Sleep/Wake Disorders

Assessing and Treating Patients with Sleep/Wake Disorders

The case involves a 31-year-old male who complains of insomnia. The client indicates that his troubling sleeplessness condition is getting worse. The patient has not had adequate sleep for the past six months but has experienced difficulty staying asleep and falling asleep. The case indicates how the lack of sleep causes more problems, such as performing in his work, which involves operating the forklift at the local chemical company. Although the patient has used diphenhydramine, his condition has not improved; thus, insomnia is causing the 31 years old man to risk accidents at the workplace, given that he had fallen asleep while on the machine.

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The appropriate drug therapy for the patient is prescribing intermediate-acting Trazodone. The objective of this therapy seeks to improve the quantity and quality of sleep and prevent daytime impairment. The drug therapy blends with behavioral intervention such as relaxation therapy to address the symptoms such as irregular sleeping patterns, address the past treatments responses, and the alcoholic reliance by the patient. The choice of BzRAs emerges from the past medical history of the patient. Previously, he had a history of opiate abuse leading to his reliance on hydrocodone/apap to manage his acute pain. For the last years, the patient had not received any prescription for an opiate analgesic. Currently, the patient is using alcohol to help him fall asleep.

Decision 1

The first decision for treating the 31 years old man is using Trazodone. The doctor should prescribe 50 to 100 mg every day at bedtime. The justification for this decision is to allow the patient to avoid sedating him with anti-epilepsy medications (Muehlan et al., 2020).  The symptoms that the patients manifested point to the failure to fall asleep and maintain quality sleep. All these affect his attention and concentration span. Therefore, prescribing Trazodone is effective in helping the patina manage the comorbid conditions and potential adverse side effects. Thus, the medicine supports the patient’s medical history, especially when it comes to his everyday alcohol use (Patel, Steinberg, and Patel 2018). As a result, the doctors can assume that Trazodone can work well with the patient interacting with his lifestyle with minimal unpleasant side effects of prolonged penis erection.

Pharmacological therapy is effective because the drug binds to the receptor complex responsible for hypnotic sedative muscle relaxants. Ethical considerations of the drug rest on the ability to cause potential delirium, falls, and cognitive impairment. The medicine enables the patient to develop a corrective sleep behavior through a stimulus control method. Thus, the drug therapy will effectively allow the patient to establish a reliable sleep-wake schedule (Lie et al., 2015). The pharmacological principles that demonstrate this drug’s effectiveness demonstrate how the disjoint of the stimulus impedes response relationship causing insomnia. The medicine allows the patient to develop bed and sleep association to trigger falling into sleep (Lie et al., 2015). For this reason, relying on Trazodone may affect the treatment plan for the 31-year-old patient because  it prevents him from getting ready to work or engage in meaningful activities that p as he prepares for his day. However, the positive result is that the patient does not exhibit visual or auditory hallucination and thus can manage the side effects that the medicine causes.

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Decision 2

The next decision is to decrease Trazodone to 25 gm every day. The rationale for this decision is to allow the patient to monitor the changes and aim at achieving optimal sleep levels. The 25mg dosage will be combined with benzodiazepines to help activate the GABA receptor. As a result, the patient will allow his body to develop and keep a non-REM sleep condition (Lie et al., 2015). The medication decision to reduce the Trazodone is to facilitate the patient create internal mechanisms for sleep bindles, thus slowing down the sleep wave. The Trazodone approach is sedative and may lead to reduced hypnosis. As such, the most medication that uses Trazodone tend to have standard relaxation and anxiolytic properties hence working for the case, history and comorbid conditions of the 31-year-old patient.

However, the ethical considerations to make while prescribing Trazodone in 25 mg dose for the patient is its reduced impact on morning hangovers and drowsiness. Previously, the patient reported finding it challenging to actively participate in the morning activities as he prepares to work. Therefore, the decision to reduce the dosage is effective because the patient will reduce drowsiness or morning hangovers. The perceived side effect of the medicine is that if the patient uses it persistently, it might cause additions. The goal is for the patient to use it for a short time (Sateia et al., 2017). Trazodone has pharmacological properties and chemical structures that cause huge impacts on the patient using it. For this reason, the duration of actions for this drug is for short use. The drug will thus help stabilize the patient’s mood behavior, improve sleeping abilities and reduce anxiety and agitation at night. There is a need for care when using the drugs to not over-rely on them. The efforts will reduce increased impacts.

Decision 3

Decision three is to allow the patient to continue with the dose of Trazodone for 25 gm every day. The rationale for continuing the dose is that the patient is responding to the medications, and thus, it is not prudent to discontinue it and introduce another drug therapy.  In other words, it is evident that since the patient is already indicating partial response to Trazodone, it is essential to enhance the drug therapy. Alongside continuing the trazodone dose, the doctors should carry out sleep hygiene analysis. After four weeks of monitoring the sleep pattern, the doctor will assess the results. In case the patient manifests good sleep hygiene, he may discontinue trazodone and introduce hydroxyzine. According to Lie et al. (2015), hydroxyzine is an excitatory neurotransmitter with negative side effects but helps regulate sleepy behavior. Therefore, hydroxyzine helps in regulating anxiety. The patient can consequently take hydroxyzine since it will reduce the activity in the central nervous system, calm the patient ad ease the tension. The objective for the prescription of these drugs is to prevent the side effects that Trazodone was causing.

The ethical concern for using hydroxyzine is that it enhances regular sleep patterns. Although hydroxyzine has side effects such as increased heartbeat, headache, and dizziness, the drug is safer for treating sleep disorders.  There is also the need to help the patient to avoid increased tolerance towards them. Therefore, several anti-depressors for treating insomnia have histamines as the minor binding elements. It is essential to note that inducing abrupt onsets of sleep works towards combating insomnia. The drug is effective in prolonged night awakenings, though no efficacy studies have been carried out. Research shows a 50% to 60 % reduction in sleeplessness in victims who have undergone antihistamine drug therapy. The majority of the studies point out that those individuals who have experienced the treatment have an average increment of sleep time by 30 to 40 minutes, meaning that there is an improvement in sleep efficiency (Zheng et al., 2020). The medication also helps combat the causes of insomnia and decreases the negative impacts that insomnia has on individuals.

The goal of the drug is to ensure that patients manage their condition and return to having standard sleep patterns. Pharmacological agents of insomnia have been widely used in the treatment of insomnia. The duration of action for the drugs is concise, and hence they have been recommended for short-duration use. The condition of acknowledging that external parameters do not solely cause insomnia might be particularly beneficial as the victim can adapt to the situation, thereby learning how to avoid it.


Trazodone, benzodiazepines, and histamine antagonist drugs are some of the most effective pharmacological treatments for treating insomnia. Although Trazodone was inferior because of its adverse side effects, a combination of more than one drug with an antihistamine can prove more effective in restoring the quality sleep behavior for the 31-year-old patient. The complete treatment of the insomnia condition depends on the ability of the doctor to avoid drug therapy that can cause more harm to the patient. Effective treatment of insomnia should be based on an individual condition and not a generalized scenario. For this reason, pharmacological therapy can be subjective in the particular system while being adjunctive in other circumstances. Therefore, insomnia should not be ignored, as it should be handled with the utmost care since it is detrimental to the rational element if not controlled. Medical practitioners can use these three drugs when correcting the sleep-wake cycles, especially in patients who succumb to jet lag or shift work insomnia. Although this is not the case with the patient in the case study, the goal of the medical practitioner must be to the causes and triggers of insomnia.

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