Insomnia

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.(Insomnia Case Study Sample)

Post a response to each of the following:

·         List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.

·         Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

·         Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.

·         List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.

·         List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

·         For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?

·         Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.

Case: An elderly widow who just lost her spouse. 

Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications: 

·         Metformin 500mg BID 

·         Januvia 100mg daily 

·         Losartan 100mg daily 

·         HCTZ 25mg daily 

·         Sertraline 100mg daily 

Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

Insomnia is one of the most common medical conditions you will encounter as a PMHNP. Insomnia is a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, and ADHD (Abbott, 2016). Various studies have demonstrated the bidirectional relationship between insomnia and mental illness. In fact, about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems (Abbott, 2016). Due to the interconnected psychopathology, it is important that you, as the PMHNP, understand the importance of the effects some psychopharmacologic treatments may have on a patient’s mental health illness and their sleep patterns. Therefore, it is important that you understand and reflect on the evidence-based research in developing treatment plans to recommend proper sleep practices to your patients as well as recommend appropriate psychopharmacologic treatments for optimal health and well-being.

Insomnia Case Study Sample- Solution

Case Study – Managing Insomnia: A Comprehensive Approach

Abstract:

Insomnia, a common sleep disorder, affects millions of people worldwide. This case study examines the management of insomnia in a 35-year-old male named John. The essay outlines the patient’s background, presenting complaints, diagnostic assessment, treatment plan, and outcomes. This case study aims to illustrate the importance of a comprehensive approach to treating insomnia, incorporating behavioral interventions, lifestyle changes, and pharmacotherapy to achieve optimal results.(Insomnia Case Study Sample)

Introduction:

Insomnia is a prevalent sleep disorder characterized by difficulties falling asleep, staying asleep, or experiencing non-restorative sleep. It can have a significant impact on an individual’s daily functioning, mood, and overall quality of life. This case study explores the effective management of insomnia through a holistic approach.(Insomnia Case Study Sample)

Patient Background:

John is a 35-year-old male who works as a software engineer. He has been experiencing sleep difficulties for the past six months. John reports difficulty falling asleep, frequent awakenings during the night, and waking up feeling unrefreshed. These sleep disruptions have caused increased irritability, difficulty concentrating at work, and reduced energy levels throughout the day.(Insomnia Case Study Sample)

Presenting Complaints:

John describes his typical sleep pattern as follows:

• Difficulty falling asleep: It takes him approximately 1 to 2 hours to fall asleep.
• Frequent awakenings: John wakes up at least three times during the night and has trouble falling back to sleep.
• Non-restorative sleep: Despite spending 7 to 8 hours in bed, he wakes up feeling tired and fatigued.
• Daytime symptoms: John feels fatigued during the day, has difficulty concentrating, and experiences mood swings.(Insomnia Case Study Sample)

Diagnostic Assessment:

To diagnose and assess John’s insomnia, a comprehensive evaluation is conducted. This includes:

• Sleep diary: John maintains a sleep diary for two weeks to track his sleep patterns, wake times, and daytime symptoms.
• Medical history: Assessing medical conditions, medications, and any potential triggers for insomnia.
• Psychological evaluation: Identifying stressors, anxiety, or depression that may contribute to sleep disturbances.
• Polysomnography: Conducting an overnight sleep study to rule out any underlying sleep disorders.(Insomnia Case Study Sample)

Treatment Plan:

Based on the assessment, a comprehensive treatment plan is developed, incorporating behavioral, lifestyle, and pharmacological interventions.

Behavioral Interventions:

• Sleep restriction therapy: Restricting the time spent in bed to match the actual sleep duration, gradually increasing it as sleep improves.
• Stimulus control: Establishing a consistent sleep schedule, limiting bedroom activities to sleep-related behaviors only.
• Relaxation techniques: Practicing progressive muscle relaxation or deep breathing exercises to reduce anxiety and promote sleep.
• Cognitive Behavioral Therapy for Insomnia (CBT-I): Addressing negative thought patterns and promoting healthy sleep habits.(Insomnia Case Study Sample)

Lifestyle Changes:

• Sleep hygiene education: Educating John about good sleep practices, such as avoiding stimulants before bedtime and creating a sleep-conducive environment.
• Exercise: Encouraging regular physical activity, which can improve sleep quality.
• Diet: Recommending a balanced diet and avoiding heavy meals close to bedtime.
• Stress management: Teaching stress reduction techniques, such as mindfulness meditation or yoga.(Insomnia Case Study Sample)

Pharmacotherapy:

• Short-term use of sedative-hypnotics: Prescribing medications such as zolpidem or eszopiclone for a limited duration while simultaneously implementing behavioral and lifestyle changes.(Insomnia Case Study Sample)

Treatment Outcomes:

Over the course of ten weeks, John consistently followed the treatment plan. The results were as follows:(Insomnia Case Study Sample)

• Sleep diary improvements: John’s sleep diary revealed a gradual reduction in the time taken to fall asleep, fewer awakenings, and longer periods of uninterrupted sleep.(Insomnia Case Study Sample)
• Daytime symptoms: John reported feeling more rested during the day, experiencing improved concentration and a more stable mood.
• Polysomnography: A follow-up sleep study showed significant improvements in sleep efficiency and reduced sleep latency.

Conclusion:

This case study demonstrates the successful management of insomnia in a 35-year-old male using a comprehensive approach that combines behavioral interventions, lifestyle changes, and short-term pharmacotherapy. By addressing multiple aspects of sleep disruption, this approach proves to be effective in improving sleep quality and overall well-being. Early intervention and a tailored treatment plan can significantly alleviate the impact of insomnia on an individual’s life. However, it is essential to acknowledge that individual responses to treatment may vary, necessitating personalized adjustments to optimize outcomes. Further research and clinical studies are warranted to continually refine and enhance our understanding of insomnia management strategies.(Insomnia Case Study Sample)

Reference

https://www.ncbi.nlm.nih.gov/