NURS 6670
WEEK 10 DISCUSSION
INITIAL POST
Insomnia
Insomnia is a sleep disorder that is characterized by trouble falling or staying asleep. (“Insomnia and its causes,” 2016) The condition can be acute or chronic and is mainly caused by psychiatric, medical, biological, and unhealthy sleep habits, among others. There are two types of insomnia. Primary insomnia is a type whose problems are not associated with any health or medical problem. Secondary insomnia is caused by a health condition such as arthritis, cancer, asthma, depression, pain, and substance abuse, among others(“Insomnia and its causes,” 2016).
Diagnostic Criteria for Insomnia
According to the American Psychiatric Association, 2013, the diagnostic criteria for insomnia (DSM-5) include difficulty in maintaining and initiating sleep for at least three months. This sleep disturbance should cause significant distress and impair the patients’ social, occupational, academic, behavioral, and educational life. Despite the patient having adequate opportunity to sleep, the sleep difficulty should occur, but at least for three nights every week. The condition should not be better explained by any other sleep-wake disorder and does not exclusively occur in the course of another sleep-wake disorder.
Psychotherapy and Psychopharmacologic Treatment for Insomnia
Psychopharmacologic treatment of insomnia includes the use of both benzodiazepine (BZD) and non-BZD agents (Schweitzer & Feren, 2016). Benzodiazepines that are currently approved include triazolam, flurazepam, quazepam, estazolam, and temazepam, among others. The choice of these drugs depends on the desired onset and their duration of action. On-BZD agents that are commonly used include zaleplon and Eszopiclone. Eszopiclone is mostly preferred since its easily absorbed, therefore making it useful for the long term treatment of insomnia.
Stimulus control therapy, sleep restriction therapy and sleep hygiene education is the psychotherapies used in the treatment of insomnia (Espie & Kyle, 2012). Stimulus control therapy includes prohibiting the patient from engaging in non-sleep activities; therefore, re-establishing the connection between bed and sleep. Sleep restriction therapy includes restricting the patient only to spend time in bed when sleeping. Sleep hygiene education includes identifying lifestyle and environmental factors that affect the patients’ sleep and encouraging the patients to avoid them (Espie & Kyle, 2012). For instance, the patient can be encouraged to reduce the use of caffeine, alcohol, heavy meals close to bedtime, and avoiding vigorous exercise close to bedtime, among others.
A client should be referred to a primary care physician when he or she presents with symptoms that can’t be explained by any sleep disorder. Patients who exhibit an increased risk of suicide mediated by underlying depression should also be referred to a primary care physician. Clients that show little improvement after psychotherapy and psychopharmacologic Treatment may have other causes of insomnia and should be referred to a primary care physician.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Espie, C. A., & Kyle, S. D. (2012). Cognitive behavioral and psychological therapies for chronic insomnia. Therapy in Sleep Medicine, 161-171. doi:10.1016/b978-1-4377-1703-7.10012-x
Insomnia and its causes. (2016). Sleep Medicine in Clinical Practice, 198-209. doi:10.3109/9781616310059-13
Schweitzer, P. K., & Feren, S. D. (2016). Pharmacological treatment of insomnia. Clinical Handbook of Insomnia, 97-132. doi:10.1007/978-3-319-41400-3_7