Decision Tree in Treating Insomnia

Insomnia is sleep disarray, where a person has the challenge of falling asleep or continue sleeping after waking up. This disorder can be acute or chronic. Acute insomnia lasts for a few weeks, and chronic insomnia occurs three nights in seven days for three months (Sateia et al., 2017). The significant symptoms of this sleep disorder are difficulty falling asleep, feeling tired and sleepy during the day, challenges in paying attention and focusing, anxiety, depression, waking up at night and early in the morning.

The disorder can affect a person’s mood, health, energy level, performance, and quality of life. A person needs to sleep for at least eight hours to have a sufficient sleep a night. At the same time, many adults experience acute insomnia that results from traumatizing, depressive, and stressful events (Sateia et al., 2017). Insomnia can last more than a month; however, it is not always the main challenge. The condition may be correlated to other medical problems. In our case study, the patient has been experiencing progressive insomnia for the last six months. The patient confirms that sleeping has not been a challenge to him in the past but recently, falling and staying asleep has been a challenge.

The patient reported that the problem began after the immediate loss of his fiancé. The patient works as a fork lifter in a chemical company and reports that the challenge has affected his general performance on the job. Additionally, the patient admits that he has been taking diphenhydramine; however, the outcomes are not pleasing. Besides that, the patient has a history of opiate abuse that began after the patient had injured his ankle. However, for the last four years, the patient has not received any opiate prescription. This assignment aims to help cure the disorder and restore the patient to the initial state.

Decision One

I have three options for this decision: Zolpidem 10 mg taken daily at bedtime, hydroxyzine 50mg, and trazodone 50-100mg, all taken at bedtime. In this first decision, I have selected zolpidem 10 mg taken daily at bedtime. I have chosen zolpidem 10 mg because it treats insomnia in adults (Garg, 2018). If a person has trouble falling asleep, zolpidem 10 mg helps him sleep faster hence getting adequate night rest and also prevents a person from waking up during the night. The medication acts on a person’s brain producing a calming effect, and it should get used for a limited period of one to two weeks.

Furthermore, I have not chosen hydroxyzine 50mg because it treats tension and anxiety, and our patient suffers from insomnia disorder. It also acts as an antihistamine to mitigate the effects of natural chemical histamine on the human body. Besides that, it is also applicable in treating allergic skin reactions (Krzystanek et al., 2020). At the same time, I have not chosen trazodone 50-100mg because it is medically used to treat depression, and the patient has insomnia. However, trazodone 50-100mg can also get prescribed by a mental health officer to treat insomnia, anxiety, and panic attacks. In our case study, the client did not report any mental issue; hence trazodone 50-100mg is not applicable.

By deciding to prescribe zolpidem 10 mg, I intend to achieve chemical balance in the patient’s brain to help him fall and stay asleep. Hence, the patient will fall asleep quickly and fall back to sleep if he wakes up during the night (Garg, 2018). There are ethical considerations that may affect my treatment plan for this patient. I have to consider whether the patient has a guardian who will monitor his progress and ensure he takes the medication as prescribed. Secondly, I will communicate with the patient on the side effects of the drug and why he should not overdose or give them to someone else even though they have similar symptoms. Examples of the side effects are swelling of the tongue, face, lips, throat, and also difficulty in breathing.

Decision Two

After two weeks, the patient returned to the hospital and reported that all the night activities had been reduced. However, the girlfriend reports that there is a time he got up to go for a drive at night. The patient reports no cases of hallucinations and says that zolpidem 10 mg was helpful. At this decision, I have three options decrease zolpidem to 5 mg, introduce therapy with eszopiclone and discontinue zolpidem and lastly, initiate treatment with trazodone and discontinue zolpidem, all taken at bedtime.

The choice I have made in this second decision is to reduce zolpidem to 5 mg. This is to reduce the “being knocked out” feeling and consume the drug with beer and get I have not chosen eszopiclone because the patient should use it for a short period, not more than two weeks (Dang et al., 2011). Hence the patient has returned to the hospital after two weeks meaning eszopiclone cannot get prescribed. Furthermore, eszopiclone will have side effects on the patients; hence it can be administered in the first or second therapy. Moreover, the patient has been mixing his medication with alcohol, and eszopiclone cannot get mixed with alcohol because of its negative effects (Monti & Pandi-Perumal, 2007). At the same time, discontinuing zolpidem will make the patient experience withdrawal symptoms because the drug should get stopped systematically. At this stage, I hoped to achieve improvements and comfortable sleep and reduced waking up at night. This is because decreasing zolpidem to 5 mg will help reduce the side effects the patient has been experiencing in the past two weeks. The ethical consideration I will consider in this stage is the side effects of the medication. I will also talk to the person looking after the patient on the importance of maintaining zolpidem to 5 mg and ensuring that the patient does not exceed. For instance, the patient should avoid alcohol consumption.

Decision Three

In this decision, I have three options: maintaining Zolpidem 5 mg, discontinuing Zolpidem 5 mg, administering intermezzo 5mg sublingual tablets, and starting therapy with trazodone 50 mg. At this point, I will initiate trazodone 50 mg therapy because it is a selective serotonin reuptake barrier that is a safer choice. I have discontinued Zolpidem 5 mg because it has a negative effect on the patient, and the patient has already started mixing it with alcohol, which is not allowed (Edinoff et al., 2021). At the same time, the patient is also experiencing complex sleep patterns and behavior. Additionally, I have not chosen intermezzo 5mg sublingual tablets because they contain zolpidem, and they are taken only when a person wakes up at night. The patient should have a minimum of four hours of bedtime remaining when taking them.

Additionally, by selecting trazodone 50 mg, I hope to reduce the side effects of zolpidem and balance chemicals in the brain, helping the patient have a comfortable sleep and end insomnia. Trazodone 50 mg will also help the brain cells communicate with each other and impact activities such as sleep (Jaffer et al., 2017). There are ethical considerations I will consider when administering trazodone 50 mg because it has side effects like all other medications. One of the ethical considerations is the possibility of developing allergic reactions to the drug; secondly, the side effects resulting from the medication such as a dry mouth, constipation, suicidal ideation, and yellow skin.

Conclusion

Insomnia is a sleep disorder that affects a person’s performance, mood, health, and quality of life. The patient has insomnia based on the diagnosis, and the applicable procedures to cure the disorder are; first prescribe Zolpidem 10 mg because it is used to treat insomnia in adults. This is because the patient has trouble falling and staying asleep. Zolpidem 10 mg will help the patient fall asleep quickly and comfortably and prevent him from waking up at night and falling asleep again. The medication introduces a calming effect on the brain that influences sleep. After two weeks, the patient has a significant improvement; however, the girlfriend reports that he woke up to drive at night. At this point, it is important to reduce zolpidem to 5mg to reduce its negative effects on the patient.  The reduction will help suppress the side effects of the medication, and also, the patient should avoid taking alcohol because when zolpidem is mixed with alcohol results in negative effects.

Furthermore, in the last step, due to the persistent side effects of zolpidem, it should get discontinued and initiate trazodone 50 mg therapy because it is a selective serotonin reuptake barrier that is a safer choice. Zolpidem 5 mg is not applicable because of the negative side effects, and the patient is already mixing it with alcohol claiming it makes him sleep well. Additionally, the patient is also experiencing complex sleep patterns even after taking the medications. Intermezzo 5mg sublingual tablets contain zolpidem, and they are taken only when a person wakes up at night; hence they are not applicable in this last decision. Ethical considerations are significant when making the treatment plans because some medications may have side effects on the patient. A person who will look after the patient is important to avoid overdose or underdose. Hence, a physician also considers all possible risks before initiating any treatment procedure for the patient’s well-being, communicating with the patient on the side effects of the drug and why he should not overdose or give them to someone else even though they have similar symptoms.

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