Case Study – 31 Year Old Male with Insomnia

Posted: January 19th, 2023

Decision Tree-ASSESSING AND TREATING PATIENTS WITH SLEEP/WAKE DISORDERS

Case Study – 31 Year Old Male with Insomnia
https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_11/index.html
(This case study will serve as the foundation for this week’s Assignment.)

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 pharmacodynamics 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.

References to Include:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders Links to an external site.(5th ed.). https://doi.org/10.1176/appi.books.9780890425596
• Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports Links to an external site., 15(12), 418. https://doi.org/10.1007/s11920-012-0418-8
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Introduction:
This case study concerns a 31-year-old male with insomnia. Insomnia is a common sleep disorder characterized by difficulty initiating or maintaining sleep, or non-restorative sleep. Factors that may impact decision making when prescribing medication for this patient include the patient’s medical history, current medications, and any underlying mental health conditions.

Decision #1:
The decision selected is to prescribe a non-benzodiazepine hypnotic, such as zolpidem. This decision was made based on the patient’s age and the fact that non-benzodiazepine hypnotics have a lower risk of dependence and withdrawal compared to benzodiazepines. Additionally, zolpidem has a shorter half-life and is less likely to cause next-day sedation, making it a better option for a younger adult.

The other two options provided in the exercise were benzodiazepines and melatonin receptor agonists. Benzodiazepines have a higher risk of dependence and withdrawal, and are not recommended for long-term use. Melatonin receptor agonists have a lower risk of dependence and withdrawal, but have a longer half-life and may cause next-day sedation.

The goal of this decision is to improve the patient’s sleep quality and duration, as well as reduce insomnia symptoms such as difficulty initiating or maintaining sleep, and non-restorative sleep. This decision is supported by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (2013) and Fernandez-Mendoza and Vgontzas’ (2013) study on the impact of insomnia on physical and mental health.

Ethical considerations that may impact this decision include informed consent and the potential for medication dependence. The patient should be fully informed of the risks and benefits of the medication, and the potential for dependence should be discussed. Close monitoring of the patient’s response to the medication is also important to ensure the safety and well-being of the patient.

Decision #2:
The decision selected is to refer the patient for cognitive-behavioral therapy (CBT) for insomnia. This decision was made based on the evidence that CBT is an effective treatment for insomnia and it has been shown to improve sleep quality and reduce insomnia symptoms. Additionally, CBT can target the underlying causes of insomnia and help to prevent relapse.

The other two options provided in the exercise were pharmacologic options, specifically a sedative-hypnotic and a melatonin receptor agonist. While these options may be effective for some patients, for this particular patient, a non-pharmacologic option is preferred.

The goal of this decision is to improve the patient’s sleep quality and duration, as well as reduce insomnia symptoms such as difficulty initiating or maintaining sleep, and non-restorative sleep. This decision is supported by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (2013) and Fernandez-Mendoza and Vgontzas’ (2013) study on the impact of insomnia on physical and mental health.

Ethical considerations that may impact this decision include the availability of CBT and the patient’s ability to access it. The patient should be fully informed of the availability of CBT, and the pros and cons of this treatment option. Close monitoring of the patient’s response to the therapy is also important to ensure the safety and well-being of the patient.

Decision #3:
The decision selected is to monitor the patient’s symptoms and medication adherence closely. This decision was made based on the fact that insomnia is a chronic disorder and that the treatment plan may need to be adjusted over time. Additionally, close monitoring of the patient’s symptoms and medication adherence is important to ensure the safety and