Discussion Question 2
Whatadditional information would you like to obtain from ST?
Allinsomnia patients should receive treatment for any medical condition,substance abuse, sleep disorder, or psychiatric illness that may beexacerbating or precipitating insomnia (Barkoukis,2012).I would like to obtain the following additional information from ST:
Theduration and the number of pills he has taken as well as what helphim. These questions are important since benzodiazepines areassociated with withdrawals.
Whatare the possible reasons for his insomnia?
Failingto secure a full-time or permanent job perhaps has put ST into afinancial strain. It appears what he is receiving, as a part-timeworker is inadequate to meet his daily needs. Hence, he suffers fromemotional and financial stress, which could contribute to insomnia.
Whatare the possible strategies you can use to help him with insomnia?
Thetreatment strategies must take into consideration possible healthrisks associated with untreated insomnia, which include decreasedperformance, higher risk for substance abuse and psychiatriccomorbidities, poor life quality, and the relationship betweenchronic insomnia as well as the potential for all-cause mortality andcardiovascular mortality (Manber& Carney, 2015).
Thefirst strategy will be to teach ST the basic sleeping hygiene, whichincludes the following (Carney& Posner, 2016):
Avoiding consuming caffeine in the evening or next to bedtime.
Maintaining a regular sleep routine that is, going to bed and waking up at the same time
Avoiding naps as much as possible. Naps minimize ‘Sleep Debt,` which is vital for smooth sleep onset.
Avoiding staying in bed awake for more than ten minutes. If he found his mind worrying or racing about being unable to sleep in the middle of the night, he should get out of bed and sit in the dark in a chair. He should then do his mind racing in the chair until he gets sleepy, the return to bed.
He should stop reading or watching TV while in bed as this will make him associate bed with wakefulness.
Avoiding incongruous substances that normally interfere with sleep. This includes alcohol, over the counter medications, and cigarettes.
Having a comfortable, quiet bedroom.
Using bed for only sleep and sex
Avoiding eating large meals during bed time
Limiting exposure to bright light especially during evening hours.
Alongwith cognitive behavioral therapy, I may recommend OTC herbalmedication such as Valerian. I prefer prescribing this drug tobenzodiazepine or other drugs such as ramelteon (generic andRozerem), eszopiclone (generic and Lunesta), zaleplon (generic andSonata), and zolpidem (Ambien CR, Ambien, Zolpimist, generic, andEdluar) (Carney& Posner, 2016).These drugs are expensive and come with many side effects includingaddiction properties (Ong,2017). Behavioral therapy is less costly and suitable for nearly all peoplewith the sleeping problem. In addition, cognitive behavior therapy orother behavioral therapies preference to medication has been approvedand endorsed by many medical research bodies including the clinicalpractice guidelines of the American Academy of Sleep Medicine.
SinceST is given both herbal and behavioral therapy, he needs to continuewith the behavioral therapy for eight weeks. If his response totreatment is positive, then the herbal medication can be graduallyreduced while continuing with the behavioral therapy. In the case,the symptoms of the disease reappear the ST may require furtherevaluation in a sleep disorder clinic before starting medications.
Barkoukis,T. J. (2012). Therapyin sleep medicine.Philadelphia, PA: Elsevier/Saunders.
Carney,C., & Posner, D. (2016). Cognitivebehavior therapy for insomnia in those with depression: A guide forclinicians.New York : Routledge, Taylor & Francis Group.
Manber,R., & Carney, C. (2015). Treatmentplans and interventions for insomnia: A case formulation approach.New York : The Guilford Press.
Ong,J. C. (2017). Mindfulness-basedtherapy for insomnia.Washington, DC: American Psychological Association.
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