep hygiene. The overall goal is to ensure patient safety, minimize the risks associated with medication, and improve the patient's quality of life. The chosen approach aligns with current clinical guidelines while respecting the patient's unique context and needs.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418.
• Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192.
• Morgenthaler, T. I., Kapur, V. K., et al. (2007). Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. SLEEP, 30(12), 1705–1711.
• Morgenthaler, T. I., et al. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. SLEEP, 29(1), 1277–1281.
• Sateia, M. J., Buysse, D. J., et al. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13(2), 307–349.
• Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444.