Nursing: Therapy for Patients with Sleep-Wake Disorders

Case Introduction

A 31-year-old male has insomnia since he mentioned he has been finding it extremely difficult to fall asleep for the past six months. Recently, the problem had aggravated due to the sudden loss of his fianc. His history of inability to sleep fast or not being a great sleeper does exist; the problem has now become unbearable. He cannot fall asleep early and even suffers from a lack of sleep during the night.

His sleep patterns affect his work since he started falling asleep the next day. His previous night was deprived of sleep again, which caused problems at his work. He labors as a forklift operator at a local chemical company.

The client also cited that he was on diphenhydramine; however, the medication caused obstacles in his wellbeing the next morning. He even experienced unpleasant conditions due to the previous physicians prescription of opiate for acute pain management due to an accident after skiing misfortune. The prescribed hydrocodone/apap (acetaminophen) has not been given to him in 4 years for an opiate analgesic.

The point of concern arises when he mentions that alcohol helps him sleep better. He takes at least four beers before bed each night, which is not a good sign. Sleep cycles are the predictors of good mental and physical health, which, if disturbed once, can cause problems for the rest of life. Sleep initiation and maintenance need to be monitored to prevent adverse patient outcomes, especially in managing chronic diseases (Plescia et al., 2021).

The patients alcohol use for sleeping is also an issue since mild amounts of alcohol are a central nervous system relaxant and numb nerves for sometimes, stimulating sleep for several hours (Plescia et al., 2021). However, when the body gets used to it for a longer period, it might get immune to its effects, forcing the patient to take higher quantities that disrupt sleep quality, generating sleep latency, negatively impacting REM (rapid eye movement) and a total time of sleep with memory, learning and sleep-wake instabilities (Plescia et al., 2021).

Decision 1

The first decision would be to give the patient Zolpidem 5mg. Reducing the potency from 10mg to 5mg would help the patient sleep better. Since 10mg of Zolpidem caused him a knock out despite falling asleep better, he could not recall making breakfast in the middle of the night, as recalled by his girlfriend. However, the mentioned medication has memory loss side effects, which could be evident due to the high dose in the form of the patient not remembering to make breakfast (NHS, 2019).

The other two options present in the exercise were not selected since Zolpidem did initiate positive results regarding his sleep pattern. Discontinuing the medication did not seem appropriate as there were no significant side effects for the prescribed drug. However, initiating therapy to avoid alcohol use could be a great option. Still discontinuing the drug mentioned above did not seem right as the patient confidently mentioned falling asleep right away, which was not the case when he was having trouble falling asleep and then repeatedly waking up during the night.

It was hoped that sleep patterns would become stable over time after continuous intake of the prescribed medication; Zolpidem is positively impactful for insomnia patients since...…effects would improve medication adherence so that chronic illness in life stages is decreased with optimal benefits (Tan, 2020).

Ethical considerations remain the same for the third decision since communication needs to be transparent between the physician and the patient to build trust. If trust is present, the doctor would be in a stronger position to help him understand the side effects and assist him in adhering to the prescribed drug. He would provide him tips for managing throat and eye dryness. For example, he could recommend artificial tear drops to lessen eyes dryness and suggest increasing water intake. These precautions aim to provide maximum benefit for the patients health and do him no harm (Peters, 2014).

Conclusion

The primary goal of all the above-selected decisions is to improve the patients sleep cycles and reduce his intentions for alcohol consumption. Since evidence has suggested that sleep patterns are further distorted when alcohol dependency increases, directing the patient to further complications in old age, the 31-year-old patient needs to be educated about the side effects and benefits he would gain from each decision.

Where one decision suggests lowering the dose of a medicine, the other prescribes continuing the same dosage before sleep. It is also expected in one scenario that therapy would be valuable along with medications as research has corroborated cognitive behavioral intervention to be more effective along with pharmacological treatment for long-term positive health outcomes. Ethical implications guide the way a physician would be helping the patient to work for his benefit and adhere to the physicians moral duty towards his profession.