NURS 6670 Week 10 Sleep/Wake Disorders

NURS 6670 Week 10 Sleep/Wake Disorders

NURS 6670 Week 10 Sleep/Wake Disorders

Insomnia Paper Example

Sleep has been associated with important physiological and psychological functions of the body – directly or indirectly.  According to Harrison et al. (2017), normal sleep consumes about a third of the human lifetime. Therefore, the balance between sleep and wake hours is important. Sleep-wake disorders are characterized by disruption and difficulties in regulating this balance in the cycle. Insomnia disorders, code 780.52 (G47.00), is one of the sleep-wake disorders discussed in this NURS 6670 Week 10 Sleep/Wake Disorders paper.

NURS 6670 Week 10 Sleep/Wake Disorders

The Diagnostic Criteria for Insomnia

Insomnia, which people think is easily self-diagnosable, can be associated with problems of difficulty in falling asleep, maintaining sleep, or returning to sleep after an unusual awakening from sleep. Therefore, there is sleep-onset insomnia, sleep-maintenance insomnia, and late insomnia according to the latest edition of the diagnostic and statistical manual of mental disorders (DSM-V). The DSM-V provides eight-point criteria for the diagnosis of insomnia disorders (American Psychiatric Association, 2013 NURS 6670 Week 10 Sleep/Wake Disorders). The aforementioned symptoms should be the predominant complaints by the patient, the symptoms should cause impairment or disturbance in the functionality of the patient that is clinically significant, the symptoms experienced for at least 3 nights weekly, they have lasted for about three months, an appreciable opportunity for asleep is present despite the symptoms, other sleep-wake disorders are ruled out, the symptoms are not medication/drugs of abuse-associated, and the preexisting mental illness cannot adequately explain insomnia.

Therefore, the final diagnosis of insomnia is usually described as episodic if the symptoms last between one and three months, persistent if the symptoms have lasted for more than three months, or recurrent if there have been more than two episodes in one year. Insomnia disorder is not usually a stand-alone disorder and therefore, there may be certain underlying disorders in some cases. The diagnosis of insomnia disorder should specify if the insomnia disorder is associated with a medical disorder, another mental disorder that is not a sleep disorder, or another sleep disorder (Krystal et al., 2019). Therefore, the coding of the final insomnia diagnosis must include the codes for the associated disorder.

Evidenced-Based Psychotherapy and Psychopharmacologic Treatment

The management of insomnia disorder involves psychopharmacological and nonpharmacological modalities. Psychotherapy is the initial treatment for insomnia disorder. The main psychotherapy option is cognitive behavior therapy (CBT), which is the first-line treatment for insomnia (Riemann et al., 2017). The CBT options include relaxation therapy, stimulus control therapy, and biofeedback therapy. When CBT fails, psychopharmacology is added to the treatment. Medication options include benzodiazepines, melatonin receptor agonists, sedating psychotropics, anticonvulsants, and antidepressants; H1 receptor antagonists, orexin antagonists, and nonselective antihistamines. The choice of pharmacotherapy is determined by the patient factors and associated preexisting disorder. Benzodiazepines are usually used in the short-term management of insomnia. 

When to Refer the Patient

The underlying comorbidity that is associated with insomnia determines the referral. The need to treating the underlying cause determines the physician referral. Insomnia may arise from medical illnesses such as nocturnal asthma which would require referral to the pulmonologist. Obstructive sleep apnea in children may require referral to an otorhinolaryngologist. When the history suggests a restless leg syndrome the client may be referred to a sleep specialist for management of the underlying cause (Abad & Guilleminault, 2018 NURS 6670 Week 10 Sleep/Wake Disorders). This is because these cases of insomnia have physiologic etiology and require specialist interventions.

Conclusion

Insomnia is mainly characterized by sleep difficulties of initiation or maintenance. The diagnosis of insomnia disorder must meet the DSM-V criteria for insomnia. Therefore, other sleep disorders are ruled out in the process and appropriate referral is made. In some cases, insomnia may arise due to restless leg syndrome or obstructive sleep apnea and may require referral to sleep specialists or physicians for treatment of the underlying cause. Treatment is primarily through CBT for primary cases but medication such as benzodiazepines and sedating agents may be added to improve the quality of life.

NURS 6670 Week 10 Sleep/Wake Disorders References

  • Abad, V. C., & Guilleminault, C. (2018). Insomnia in elderly patients: Recommendations for pharmacological management. Drugs & Aging, 35(9), 791–817. https://doi.org/10.1007/s40266-018-0569-8
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5(r)) (5th ed.). American Psychiatric Publishing.
  • Harrison, P., Cowen, P., Burns, T., & Fazel, M. (2017). Shorter oxford textbook of psychiatry (7th ed.). Oxford University Press.
  • Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 18(3), 337–352. https://doi.org/10.1002/wps.20674
  • Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia-Borreguero, D., Gjerstad, M., Gonçalves, M., Hertenstein, E., Jansson-Fröjmark, M., Jennum, P. J., Leger, D., Nissen, C., Parrino, L., Paunio, T., Pevernagie, D., Verbraecken, J., … Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675–700. https://doi.org/10.1111/jsr.12594

Instructions – NURS 6670 Week 10 Sleep/Wake Disorders

topic :Insomnia

• Explain the diagnostic criteria for your assigned sleep/wake disorder.
• Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder. NURS 6670 Week 10 Sleep/Wake Disorders
• 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 resources.

Comments / Note

NURS 6670 6670 Week 10 Schizophrenia Case

CASE

Charlie A 49 years-old male AA, is a homeless man had never been in a relationship, works at a local grocery store as a stocker, has been diagnosed with schizophrenia, complains of hearing voices even while at work which distracts her from what she needs to do, she also states that she feels hopeless in some situations which cause her to be anti-social. NURS 6670 Week 10 Sleep/Wake Disorders

Medication:
Olanzapine-15mg PO Daily
Seroquel-200mg at night

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

Which Decision did you select?
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different? NURS 6670 Week 10 Sleep/Wake Disorders

Decision #2: Treatment Plan for Psychotherapy

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

Week 10 Discussion – Sleep/Wake Disorders

topic :Insomnia

  • 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. NURS 6670 Week 10 Sleep/Wake Disorders
    • Support your rationale with references to the Learning Resources or other academic resources.

NURS 6670 6670 Week 11

To prepare for this Discussion:

TOPIC IS GENDER DYSPHORIA

Select a gender dysphoria, that interests you.
Review the Learning Resources.
By Day 3
Post:

Explain the diagnostic criteria for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.

Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected. NURS 6670 Week 10 Sleep/Wake Disorders

Support your rationale with references to the Learning Resources or other academic resource.