Insomnia
The power of sleep to heal the body cannot be underestimated. Most research indicates that 7–8 hours of sleep are a minimum that people need to stay healthy. Clients who come to the PMHNP’s office frequently complain of sleep problems. It is estimated that 10–20% of patients report some type of sleeping problem.

In this Discussion, you will analyze the diagnostic criteria and evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders.
Learning Objectives  .Diagnostic Criteria for Sleep And Wake Disorders Essay Example
Students will:

1:Analyze diagnostic criteria for sleep/wake disorders
2:Analyze evidence-based psychotherapy and psychopharmacologic treatment for sleep/wake disorders
3:Analyze criteria for referring clients to primary care physicians for treatment of sleep/wake disorders
4:Compare differential diagnostic features of sleep/wake disorders
Please use the following 5 references and 2 more APA 6th within 5 years. Thanks.
1
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Chapter 13, “Psychosomatic Medicine” (pp. 465–503)
Chapter 16, “Normal Sleep and Sleep-Wake Disorders” (pp. 533–563)
2
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
Chapter 36, “Sleep-Wake Disorders”
3
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
“Sleep-Wake Disorders”
4
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
5
Pharmacotherapy of Insomnia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987897/

Diagnostic Criteria for Sleep/Wake Disorders

Introduction

Healthy sleep is necessary for the restoration of functioning and vigor, good memory, and also in the maintenance of immune function. Sleep disorders are common among psychiatric patients and hence maybe allied to the pathophysiology of mental illness. Insomnia is common in mental disorders such as depression and anxiety (Sadock et al, 2014). This discussion will focus on the analysis of diagnostic criteria for insomnia and the evidence-based psychotherapy and psychopharmacologic treatments.

Diagnostic Criteria for Insomnia

Insomnia is a sleep problem that presents with difficulties in initiating sleep, and impaired consolidation, duration and quality of sleep in spite of having ample opportunities and circumstances for sleep (American Psychiatric Association, 2013). According to DSM-5, the diagnostic criteria for primary insomnia includes: difficulty in sleep initiation or maintenance for minimum period of one month; poor quality sleep; the sleep disturbance results to clinically noteworthy distress or impairs functioning of areas such as social, academic, occupational aspects; sleep disturbance is not due to other sleep disorders such as narcolepsy, mental disorders or substance induced. In secondary insomnia, the sleep disorder co-occurs with other conditions such as depression (Gabbard, 2014).  Diagnostic Criteria for Sleep And Wake Disorders Essay Example

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Evidence-Based Psychotherapy for Insomnia

Cognitive-behavioral treatment insomnia such as sleep hygiene and sleep education have shown to be effective in treating insomnia (Williams et al, 2014). In sleep hygiene, the patient is educated to eliminate certain behaviors such as avoid taking coffee or liquids within two hours of bedtime or to increase behaviors likely to promote improved quality and quantity of sleep. This should be combined with cognitive therapy where patients with insomnia are taught to identify negative sleep beliefs and replace them with more adaptive sleep beliefs and attitudes (Williams et al, 2014).

Psychopharmacologic Treatment for Insomnia

Temazepam (Restoril, Mallinckrodt): This is an FDA approved benzodiazepine for treatment of insomnia. Temazepam is an intermediate-acting benzodiazepine and the most prescribed benzodiazepine for insomnia. Evidence shows that benzodiazepines are effective in reducing sleep latency and they significantly improve sleep duration (Lie et al, 2015).

Criteria for Referral to Primary Care Physicians for Treatment

Clients with insomnia should be referred to primary care physicians for treatment when the cause of lack of sleep is not known or when it is suspected that the client may be having hypersomnia, idiopathic or narcolepsy. Additionally, if the client does not respond to initial o subsequent sleep therapy, they may be reefed to a primary care physician (Stahl, 2014).

Differential Diagnostic Features of Sleep Disorders

During the insomnia diagnosis, it is important to assess sleep habits. A sleep diary can evaluate sleep patterns and hence aid in the diagnosis of sleep problems. For patients with sleep problems, it is also important to screen for environmental changes, medications, cute/chronic illness or the presence of any physical or psychological stressor (Suzuki et al, 2017).  Moreover, mental disorders should be ruled out after assessment of symptoms and sleep history because sleep/wake disorders such as insomnia may be a presenting symptom. For instance, restless legs syndrome may cause sleep problems because of discomfort that comes with legs’ movement; periodic limb movement disorder (PLMD) may cause sleep disturbance due to limb movement; sleep apnea causes sleep disturbance due to reduced airflow while sleeping; whole circadian rhythm disorders may be differentiated using sleep history because they are disorders of sleep timing (Suzuki et al, 2017).

Conclusion

Insomnia was the selected sleep disorder. Diagnostic criteria for insomnia include difficulties in initiating or maintaining sleep, reduced sleep duration and poor sleep quality for at least a month. For the diagnosis of insomnia, secondary causes of sleep disturbance such as mental disorders or narcolepsy should be ruled out.  Psychotherapy choices for Insomnia include cognitive-behavioral treatment insomnia and cognitive therapy. The selected psychopharmacologic treatment for insomnia is temazepam which is an FDA approved benzodiazepine.  Clients should be referred to primary care physicians for treatment if the cause of sleep problem is unknown, hypersomnia, idiopathic or narcolepsy is suspected, or if the client is not responding to initial treatment. Before making a diagnosis for any sleep disorder, it is important to perform a differential diagnosis.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

Gupta R, Das S, Gujar K, Mishra K, Gaur N & Majod A. (2017). Clinical Practice Guidelines for Sleep Disorders. Indian J Psychiatry. 59(1): S116–S138.

Lie J, Tu K, Shen D & Wong B. (2015). Pharmacological Treatment of Insomnia. P T. 40(11): 759-768, 771.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Suzuki K, Miyamoto M & Hirata K. (2017). Sleep disorders in the elderly: Diagnosis and management. J Gen Fam Med. 18(2): 61–71.

Williams J, Roth A, Vatthauer K & McCrae C. (2014). Cognitive Behavioral Treatment of Insomnia. Chest. 143(2): 554–565.

Pharmacotherapy of Insomnia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5987897/    Diagnostic Criteria for Sleep And Wake Disorders Essay Example