Insomnia is not just an inability to fall asleep, but also it is a severe disease with no less serious consequences that requires timely diagnosis and therapy. According to Abbott (2016), it is a frequent symptom of many mental illnesses, including anxiety, depression, and ADHD. The primary method of diagnosing insomnia that would be implemented is polysomnography. It gives a complete picture of the work of the body’s systems at the time of sleep (Rundo & Downey, 2019). To make a complete diagnosis, the doctor determines the stages of sleep, duration, the ratio of physiological indicators, character, and psychological state.
For the treatment of insomnia, various non-drug and drug methods are used. Psychotherapy is of particular importance in the case under study since the woman experiences severe stress after the death of her husband. In the European Guidelines for the Diagnosis and Therapy of Insomnia, cognitive-behavioral therapy (CBT) is recommended as the first-line due to its safety and proven high efficacy (Riemann et al., 2017). One of the options for CBT is therapy aimed at maintaining sleep hygiene.
In the treatment of this condition, if possible, priority should be given to non-medicinal methods aimed at eliminating adverse factors that interfere with the formation of normal sleep, relaxation. It is desirable to carry out drug treatment in short courses and only when insomnia significantly affects life activity. The results obtained during the study will be used to make a correct diagnosis and possible correction and addition of medications.
I believe that the patient suffers from depression after the loss of a loved one, since the patient emphasized that it has gotten worse. With a depressive disorder, the level of stress hormones in the human body increases, which leads to insomnia and problems with falling asleep. The difference between insomnia in such disorders and primary insomnia, which is not associated with other diseases, is the nature of experiences in the process of falling asleep.
How long have the patient had insomnia?
This question must be asked to determine the class of insomnia. It can be transient insomnia, usually associated with any emotional experiences or changes in the patient’s life, short-term insomnia, or chronic.
How long has the patient been taking these medications?
The patient takes medications such as Januvia and Metformin, which indicate that the woman has diabetes. Losartan and HCTZ are taken for hypertension and the antidepressant Sertraline. Insomnia in diabetes mellitus is a very disturbing syndrome, the presence of which should not be ignored. With timely treatment at the clinic, doctors will help normalize the sleep function, which will save a person from serious complications.
How long have you been feeling down and unwell, and, what actions do you take to combat it?
Depression is accompanied by excessive activation of the nervous system. In addition to changes in higher nervous activity and the appearance of anxiety appears the imbalance in the endocrine regulation. Changes lead to desynchronosis, and in such conditions, it is pretty tricky, for the nervous system to switch from a state of wakefulness to sleep.
To speak to or get feedback from to assess further the patient’s situation, close relatives would need to be involved. These relatives can include the children of the older woman, grandchildren, and siblings if there are such. They would be asked: “Have you observed signs of anxiety in your relative?”, “What was the patient’s behavior after the tragedy?”. It is also necessary to learn about the degree of closeness between relatives since the patient can give different information to different people, depending on the relationship and trust in each other.
All drugs have an effect on a person’s sleep, thereby acting on the recovery processes that occur during sleep. In this regard, the use of hypnotics in the treatment may be promising. The most convenient to use in the treatment of insomnia is Valocordin-Doxylamin, which is available in drops. I would keep Sertraline as a second drug to combat depression. However, I would reduce the dose to 50 grams per day, since insomnia is among the side effects of the drug.
During treatment with Valocordin-Doxylamine, regular monitoring of heart function is necessary, since changes in the ECG may occur, in particular changes in the repolarization phase. This is especially important for elderly patients, as in the case under study.
A control point can be set on the initial therapeutic effect, which can develop over 7 days. The next point may already be when the full effect is achieved two or three weeks after the appointment. For the duration of treatment is a maximum of 14 days.
References
Abbott, J. (2016). What’s the link between insomnia and mental illness? Health. Web.
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Garcia-Borreguero, D., Gjerstad, M., Gonçalves, M., Hertenstein,E., Jansson-Fröjmark, M., Jennum, P.J., Leger, D., Nissen, C., Parrino, L., Paunio,T., Pevernagie, D., Verbraecken, J., Weeß, H., Wichniak, A., Zavalko, I., Arnardottir, E.S., Deleanu, O., Strazisar, B., Zoetmulder,M., & Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of sleep research, 26(6), 675-700. Web.
Rundo, J. V., & Downey III, R. (2019). Polysomnography. Handbook of clinical neurology, 160, 381-392. Web.