Assignment 2: Assessing and Treating Patients With Sleep/Wake Disorders Sleep disorders are conditions that result in changes in an individual’s pattern of sleep (Mayo Clinic, 2020). Not surprisingly, a sleep disorder can affect an individual’s overall health, safety, and quality of life. Psychiatric nurse practitioners can treat sleep disorders with psychopharmacologic treatments, however, many of these drugs can have negative effects on other aspects of a patient’s health and well-being. Additionally, while psychopharmacologic treatments may be able to address issues with sleep, they can also exert potential challenges with waking patterns. Thus, it is important for the psychiatric nurse practitioner to carefully evaluate the best psychopharmacologic treatments for patients that present with sleep/wake disorders. Reference: Mayo Clinic. (2020). Sleep disorders . https://www.mayoclinic.org/diseases-conditions/sleep-disorders/symptoms-causes/syc-20354018 To prepare for this Assignment: Review this week’s Learning Resources, including the Medication Resources indicated for this week. Reflect on the psychopharmacologic treatments you might recommend for the assessment and treatment of patients with sleep/wake disorders. The Assignment: 5 pages Examine  Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.  You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. At each decision point, you should evaluate all options before selecting your decision and moving throughout the exercise. Before you make your decision, make sure that you have researched each option and that you evaluate the decision that you will select. Be sure to research each option using the primary literature. Introduction to the case (1 page) Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision making when prescribing medication for this patient. Decision #1 (1 page) Which decision did you select? Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature. What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature). Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples. Decision #2 (1 page) Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resou.

1. Assignment 2: Assessing and Treating Patients With
Sleep/Wake Disorders
Sleep disorders are conditions that result in changes in an
individual’s pattern of sleep (Mayo Clinic, 2020). Not
surprisingly, a sleep disorder can affect an individual’s overall
health, safety, and quality of life. Psychiatric nurse
practitioners can treat sleep disorders with
psychopharmacologic treatments, however, many of these drugs
can have negative effects on other aspects of a patient’s health
and well-being. Additionally, while psychopharmacologic
treatments may be able to address issues with sleep, they can
also exert potential challenges with waking patterns. Thus, it is
important for the psychiatric nurse practitioner to carefully
evaluate the best psychopharmacologic treatments for patients
that present with sleep/wake disorders.
Reference: Mayo Clinic. (2020).
Sleep disorders
. https://www.mayoclinic.org/diseases-conditions/sleep-
disorders/symptoms-causes/syc-20354018
To prepare for this Assignment:
Review this week’s Learning Resources, including the
Medication Resources indicated for this week.
Reflect on the psychopharmacologic treatments you might
recommend for the assessment and treatment of patients with
sleep/wake disorders.
The Assignment: 5 pages

2. Examine
Case Study: Pharmacologic Approaches to the Treatment of
Insomnia in a Younger Adult.
You will be asked to make three decisions concerning the
medication to prescribe to this patient. Be sure to consider
factors that might impact the patient’s pharmacokinetic and
pharmacodynamic processes.
At each decision point, you should evaluate all options before
selecting your decision and moving throughout the exercise.
Before you make your decision, make sure that you have
researched each option and that you evaluate the decision that
you will select. Be sure to research each option using the
primary literature.
Introduction to the case (1 page)
Briefly explain and summarize the case for this Assignment. Be
sure to include the specific patient factors that may impact your
decision making when prescribing medication for this patient.
Decision #1 (1 page)
Which decision did you select?
Why did you select this decision? Be specific and support your
response with clinically relevant and patient-specific resources,
including the primary literature.
Why did you not select the other two options provided in the
exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary
literature.

3. What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment
plan and communication with patients. Be specific and provide
examples.
Decision #2 (1 page)
Why did you select this decision? Be specific and support your
response with clinically relevant and patient-specific resources,
including the primary literature.
Why did you not select the other two options provided in the
exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary
literature.
What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment
plan and communication with patients. Be specific and provide
examples.
Decision #3 (1 page)
Why did you select this decision? Be specific and support your
response with clinically relevant and patient-specific resources,

4. including the primary literature.
Why did you not select the other two options provided in the
exercise? Be specific and support your response with clinically
relevant and patient-specific resources, including the primary
literature.
What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment
plan and communication with patients. Be specific and provide
examples.
Conclusion (1 page)
Summarize your recommendations on the treatment options you
selected for this patient. Be sure to justify your
recommendations and support your response with clinically
relevant and patient-specific resources, including the primary
literature.
Note:
Support your rationale with a minimum of five academic
resources. While you may use the course text to support your
rationale, it will not count toward the resource requirement.
You should be utilizing the primary and secondary literature.
Reminder
: The College of Nursing requires that all papers submitted
include a title page, introduction, summary, and references. The

5. Sample Paper provided at the Walden Writing Center provides
an example of those required elements (available at
https://academicguides.waldenu.edu/writingcenter/templates/gen
eral#s-lg-box-20293632). All papers submitted must use this
formatting.
Learning Resources
Required Readings
(click to expand/reduce)
American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.)
.
https://doi.org/10.1176/appi.books.9780890425596
Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia
and its impact on physical and mental health.
Current Psychiatry Reports, 15
(12), 418. https://doi.org/10.1007/s11920-012-0418-8
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The
pathophysiology of insomnia.
Chest, 147
(4), 1179–1192.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4388122/
Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J.,
Alessi, C., Aurora, R. N., Boehlecke, B., Chesson, A. L.,
Friedman, L., Maganti, R., Owens, J., Pancer, J., & Zak, R.
(2007). Practice parameters for the treatment of narcolepsy and
other hypersomnias of central origin.
SLEEP, 30
(12), 1705–1711. https://j2vjt3dnbra3ps7ll1clb4q2-
wpengine.netdna-ssl.com/wp-

6. content/uploads/2017/07/PP_Narcolepsy.pdf
Morgenthaler, T. I., Owens, J., Alessi, C., Boehlecke, B,
Brown, T. M., Coleman, J., Friedman, L., Kapur, V. K., Lee-
Chiong, T., Pancer, J., & Swick, T. J. (2006). Practice
parameters for behavioral treatment of bedtime problems and
night wakings in infants and young children.
SLEEP
,
29
(1), 1277–1281. https://j2vjt3dnbra3ps7ll1clb4q2-
wpengine.netdna-ssl.com/wp-
content/uploads/2017/07/PP_NightWakingsChildren.pdf
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., &
Heald, J. L. (2017). Clinical practice guideline for the
pharmacologic treatment of chronic insomnia in adults: An
American Academy of Sleep Medicine clinical practice
guideline.
Journal of Clinical Sleep Medicine, 13
(2), 307–349. https://jcsm.aasm.org/doi/pdf/10.5664/jcsm.6470
Winkleman, J. W. (2015). Insomnia disorder.
The New England Journal of Medicine, 373
(15), 1437–1444. https://doi.org/10.1056/NEJMcp1412740
Medication Resources
(click to expand/reduce)
IBM Corporation. (2020).
IBM Micromedex
.
https://www.micromedexsolutions.com/micromedex2/librarian/d
eeplinkaccess?source=deepLink&institution=SZMC%5ESZMC
%5ET43537

7. Note:
To access the following medications, use the IBM Micromedex
resource. Type the name of each medication in the keyword
search bar. Be sure to read all sections on the left navigation
bar related to each medication’s result page, as this information
will be helpful for your review in preparation for your
Assignments.
alprazolam
amitriptyline
amoxapine
amphetamine
desipramine
diazepam
doxepin
eszopiclone
flunitrazepam
flurazepam
hydroxyzine
imipramine
lemborexant
lorazepam

8. melatonin
methylphenedate
modafinil
armodafinil
carnitine
clomipramine
clonazepam
nortriptyline
pitolisant
ramelteon
sodium oxybate
solriamfetol
SSRI’s
temazepam
trazodone
triazolam
trimipramine
wellbutrin

9. zaleplon
zolpidem
Insomnia
31-year-old Male
BACKGROUND
This week, we examine a 31-year-old male who presents to the
office with a chief complaint of insomnia.
SUBJECTIVE
Patient is a 31-year-old male. He states that his insomnia has
gotten progressively worse over the past 6 months. Per the
patient, he has never been a “great sleeper” but is now having
difficulty both falling asleep and staying asleep at night. The
problem began approximately 6 months ago after the sudden
loss of his fiancé. The patient states this is affecting his ability
to perform his job, which is a forklift operator at a local
chemical company. The patient states he has used
diphenhydramine in the past to sleep but does not like the way
it makes him feel the morning after. He states he has fallen
asleep on the job due to lack of sleep from the night before. The
patient's medical record from his previous physician states that
he has a history of opiate abuse, which began after he broke his
ankle in a skiing accident and was prescribed hydrocodone/apap
(acetaminophen) for acute pain management. The patient has
not received a prescription for an opiate analgesic in 4 years.
The patient states recently he has been using alcohol to help
him fall asleep, approximately four beers prior to bed.

10. MENTAL STATUS EXAM
The patient is alert and oriented to person, place, time, event.
He makes good eye contact and is dressed appropriately for time
of year. He denies auditory/visual hallucinations. Judgement,
insight, and reality contact are all intact. Patient denies
suicidal/homicidal ideation, and is future oriented.
Decision Point One
Select what you should do:
Zolpidem: 10 mg daily at bedtime
Trazodone: 50–100 mg daily at bedtime
Hydroxyzine: 50 mg daily at bedtime
Insomnia
31-year-old Male
Decision Point One
Zolpidem: 10 mg daily at bedtime
RESULTS OF DECISION POINT ONE
Patient returns to clinic in 2 weeks.
Patient states the medication “knocked him out” but felt he slept
well.

11. His new girlfriend was concerned as he woke up in the middle
of the night and cooked breakfast, yet the patient has no
recollection of the occurrence.
Patient states that the medication helps him sleep especially
well when taken with a beer right before bedtime. Patient denies
auditory/visual hallucinations and is future oriented.
Decision Point Two
Decrease zolpidem to 5 mg daily at bedtime
RESULTS OF DECISION POINT TWO
Patient returns to clinic in 2 weeks.
Patient states his episodes of “nighttime activity” has greatly
decreased.
His girlfriend told him that one time in the 2 weeks he got up
and was getting ready to go for a drive.
Patient denies auditory/visual hallucinations and is future
oriented.
Patient states that he likes the way the zolpidem helps him sleep
and “is good with continuing to take it if most of the time I
sleep through the night undisturbed.”
Decision Point Three
Select what you should do next:

12. Maintain dose. Patient to return in 4 weeks for follow up
appointment
Discontinue zolpidem 5 mg tablets. Initiate therapy with
Intermezzo 5 mg sublingual tablet nightly at bedtime, as
needed. Follow up in 4 weeks
Discontinue zolpidem. Initiate therapy with trazodone 50 mg
nightly at bedtime. Instruct patient he may take up to 100 mg if
50 mg is ineffective. Follow up in 4 weeks
Insomnia
31-year-old Male
Decision Point One
Zolpidem: 10 mg daily at bedtime
RESULTS OF DECISION POINT ONE
Patient returns to clinic in 2 weeks.
Patient states the medication “knocked him out” but felt he slept
well.
His new girlfriend was concerned as he woke up in the middle
of the night and cooked breakfast, yet the patient has no
recollection of the occurrence.
Patient states that the medication helps him sleep especially
well when taken with a beer right before bedtime. Patient denies
auditory/visual hallucinations and is future oriented.

13. Decision Point Two
Decrease zolpidem to 5 mg daily at bedtime
RESULTS OF DECISION POINT TWO
Patient returns to clinic in 2 weeks.
Patient states his episodes of “nighttime activity” has greatly
decreased.
His girlfriend told him that one time in the 2 weeks he got up
and was getting ready to go for a drive.
Patient denies auditory/visual hallucinations and is future
oriented.
Patient states that he likes the way the zolpidem helps him sleep
and “is good with continuing to take it if most of the time I
sleep through the night undisturbed.”
Decision Point Three
Maintain dose. Patient to return in 4 weeks for follow up
appointment
Guidance to Student
Zolpidem is a medication that has a host of negative side
effects. It should not be the first choice of therapy due to these

14. side effects. Caution must be exercised if prescribing this
medication to a patient. The patient should be instructed not to
mix the medication with alcohol or any other medication unless
first speaking with their provider.
In this case, the patient is experiencing complex sleep behavior.
It is prudent as the patient's healthcare provider to discontinue
this medication and prescribe something different.
Trazodone is a selective serotonin reuptake inhibitor that is a
much safer choice. In adults you will want to start with 50mg at
bedtime and titrate up as needed.
USE 6 RESOURCES FROM SCHOOL RESOURCES