Question

Insomnia: One of GK’s complaints is inability to sleep. Two years ago, she was prescribed temazepam 30mg HS. She stopped taking the temazepam because she felt groggy all day and unable to focus and work. She then tried triazolam 0.25mg HS. It helped her fall asleep but she would still wake up in the middle of the night and have difficulty falling back asleep unless she took another triazolam.

1. Explain how both of the medications work to treat insomnia and explain why the patient was experiencing the effects from each that she was.
2. Taking into consideration the patient’s use of hydrocodone for pain, would a benzodiazepine be an appropriate therapeutic option for this patient? Explain why or why not.
3. Identify three alternatives that exist for this patient to help her manage her insomnia and explain from a mechanistic standpoint how each works to treat insomnia.
4. Of the three options identified, which do you think represents the BEST option and why?
5. Good sleep hygiene education should be part of any treatment plan for insomnia. What should this education include?

Answer 1

Answer:

a. Both the medications temazepam and triazolam are benzodiazepines used to treat insomnia. Temazepam acts shortly within 10 to 20 minutes and makes to fall asleep. It acts on the neurotransmitter of CNS and makes a sedative effect. So the patient feels drowsy and sleepiness on the next day. Triazolam helps to fall asleep by mediating the sleep quality. But the body utilizes these medications quickly. So that the patient awake in the middle of night and needs of additional dose.

b. Benzodiazepines may interact with the hydrocodone(pain medication) and result in the risk of breathing difficulties. So this is not an appropriate option for this patient.

c. Three alternatives for the patient to manage insomnia

• A balanced diet and exercise to promote a healthy lifestyle and sleeping behavior.
• Cognitive behavioral therapy to improve the sleeping pattern.
• Psychotherapy to reduce stress and improve sleeping habits.

d. Among three I think, the best option is Cognitive behavioral therapy. Because it is effective to improve sleeping by eliminating the negative thoughts and beliefs of the patient. It includes correcting the underlying cause for insomnia, promotes muscle relaxation, restricts daytime sleep, and light therapy to control your sleep and awake.

e. Good sleep hygiene education must include the following points

• Go to bed when getting sleep.
• Avoid spending unnecessary time in bed.
• Do some work if not getting sleep instead of awakening on the bed.
• Make the environment comfortable to sleep.
• Avoid daytime sleep.
• Avoid taking heavy meals just before bedtime.
• Do relaxation therapy such as yoga, meditation, reading books before going to bed.
• Do regular exercise in the evening.
• Have the habit of getting early in the morning.