Colleagues response week 10 | NURS 6670 – Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults | Walden University

ASSIGNMENT:

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned( HYPERSOMNIA)  to the diagnostic features of the disorder your colleagues were assigned.

Note: Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Respond # 1

The assigned sleep/wake disorder is Insomnia. According to Ruiz, Sadock, & Sadock (2014) insomnia is defined as difficulty initiating or maintaining sleep. It is currently considered as an independent condition where as in the past causes of the condition rather than symptoms were treated.

 
 

Diagnostic Criteria for Insomnia

 
 

According to American psychiatric association (2013), individuals need to meet criteria A to criteria H to diagnose insomnia. Criteria A requires one or more of the three symptoms such as difficulty in initiating sleep, difficulty in maintain sleep and early morning awakening with inability to return back to sleep which cause dissatisfaction with the sleep quantity or quality (American Psychiatric association 2013). The other criteria from B to H explains that the sleep disturbance causes impairment in social,  occupational, educational, educational, behavioral or other important areas of functioning, disturbance occurs three nights per week and present for at least three months, it occurs despite adequate opportunity to sleep, insomnia do not caused by another sleep wake disorder, not attributable to physiological effect of a substance, and coexisting mental disorders or medical condition do not adequately explain insomnia (American psychiatric association 2013).

 
 

Psychotherapy Treatment

 
 

The psychological and behavioral therapies for insomnia according to Gabbard (2014) are sleep hygiene education, stimulus control therapy, sleep restriction, cognitive therapy, and relaxation therapies. Sleep focused cognitive-behavior therapy (SCBT) is a combination of various non pharmacological strategies and it is structured and time limited with a focus on sleep related issues (Gabbard 2014). It is for 6-8 weeks, once in each week. The treatment has shown benefit for up to six months after termination of SCBT (Gabbard 2014). However, there are some pitfalls with this treatment as it requires patient initiative, motivation and active participation in the treatment process, along with greater time commitment and limited availability of practitioners (Gabbard 2014).

 
 

Psychopharmacological Treatments

 
 

The pharmacological treatment of insomnia are hypnotics and the sleep medications according to Ruiz et al (2014) should not be prescribed for more than 2 weeks due to development of tolerance and withdrawal. According to Gabbard (2014) the FDA approved hypnotic agents are benzodiazepines, non-benzodiazepines, melatonin receptor agonists, and Histamine H1 receptor antagonists. For Treatment of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakening flurazepam can be used which is a benzodiazepine (Gabbard 2014). It is expected to work in one hour and if it does not work after 7-10 days it may be manifestation of primary psychiatric or physical illness (Stahl 2014) The other benzodiazepines used for insomnia are Temazepam, and Triazolam which are used for short term treatment of insomnia. Benzodiazepines used to treat individuals with difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakenings are Quazepam, and Estazolam (short term use). The non-benzodiazepines which can be used for insomnia are zolpidem which is available in oral pill, oral spray, extended release and sublingual, zaleplon, and eszopiclone (Gabbard 2014). Ramelteon which is a melatonin receptor agonist used for sleep onset and Doxepin which is a histamine H1 receptor antagonist also used for sleep maintenance (Gabbard 2014)  

 
 

There are over the counter treatments such as sedating antihistamines, protein precursors. Melatonin is an endogenous hormone produced by the pineal gland to regulate sleep and exogenous form of melatonin have resulted in mixed results in insomnia (Ruiz et al., 2014).     

 
 

Point at which Referral is Required

 
 

Individuals with sleep disorders because of breathing related sleep disorders, treatment should be by a specialist other than the psychiatry practitioner. Conditions such as obstructive sleep apnea hypopnea where the symptoms are excessive sleepiness, snoring, obesity, restless sleep, nocturnal awakening with chocking or gasping for breath, morning dry mouth, morning head aches and heavy nocturnal sweating (Ruiz et al., 2014). Another situation where a referral is needed is in elderly individuals where the insomnia is related to central sleep apnea where it is caused by lack of respiratory effort leads to repeated efforts of apneas and hypopneas in a periodic intermittent pattern during sleep (Ruiz et al., 2014). The lack of respiratory effort is due to disorder of ventilatory control (Ruiz et al., 2014). Comorbid sleep-related hypoventilation occurs as a consequence of medical condition such as pulmonary parenchymal or vascular pathology, lower airway obstruction or neuromuscular or chest wall disorders (Ruiz et al., 2014) and it requires a referral to appropriate medical practitioner. Common neurological issues associated with insomnia are epilepsy, neuromuscular disorders, movement disorders, and stroke. If the patients sleep disturbance is related to above condition, clients must be referred to neurologists (Penn medicine 2020).

 
 

Colleagues Respond # 2

Parasomnia Disorder

Parasomnia is a sleep disorder that causes abnormalities in sleeping behavior. We can see the behavior at any stage of sleep that includes the transition from wakefulness to sleep. Having parasomnia makes one move around, do unusual things during sleep, and even talk. This makes other people think you are awake while, in the real sense, the person is unconscious, and definitely, you won’t remember anything about the incident. This condition is common but makes sleep difficult by giving one a restless sleep (Mysliwiec, 2018). It might disturb someone’s sleep and even other people in the same room. This condition can be dangerous to other people, especially since they are not are of the surroundings, and it has health-related side effects, including psychological stress. Just like any other sleep disorder, this condition is treatable.

Diagnosis of Parasomnia

A primary doctor can help diagnose the parasomnia condition, and they will most likely refer you to see a sleep specialist who further will examine the sleeping behavior. The diagnosis includes the following: the doctor will follow up on the medical history, and they will ask about the underlying medical conditions, lifestyle, family history, and current medications. Sleep history will be analyzed, and a sleep diary will show sleep behavior patterns. This can be achieved with the help of sleeping partners who can observe how one sleeps. Polysomnogram is where one has to sleep in the lab overnight, where the specialist will analyze the individual’s sleeping behavior. They will have to record the breathing, heart rate, and brain waves to make the diagnosis.

Parasomnia Treatment

The treatments of this condition can be varying depending on the severity and the frequency of the individual’s symptoms. In the first instance, the doctor must observe and identify the underlying health issues or sleep disorders. If there is an existing condition, treating it may also result in treating the resulting parasomnia. Hypnosis, talk therapy, and cognitive behavioral therapy may help relieve the symptoms associated with NREM parasomnias. There are tranquilizers, which include benzodiazepines, which are very useful in treating arousal of parasomnias such as the RBD and sleepwalking (Schenck, 2019).

People who live with individuals with movement-related parasomnia such as sleepwalking and RBD may need to sleep in a separate bedroom with such individuals. This will create a safe environment by removing padding and sharp object in the bedroom furniture.

In children

Most of the parasomnias occur in children except for the RBD condition, mostly seen in male adults. Some of the causes of this condition are genetic components of the family and maybe running in the family’s bloodline. This condition does not have significant adverse health effects; however, RBD indicates an underlying neurological condition. As children get older, the frequency of parasomnia episodes decreases. Medical treatment cannot be necessary at this stage unless the symptoms affect the child’s daily activities or mental health.

Behavioral therapy, hypnosis, and relaxation techniques are methods that can be used to reduce the frequency and intensity of the parasomnias resulting from anxiety or stress. A doctor may prescribe antidepressants or tranquilizers for children with frequent or severe sleep terrors or sleepwalking (Thorpy, 2017).

In conclusion, parasomnias can interfere with someone’s quality of sleep and increase the risk of injuries or accidents. Fortunately, this condition is treatable and can be resolved mostly during the childhood stages. An individual may seek medical advice when they notice that their loved ones exhibit the symptoms of parasomnia.

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