Discussion: Treatment of Sleep/Wake Disorders

The power of sleep to heal the body cannot be underestimated. Most research indicates that 7–8 hours of sleep are a minimum that people need to stay healthy. Clients who come to the PMHNP’s office frequently complain of sleep problems. It is estimated that 10–20% of patients report some type of sleeping problem. In this Discussion, you will analyze the diagnostic criteria and evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders. Learning Objectives Students will: Analyze diagnostic criteria for sleep/wake disorders Analyze evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders Analyze criteria for referring clients to primary care physicians for treatment of sleep/wake disorders Compare differential diagnostic features of sleep/wake disorders To prepare for this Discussion: By Day 5 of Week 9, your Instructor will have assigned you a sleep/wake disorder, which will be the focus of your original post for this Discussion. Discussion: Treatment of Sleep/Wake Disorders. Topic for my discussion is INSOMNIA. Review the Learning Resources. By Day 3 Post: Explain the diagnostic criteria for your assigned sleep/wake disorder. Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder. Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why. Support your rationale with references to the Learning Resources or other academic resource.

Sleep disorders are common and sometimes they are associated with mental disorders. Insomnia is a common type of sleep disorder and it is commonly associated with mental disorders like bipolar disorder, anxiety, or depression (Sadock et al., 2014). When diagnosing insomnia, sleep habits should be assessed. For example, a sleep diary can be used to examine the client’s sleep patterns (Suzuki et al., 2017). The environment changes should also be screened assessed, as well as the medications, disease, or presences of any psychological or physical stressor. This discussion focuses on the diagnostic criteria for insomnia and the appropriate treatments.

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Diagnostic Criteria

Insomnia is a sleep disorder where an individual experiences difficulty to initiate sleep, impaired consolidation of sleep, as well as impaired quality and duration of sleep despite the person having good circumstances and opportunities to sleep (Seow et al., 2018). The DSM-5 criteria stipulate symptoms of insomnia as; poor quality of sleep; difficulty to initiate or maintain sleep for over a month; and the sleep disturbance causes significant distress and significantly impairs the functioning of an individual (Seow et al., 2018). Additionally, the sleep disturbance should not be as a result of any mental disorder, substance abuse, or sleep disorder like narcolepsy. Secondary insomnia co-occurs with other comorbidities like anxiety or depression (Seow et al., 2018). Discussion: Treatment of Sleep/Wake Disorders.

Psychotherapy Treatment

Sleep hygiene therapy has demonstrated efficacy in the treatment of insomnia. In sleep hygiene therapy, an individual is educated about avoiding some behaviors likely to interfere with the sleep, for example, avoiding taking caffeine in two hours before bedtime or increasing behaviors likely to improve the quantity and quality of sleep. Cognitive-behavioral therapy (CBT) can be combined with sleep hygiene to teach the individual with insomnia to recognize the maladaptive sleep beliefs and attitudes and replace them with more positive sleep attitudes and beliefs (Anderson, 2018).

Psychopharmacologic Treatment

Temazepam: This medication is a benzodiazepine that is approved by the FDA to treat insomnia. It is an intermediate-acting medication that has demonstrated efficacy in improving sleep duration and decreasing sleep latency (Lie et al., 2015). 

Criteria for Referral to Primary Care Physicians

When the cause of insomnia cannot be identified or when the individual is suspected to have hypersomnia, narcolepsy, or idiopathic; it is necessary to refer the client to a primary care physician. It is also necessary to refer the client if they do not respond to the prescribed sleep therapies (Stahl., 2014).

Conclusion

Insomnia is characterized by symptoms like poor quality of sleep; difficulties to initiate or maintain sleep; and decreased sleep duration. The symptoms should manifest for over a month. CBT and sleep hygiene are the recommended psychotherapy choices for insomnia while temazepam is the recommended pharmacological treatment choice. If the client fails to respond to the prescribed treatment, and the cause of insomnia cannot be identified, it is important to refer the client to a primary care physician for further assessment and treatment. Discussion: Treatment of Sleep/Wake Disorders.

References

Anderson K. N. (2018). Insomnia and cognitive-behavioral therapy-how to assess your patient and why it should be a standard part of care. Journal of thoracic disease, 10(Suppl 1), S94–S102. https://doi.org/10.21037/jtd.2018.01.35

Lie J, Tu K, Shen D & Wong B. (2015). Pharmacological Treatment of Insomnia. P T, 40(11): 759-768, 771.

Seow, L., Verma, S. K., Mok, Y. M., Kumar, S., Chang, S., Satghare, P., Hombali, A., Vaingankar, J., Chong, S. A., & Subramaniam, M. (2018). Evaluating DSM-5 Insomnia Disorder and the Treatment of Sleep Problems in a Psychiatric Population. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine, 14(2), 237–244. https://doi.org/10.5664/jcsm.6942

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Suzuki K, Miyamoto M & Hirata K. (2017). Sleep disorders in the elderly: Diagnosis and management. J Gen Fam Med, 18(2): 61–71. Discussion: Treatment of Sleep/Wake Disorders .