Insomnia: the Case of the Patient S.H.

In the case of the patient, S.H., who is experiencing difficulties with falling and staying asleep, the relevant goals of pharmacological and non-pharmacological therapy include the achievement of proper sleeping patterns, education about the potentially adverse effects of self-treating with OTC products, and establishing positive diet and lifestyle practices that would improve the patient’s overall well-being and health. Because the patient’s insomnia has become a chronic condition, it is necessary to prescribe non-benzodiazepine sedatives that would help induce sleep, such as zaleplon or zolpidem, as their side effects are usually less severe compared to benzodiazepine medication (Schoeck et al., 2016). Since S.H. also has issues staying asleep, doxepin may sometimes be taken to help with the problem. However, it is recommended not to take the drug unless the patient can get seven-eight hours of sleep.

The parameters for monitoring the therapy’s success include the development of a consistent sleeping pattern, the decrease of stress associated with insomnia, as well as the overall improved state. However, to achieve success in the treatment efforts, patient education is needed. Based on the prescribed therapy, S.H. should be informed about the high intensity of the medication that she is taking, such as the possibility of morning sleepiness. In case if the selected agents cause extreme drowsiness in the patient or lead to severe nausea, it is imperative to change therapy or try lower dosages. As a second-line therapy, it is possible to try benzodiazepine-containing medications, which should not be taken for prolonged periods due to their addictiveness. Therefore, it is important to monitor the effects of the prescribed medications regularly in order to make appropriate adjustments in the treatment.

Sine S.H. has already taken Tylenol PM, which combined pain relievers with antihistamines, it is recommended for the patient to try doxylamine and diphenhydramine. However, it is rather recommended for the patient to try alternative treatments that would help overcome the challenge of falling and staying asleep. Alternative therapies can include acupuncture, hypnosis, yoga, aromatherapy, massage, and herbal remedies. Among herbal remedies, chamomile and valerian root are considered relaxing and can, therefore, be used to help the patient calm down before doing to bed (Liu, Liu, Wang, Wang, Li, & Li, 2015). Meditation and relaxation through yoga and mild exercise can also have a positive effect on the overall well-being of the patient. Research has shown that regular yoga and meditation practice can result in higher levels of melatonin in the blood, which is an important sleep regulator (Krishnakumar, Hamblin, & Lakshmanan, 2015). In combination with a healthy diet containing foods rich in tryptophan, which supports the development of serotonin, regular exercise and relaxation practices can significantly increase the chances of having a good sleep routine. It is advised to lower the consumption of refined sugar and carbohydrates in the diet as they represent empty calories causing rapid spikes in blood sugar. When it comes to the possible interactions between the selected agent, it is notable that the prescribed substances should not be taken with alcohol because of the potentially adverse impact on the patient’s well-being. Because of this, it is recommended that the patient considers limiting the intake of alcohol when taking the prescribed medication to reduce the risks associated with the negative interactions that could limit the success of therapy.

References

Krishnakumar, D., Hamblin, M. R., & Lakshmanan, S. (2015). Meditation and yoga can modulate brain mechanisms that affect behavior and anxiety-a modern scientific perspective. Ancient Science, 2(1), 13-19.

Liu, L., Liu, C., Wang, Y., Wang, P., Li, Y., & Li, B. (2015). Herbal medicine for anxiety, depression and insomnia. Current Neuropharmacology, 13(4), 481-493.

Schroeck, J., Ford, J., Conway, E., Kurtzhalts, K., Gee, M., Vollmer, K., & Mergenhagen, K. (2016). Review of safety and efficacy of sleep medicines in older adults. Clinical Therapeutics, 38(11), 2340-2372.

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