Mental health disorders diagnosis and management are often symptomatic. Care providers use symptoms according to DSM 5 to diagnose and prescribe medications according to their effectiveness and FDA approval. Care providers observe patients’ responses and determine the management interventions depending on their response to the interventions. Psychiatric/mental health nurses play vital roles in assessing patients, and prescribing the correct medication interventions is integral. Insomnia is a mental health issue defined as trouble initiating or maintaining sleep and waking up early.
Insomnia accompanies most conditions, such as Alzheimer’s disease. It also arises from environmental stressors such as depression and medications such as alpha and beta blockers. Insomnia can negatively affect health and productivity and should be promptly addressed while paying attention to the adverse effects and their effects on life quality. This essay reviews management interventions for insomnia patients and explains the reasons behind the decisions.
The patient presents with insomnia and clarifies that he has trouble falling asleep and maintaining sleep. The patient admitted to having less sleep at night and had an incidence of sleeping at work for not having enough night sleep, which is dangerous given the risky nature of his job. The patient also reports that his symptoms worsened after losing her fiancé. He used diphenhydramine for a while but stopped due to the side effects. The goals of the first decision are to ensure the patient has no problems initiating or maintaining sleep, does not sleep at work or, experiences daytime sleepiness, and reduces risky incidences at work.
The first decision is to initiate Zolpidem 10mg at bedtime. Zolpidem is a sedative-hypnotic in the class of imidazopyridines and a GABA A receptor agonist. It is an FDA-approved medication for short-term insomnia management (Xiang et al., 2020). According to Bouchette et al. (2022), the medication is helpful for patients with problems initiating sleep, improves sleep duration, and reduces night awakenings in transient insomnia. These functions match the requirements of patients who have trouble initiating and maintaining sleep. The approved dose in adults is 10mg and 5mg in the elderly.
Trazodone is an antidepressant medication often used in major depression, mood and anxiety disorders, and sleep disorders. Trazodone is a serotonin antagonist and reuptake inhibitor that is FDA-approved for depression (Stern et al., 2016). According to Madari et al. (2021), The medication is effective at doses between 20-100mg and reduces the risks for tolerance and daytime sleep. It can also be helpful for this patient who admits to being depressed after losing his partner. However, there is insufficient data on its effectiveness in insomnia; thus, the medication is not FDA-approved for insomnia but has off-label uses in managing insomnia. Thus, it is not the decision of choice.
Hydroxyzine is an antihistamine often used for allergic reactions. The medications’ drowsy effects take 4-6 hours, hence their limited use in managing sleep. The medication is FDA-approved for providing sedation (hence used as premedication in procedures), relieving anxiety symptoms, and relieving skin itchiness in atopic dermatitis (Krzystanek et al., 2020). The medication helps relieve insomnia resulting from anxiety. However, the medication is not approved for FDA-approved for insomnia. In addition, the patients admit to developing severe side effects that affect his uptake of antihistamines; thus, this medication is not the medication of choice. Therapy changes using drugs in the same class are done with caution due to the possibility of severe side effects.
It is also essential to consider the safety and effectiveness of the medication before medication. In addition, it is essential to consider the side effects of medications that could interfere with intake. For example, medications with low efficacy or late onset of action may not help manage acute symptoms. It is vital to avoid medication with a short maximum use period. Trazodone is licensed for use for a maximum of 2 weeks. Patient safety is essential, and for initiating therapy, the FDA recommends that healthcare providers prescribe FDA-approved medications and only use off-label mediations in rare occasions such as resistance, known greater efficacy, and unavailability of FDA-approved medications (Bouchette et al., 2021).
Once care providers make a medical management decision, they observe the patient’s reaction and make medical decisions depending on side effects and effectiveness in managing the symptoms. The patient had a night wakening, does not recall the incident, and says he
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