In view of the serious disruptions that insomnia poses, my treatment goals for this patient would include; ensuring that the patient gets enough sleep during the night. My second goal would be to improve daytime functioning of the patient by ensuring that they get enough sleep at night, thirdly, I would want to reduce the distress that is associated with the not getting enough sleep. Last but not least, I would want to investigate the cause of their insomnia where it is organic or related to some medical condition.
I would prescribe for this patient zolpidem because it has been shown to be effective in treating chronic insomnia. I would have to caution the patient against use of alcohol and other drugs with sedating effects.
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In monitoring the patient, I would use tools such as questionnaire, continuous sleep studies as well as sleep logs. The parameters that I would be interested in is improvement in the number of hours that the patient sleeps at night and reduction in night time waking time. Also, I would be interested in the day time sleepiness whereby I would expect that the number of times the patient falls asleep during the day would reduce.
Based on the prescribed therapy, I would advise the patient to avoid alcoholic drugs as they are likely to cause respiratory depression which might be fatal. It is also important to caution the patient not to overdose the drug as this would also be fatal. I would also advice the patient to ensure that they have at least 7 hours of sleep before being active after taking the drug.
Some of the side effects that might make me discontinue the drug is if the patient experiences shortness of breath associated with the drug oh having a feeling that they might pass out. My second choice drug in that case would be temazepam as it has also been shown to be effective in managing insomnia. Alternatively, I would prescribe for the patient an OTC drug known as melatonin as it also improves the symptoms of insomnia.
I would advise the patient to practice good sleep hygiene like putting off the music as they sleep, putting off lights as they sleep and also ensure that their beddings are clean all the time.
Zolpidem interacts negatively with diazepam, phenobarbital and other drugs that are known to increase drowsiness.
