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According to the DSM 5, sleep disorders are identified as being present for at least 3 months, with problems in quality, amount and time of sleep. Most adults should get a minimum of 7 hours of sleep per night. Sleep disorders may include the inability to fall asleep, stay asleep, or early morning waking that occurs at least three nights a week, given the presence of opportunity to obtain a good night’s rest. Risk factors such as being female, obesity, taking certain medications, including caffeine, advancing age, and other health disorders, such as anxiety and depression can greatly impact the presence of sleep disorders. Insomnia occurs in approximately 33-50% of the adult population of the United States. (Lei et al., 2017).
Without sleep, our cognitive and emotional abilities become markedly disrupted. This is especially apparent in the domains of attention, working memory, mood and behavioral disturbances, as well as decreased reaction times. Sleep deprivation can affect all domains of cognition and affect. “Sleep deprivation leads to elevated levels of excitatory neurotransmitters and abnormalities in certain other neuromodulators which ultimately has effects on neuronal and executive functions,” (Parameswari et al, 2017, p 104). In relation to mood, studies have found that sleep-deprived subjects, the lack of sleep inhibits certain parts of dopamine transmission. The Brain cells will release dopamine, but not to receive it. (Krause et al., 2017). This may lead to feelings of depression and low mood.
Hypnotic drugs are intended to induce sedation and promote sleep. They lower cogitative performance after their intake. Commonly prescribed hypnotics include benzodiazepine receptor agonists. They can have a direct effect on memory in addition to their sedative effects. Benzodiazepines such as estazolam, alprazolam and lorazepam have been used for many years for the treatment of insomnia. However, non-benzodiazepines are more commonly used for insomnia. This class includes, zaleplon, eszonpiclone, and zolpidem. Other sedating drugs prescribed for improved sleep, such as histamine H1 antagonists or melatonin agonists, may not be as potent and effective but have a lessor negative effect of memory and learning. (Parameswari et al, 2017).
APRN Patient Treatment Plan:
An effective sleep management plan may include pharmacologic and non-pharmacologic methods. Progress can be monitored by having the patient keep a sleep log and biweekly follow ups on progress.
The APRN should educate and recommend setting a schedule to go to bed and wake up at the same time every day. Suggest that the patient exercise 20-30 minutes per day, but not in the 2-3 hours before bed. Educate on avoiding caffeine and nicotine late in the day, or drinking alcohol before bed. Create a peaceful environment for sleep. This includes a dark room, with no electronics on. If a quiet place is not available, use ear plugs or white noise machines. Practice relaxing activities before bed such as meditation or reading. Avoid daytime napping. (Pop et., al 2019).
The first line of pharmacologic is recommended to be those with the least side effects such as melatonin. If that is not sufficient in obtaining sleep, a non-benzodiazepine such as Ambien (zolpidem) may be prescribed. As a last measure, the patient may be prescribed a benzodiazepine which is proven effective but also has the most side effects and a higher risk for addiction. (Pop et al., 2019).
References:
Krause, A.J., Simon, E.B., Mander, B.A., Greer, S.M., Saletin, J.M., Goldstein-Piekarski, A.N., & Walker M.P. (2017).The sleep-deprived human brain. Nat Rev Neuroscience.(7):404-418.
Lei, Y., Wang, L., Chen, P., Li, Y., Han, W., Ge, M., Yang, L., Chen, S., Hu, W., Wu, X., & Yang, Z. (2017). Neural correlates of increased risk-taking propensity in sleep-deprived people along with a changing risk level. Brain Imaging & Behavior, 11(6), 1910–1921. to an external site.
Parameswari, P.R., Nagabushan, C., & Chidambaram, B.S. (2017) Neurochemicals and behavioural alterations in sleep deprivation: A revisit. J Dement 1: 104.
Pop, P., Bronskill, S. E., Piggott, K. L., Stall, N. M., Savage, R. D., Visentin, J. D., McCarthy, L. M., Giannakes, V., Wu, W., Gruneir, A., Gatley, J. M., & Rochon, P. A. (2019). Management of sleep disorders in community?dwelling older Women and men at the time of diagnosis. Journal of the American Geriatrics Society, 67(10), 2094–2111.
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NSU Sleep Disorders Discussion
Introduction:
Sleep disorders are a common health issue, affecting a significant portion of the population. In order to effectively manage sleep disorders, healthcare professionals, such as advanced practice registered nurses (APRNs), need to develop comprehensive treatment plans that incorporate both pharmacologic and non-pharmacologic interventions. This response will discuss the APRN’s role in creating an effective sleep management plan for patients, including education, lifestyle recommendations, and pharmacologic options.
Answer to Content:
An effective sleep management plan for patients with sleep disorders should encompass both pharmacologic and non-pharmacologic approaches. The APRN plays a crucial role in designing and implementing a comprehensive treatment plan. To begin, the APRN can educate the patient on the importance of maintaining a regular sleep schedule, suggesting that they go to bed and wake up at the same time every day. This consistency helps regulate the body’s internal clock and promote better sleep.
Engaging in physical activity is another important aspect of a sleep management plan. The APRN should recommend that patients engage in regular exercise, preferably for 20-30 minutes, but not within 2-3 hours of bedtime. Physical activity helps tire the body, making it easier to fall asleep at night. However, exercising too close to bedtime can have a stimulant effect and disrupt sleep.
Educating patients on avoiding substances that can disrupt sleep is also crucial. The APRN should advise patients to avoid consuming caffeine or nicotine late in the day, as these substances can interfere with falling asleep. Additionally, drinking alcohol before bed should be discouraged, as it can disrupt the normal sleep cycle.
Creating a peaceful sleep environment is another key component of a sleep management plan. The APRN should recommend that patients sleep in a dark room, free from electronic devices. Electronic screens emit blue light, which can interfere with the production of melatonin, a hormone that helps regulate sleep. If the patient cannot achieve a quiet environment, using earplugs or white noise machines can help mask external sounds and promote better sleep.
Engaging in relaxation activities before bed can also aid in falling asleep. The APRN should suggest practices such as meditation or reading, as these activities can help calm the mind and induce a sense of relaxation. Finally, it is important to discourage daytime napping, as it can disrupt the sleep-wake cycle and make it harder to fall asleep at night.
In terms of pharmacologic interventions, the APRN should follow a step-wise approach in prescribing sleep medications. The first-line option should be melatonin, a hormone that regulates sleep and wakefulness. Melatonin supplementation can help promote sleep without significant side effects. If melatonin does not provide sufficient improvement in sleep, the APRN may consider prescribing a non-benzodiazepine sleep medication, such as zolpidem (Ambien). These medications are commonly used for short-term treatment of insomnia and have a lower risk of addiction compared to benzodiazepines.
Benzodiazepines, such as estazolam, alprazolam, or lorazepam, should be reserved as a last resort due to their higher risk of side effects and potential for addiction. They can be effective in treating insomnia but should be used cautiously and for a limited duration.
To monitor the patient’s progress, the APRN should encourage them to keep a sleep log, documenting their sleep duration, quality, and any disruptions. Regular follow-up appointments, on a biweekly basis, should be scheduled to evaluate the effectiveness of the treatment plan and make any necessary adjustments.
In conclusion, an effective sleep management plan for patients with sleep disorders should incorporate both pharmacologic and non-pharmacologic interventions. The APRN’s role is to educate patients about sleep hygiene practices, recommend lifestyle changes, and prescribe appropriate medications when necessary. By providing comprehensive care and ongoing evaluation, the APRN can assist patients in achieving better sleep and improving their overall well-being.
