Introduction
The most common reasons for insomnia are psychological problems, disruption of the regular regimen, various diseases of the cardiovascular system and gastrointestinal tract, psychotropic drugs, alcohol, coffee, overeating in the evening, and especially the abuse of heavy, fatty foods. Insomnia can occur with overwork, the constant expectation of poor sleep and related experiences, and insufficient physical activity. Mayo Clinic (2020) states, “A sleep disorder can affect your overall health, safety, and quality of life.” In cases where insomnia persists or is aggravated, pharmaceutical treatment is used.
In some cases, when people seek medical treatment, their insomnia is not a difficult case and does not require intervention. In rare cases, patients are troubled by sleep disturbance. In their practice, the science community quickly prescribes sleeping pills without establishing the actual cause of sleep disturbance. An important aspect of treating patients with insomnia is identifying its causes and prescribing the correct pharmaceutical treatment.
Case Study
The patient is a 31-year-old male who presented with an insomnia problem which has worsened over the past six months. Previously, the patient did not always sleep well, but now the situation has become more problematic. He began to experience rest problems after the loss of his fiancée. Constant sleep deprivation negatively affects his ability to perform at work. The patient claims to have used diphenhydramine in the past to help him sleep better, but he does not like the side effects. His previous doctor indicated that the man had abused opiates after the patient broke his ankle. The patient has been prescribed Trazodone 50 mg orally and Hydroxyzine 50 mg daily at bedtime. Unique factors that may affect the final choice of treatment are the impact of a solid overwhelming state due to the loss of a fiancée and the development of dependence on opiates reported by the previous doctor.
Selected Decision 1
This option was rejected due to the ineffectiveness of the drug. Zolpidem is not the right solution in this situation because of its unsafety. One of the main problems in treating insomnia with Zolpidem is that it is not so much its effectiveness but the lack of safety of treatment with this drug if it is used in violation of the instructions. In support of this, researchers Xiang et al. (2021) state that “it is necessary to comprehensively analyze the effectiveness and safety of zolpidem” (p. 252). When taking Zolpidem, symptoms of somnambulism may appear – the patient can get out of bed in a sleepy state and perform various activities that he does not remember in the morning. The combined use of Zolpidem with hypnotics, drugs that depress the function of the central nervous system, as well as in doses exceeding the maximum limits, the risk of sleepwalking increases.
Given that the patient experiences a sleepy state while awake, this drug can aggravate this state even more. When prescribing the drug to patients with concomitant depressive conditions, it is necessary to consider the possibility of suicidal tendencies. This is another reason why this tool does not fit. The patient has had a traumatic experience, and using Zolpidem may cause depression. By excluding this treatment option, it is possible to improve the patient’s general condition and prevent the development of suicidal tendencies. From an ethical point of view, prescribing this drug is not the right decision because it can cause a depressive state. Other treatment options are more suitable because they do not carry severe side effects.
Selected Decision 2
The optimal choice in this situation would be solution three, continuing dosing with the excellent drug trazodone. This drug is an antidepressant, a thiazolopyridine derivative. It has a thymoleptic, anxiolytic, sedative, and muscle relaxant effect. It has a high affinity for some subtypes of serotonin receptors, inhibits serotonin reuptake, and has little effect on the neuronal uptake of norepinephrine and dopamine. Zheng et al. (2022) state that trazodone can be taken in high doses without harm to health. This confirms the thesis that this drug is safe and can be used. It is permissible to divide the dose into two. Thus, it will be possible to reduce daytime sleepiness. This decision was made because the drug positively affects the patient’s condition. In addition, the antidepressant properties that trazodone possesses are essential for a man because six months ago, he experienced the loss of his bride, which affected his mental state.
The other two options suggested in the exercise could not be selected as they would exacerbate unwanted side effects and have little effect on insomnia. In addition, Zolpidem 10 strongly affects the central nervous system, and the patient may wake up unconsciously at night. The desired outcome of this decision is to eliminate side effects while maintaining a positive effect on the patient’s sleep. In support of this, Edinoff et al. (2021) state that “zolpidem has a wide variety of adverse effects and has some special considerations” (p. 1). Compliance with medical ethics involves the preservation of medical secrecy. Doctors have the right to disclose personal information about the patient and his diagnosis only if it is necessary for treatment or the patient has consented. For ethical reasons, prescribing trazodone is the best given the patient’s situation. At the same time, Zolpidem can worsen a man’s state of mind.
Selected Decision 3
The third solution should be to split the dose in half. Maras et al. (2018) state that “Clinical guidelines recommend sleep hygiene and behavioral intervention as the first-line treatment” (p. 700). Therefore, reducing the dose of pharmacological treatment can lead to the desired result. Thus, it is possible to eliminate the feeling of drowsiness during the day, which the patient complains about. Sleeping pills are psychoactive drugs that help fight insomnia and improve sleep quality. They depress the central nervous system, resulting in a person feeling relaxed, and it becomes easier for him to fall asleep. However, in some cases, drugs can have a detrimental effect on the human body. These drugs are fast-acting and are used only symptomatically, that is, they are used as needed. The result of such a decision should be eliminating signs of drowsiness during the day. On the ethical side, reducing the dosage can be positively perceived by the patient because it will remove drowsiness.
In addition, trazodone increases serotonin and melatonin, which is an essential aspect of a treatment since the patient may develop depression or a depressed state. Melatonin is a hormone derived from indole and is produced mainly by the pineal gland during the hours of darkness. It binds to specific MT^ and MT2 receptors, the maximum density of which is found in the suprachiasmatic nuclei of the hypothalamus, which are responsible for determining time. This drug positively affects melatonin preparations on falling asleep, the duration and quality of a night’s sleep. In addition, trazodone does not have the dependent effect that other drugs can cause. This is a positive feature because the patient was addicted to opiates, and therefore it is best to avoid substances that may be addictive in the treatment. With insomnia, the desired treatment effect will be normalized sleep and restore the normal rhythm of the patient’s life. The use of the drug can be unlimited since there is no data on the formation of tolerance, dependence, or cancellation syndrome. The other option was not accepted because it is not entirely safe, as stated above.
Conclusion
Drugs for sleep disorders are sedatives and sedatives that are used not only to treat insomnia but also for several other pathological conditions. Such conditions can be, for example, frequent nocturnal awakenings, tension caused by stress, diseases of the nervous system, and memory disorders. The patient was extended by trazodone, but at the same time, it was recommended to reduce the dose and extension of the treatment time to eliminate side effects. Many of the studies reviewed for this paper confirm that trazodone treatment positively affects insomnia targets. In addition, the adoption of 50 mg Hydroxyzine is recommended every day before bedtime. This drug blocks H1-histamine receptors, has anti-muscarin and sedative effects and contributes to inhibiting the activity of some subcortical zones. Gidoxidine improves cognitive functions, such as attention and memory. This has a beneficial effect on the patient’s condition and his problems of drowsiness during daytime work. However, not in all cases can sleeping pills be used since, with specific individual characteristics and diseases, they can lead to side effects. There are several contraindications for taking sleeping pills. These include sleep apnea, bradycardia, severe respiratory failure, renal failure, arterial hypertension, bronchial asthma, and coronary heart disease. The patient was not found to have any diseases that could cause aggravating effects of the actions of drugs, so he was prescribed appropriate treatment.
References
Edinoff, A. N., Wu, N., Ghaffar, Y. T., Prejean, R., Gremillion, R., Cogburn, M., Azem, C., Adam, K. & Kaye, A. D. (2021). Zolpidem: Efficacy and side effects for insomnia. Health Psychology Research, 9(1). Web.
Maras, A., Schroder, C. M., Malow, B. A., Findling, R. L., Breddy, J., Nir, T., Shiri, S., Nava, Z. & Gringras, P. (2018). Long-term efficacy and safety of pediatric prolonged-release melatonin for insomnia in children with autism spectrum disorder. Journal of Child and Adolescent Psychopharmacology, 28(10), 699-710. Web.
Mayo Clinic. (2020). Sleep disorders. Web.
Xiang, T., Cai, Y., Hong, Z., & Pan, J. (2021). Efficacy and safety of Zolpidem in the treatment of insomnia disorder for one month: A meta-analysis of a randomized controlled trial. Sleep Medicine, 87, 250-256. Web.
Zheng, Y., Lv, T., Wu, J., & Lyu, Y. (2022). Trazodone changed the polysomnographic sleep architecture in insomnia disorder: a systematic review and meta-analysis. Scientific Reports, 12(1), 1-11. Web.