NURS 6630 Therapy for Patients With Sleep or Wake Disorders

Sample Answer for NURS 6630 Therapy for Patients With Sleep or Wake Disorders Included After Question

NURS 6630 Therapy for Patients With Sleep or Wake Disorders


From negative changes in mood to problems concentrating, sleep/wake disorders can have a tremendous impact on patients’ lives. When patients suffer from these disorders, they often seek medical care with the intent of receiving medications to manage symptoms. However, many of the medications used to treat sleep/wake disorders may be addictive, making thorough patient assessments and close follow-up care essential. To prescribe appropriate therapies with patient safety in mind, you must understand not only the pathophysiology of these disorders but also the pharmacologic agents used to treat them.

This week, as you study therapies for individuals with sleep/wake disorders, you examine the assessment and treatment of patients with these disorders. You also explore ethical and legal implications of these therapies.

Learning Objectives

Students will:

NURS 6630 Therapy for Patients With Sleep or Wake Disorders
NURS 6630 Therapy for Patients With Sleep or Wake Disorders
  • Synthesize concepts related to the psychopharmacologic treatment of patients
  • Assess patient factors and history to develop personalized therapy plans for patients with sleep/wake disorders
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in patients requiring therapy for sleep/wake disorders
  • Synthesize knowledge of providing care to patients presenting for sleep/wake disorders
  • Analyze ethical and legal implications related to prescribing therapy for patients with sleep/wake disorders

Learning Resources

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Required Readings (click to expand/reduce)


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its impact on physical and mental health. Current Psychiatry Reports, 15(12), 418.

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192.

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.

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.

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.

Winkleman, J. W. (2015). Insomnia disorder. The New England Journal of Medicine, 373(15), 1437–1444.


Medication Resources (click to expand/reduce)


U.S. Food & Drug Administration. (n.d.). Drugs@FDA: FDA-approved drugs.


Note: To access the following medications, use the Drugs@FDA resource. Type the name of each medication in the keyword search bar. Select the hyperlink related to the medication name you searched. Review the supplements provided and select the package label resource file associated with the medication you searched. If a label is not available, you may need to conduct a general search outside of this resource provided. Be sure to review the label information for each medication 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
  • melatonin
  • methylphenedate
  • modafinil
  • armodafinil
  • carnitine
  • clomipramine
  • clonazepam
  • nortriptyline
  • pitolisant
  • ramelteon
  • sodium oxybate
  • solriamfetol
  • SSRI’s
  • temazepam
  • trazodone
  • triazolam
  • trimipramine
  • wellbutrin
  • zaleplon
  • zolpidem

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A Sample Answer For the Assignment: NURS 6630 Therapy for Patients With Sleep or Wake Disorders

Title: NURS 6630 Therapy for Patients With Sleep or Wake Disorders

Assessing and Treating Patients with Sleep/Wake Disorders  

Insomnia is a mental disorder that affects significantly the health, wellbeing, and functioning of the patients. Therefore, this paper examines a case study of a 31-year-old male that presents with chief complaint of insomnia. The patient reported that the insomnia has worsened progressively over the last six months. The problem started about six months ago after his fiancé passed on. Insomnia has affected his ability to perform at his job as a forklift operator. The patient has a history of using diphenhydramine to enhance sleep but did not like what he felt the morning after, as he fallen asleep because of lack of sleep the night before. The patient’s history also shows that he has opiate abuse after breaking his ankle where he was prescribed acetaminophen for pain management. However, he has not received an opiate prescription for the last four years.   

The patient also has a history of alcohol use to induce sleep. He drinks about four beers before bed. Mental status exam performed on the patient showed that he was oriented to place, time, person, and event. He made eye contact, dressed appropriately for the occasion, denied hallucinations, with judgement, insight, and reality being intact. He also denied suicidal ideation and future oriented. Therefore, the patient factors that will affect the selected treatment include his age, experience with diphenhydramine, opiate abuse, and alcohol use. The selected treatments should not predispose him to unwanted outcomes such as poor performance at workplace, dependence, or increased use of alcohol to manage insomnia symptoms.  

Decision 1 

Selected Decision  

Zolpidem: 10 mg daily at bedtime  

Why I Selected the Decision  

I selected Zolpidem for the patient because of its high level of tolerance and efficacy in managing insomnia and minimal residual effects. According to Xiang et al., (2021), Zolpidem is highly effective in increasing the total sleep time, reducing sleep latency, and enhancing sleep quality in patients suffering from insomnia disorder. Clinical trials have also demonstrated that Zolpidem has a high efficacy level in improving wake after sleep onset, which enhances the performance and productivity of the patients affected by insomnia disorder (Inoue et al., 2022). In another study, zolpidem was found to increase patients’ ability to sleep within 30 minutes, eliminate troubles they experience staying awake during daytime, and remaining motivated to get things done (Asok et al., 2019). The effectiveness was high as compared to placebo and use of other agents to enhance sleep.  

Why the Other Two were not Selected? 

I did not select the decision to initiate the patient on Trazodone 50 mg PO at bedtime because it is not the first-line drug of choice for insomnia. Instead, it is recommended for patients treated with selective serotonin reuptake inhibitors (SSRIs) to manage their associated insomnia (Cuomo et al., 2019). I did not select the decision to start the patient with Hydroxyzine 50 mg daily at bedtime. This is because it is a histamine H1 blocker, which the patient reported having a negative experience with it (Sharma et al., 2019). Its administration is likely to affect treatment adherence, hence, the lack of realization of the desired outcomes.  

What I was Hoping to Achieve 

I was hoping to achieve improvements in sleep quality, latency, after night performance, and functioning in the patient. This is largely attributed to the effects of zolpidem on sleep. I was also hoping to see the patient tolerating the selected treatment (Xiang et al., 2021).   

Ethical Considerations  

The ethical consideration that informed the adopted decision is the principle of beneficence and non-maleficence. Psychiatric mental health nurses should adopt treatments associated with minimal harm and optimum patient benefits. As a result, zolpidem has more benefits than harm as compared to the given options (Xiang et al., 2021).  

Decision 2 

Selected Decision  

Discontinue zolpidem and initiate therapy with Trazodone 50-100 mg daily at bedtime.  

Why I Selected the Decision  

The decision to discontinue zolpidem and initiate therapy with trazodone 50-100 mg daily at bedtime was adopted. This is because the patient returned to the clinic with complains that suggested that he developed adverse effects associated with zolpidem. Accordingly, he reports that he felt knocked out, waking up in the middle of the night and cooking breakfast and having no recollection of the occurrence, and taking the medication with beer right before bedtime to get sleep. As shown by Asok et al., (2019), these are some of the unwanted side effects of zolpidem. Trazodone would be the best drug of choice at this time. According to Pochiero et al., (2022), Trazodone is an off-label drug that is used in treating acute cases of insomnia because of its high affinity for alpha 1 and serotonin 2A receptors that regulate sleep. The long-term use of trazodone is associated with improved sleep complaints and enhanced cognitive and functional scores among patients suffering from insomnia (La et al., 2019). Therefore, it makes it an effective drug to manage insomnia symptoms for the patient.  

Why the Other Two were not Selected? 

I did not select the decision to decrease zolpidem to 5 mg daily at bedtime because the client demonstrated symptoms of adverse reaction to the drug. Its continued administration is associated with the increased risk of worsening symptoms and poor treatment adherence. I did not select the decision to discontinue zolpidem and initiate eszopiclone 1 mg daily at bedtime because it has a high risk of symptom relapse as well as studies demonstrating high efficacy when used in elderly patients (Liang et al., 2019).  

What I was Hoping to Achieve  

I was hoping to eliminate the adverse effects the patient developed towards zolpidem. I was also hoping to improve his sleep quality, eliminate night awakening, and improve his daily functioning. I was also hoping to improve his overall tolerance to the treatment (Cuomo et al., 2019).  

Ethical Considerations  

The ethical consideration that informed the above decision is utilizing evidence-based data to ensure safety and efficiency in treating mental health disorders. Psychiatric mental health nurses should adopt evidence-based decisions to minimize potentials of patient harm. As a result, the decision to change the treatment aimed at eliminating further risks associated with zolpidem in insomnia treatment (Xiang et al., 2021).  

Decision 3 

Selected Decision  

Continue dose. Explain to patient he may split the 50 mg table in half. The decreased dose should minimize next day drowsiness. Follow up in 4 weeks.  

Why I Selected the Decision  

The client returned to the clinic in 2 weeks. He reported that trazodone is effective at 50 mg dose. However, he wakes up sometimes the following day with next-day drowsiness. He denies any auditory or visual hallucinations and is future oriented. These findings demonstrate the Trazodone has been effective in managing symptoms associated with insomnia. The patient denies night awakening and failing to recollect his experiences. He also does not take the drug with beer to enhance sleep quality. The next-day drowsiness is an expected finding because of the effect of the current dosage of trazodone (Cuomo et al., 2019). As a result, an effective solution would be to split the 50 mg tablet in half to minimize the next day drowsiness.  

Why the Other Two were not Selected? 

The decision to discontinue trazodone, initiate therapy with sonata 10 mg nightly at bedtime and following up in 4 weeks was not selected because trazodone had demonstrated the desired treatment outcomes. There was improvement in symptoms translating into no need to initiate the patient on a new drug. Similarly, the decision to discontinue trazodone and initiate therapy with hydroxyzine 50 mg at bedtime and following up in 4 weeks was not selected since trazodone had shown its effectiveness and efficacy. In addition, the patient has negative experience with diphenhydramine, which translate into a similar effect with hydroxyzine (Inoue et al., 2022).  

What I was Hoping to Achieve  

I was hoping to see sustained improvement in insomnia symptoms. I was also hoping that the patient will report minimal side effects associated with trazodone. Splitting the tablet into half was also expected to address the issue of next-day sleepiness (Cuomo et al., 2019).  

Ethical Considerations  

Ethical considerations such as justice, beneficence, and non-maleficence could have affected the adopted treatments. Accordingly, psychiatric mental health nurses demonstrate justice in their practice by ensuring confidentiality and privacy of the patient’s data. In addition, they ensure the adopted treatments are not harmful and aim at doing for their patients. Therefore, a violation of any of these principles would affect treatment outcomes.  


In conclusion, the initially adopted treatment to begin the patient with zolpidem was ineffective. The patient demonstrated signs and symptoms of adverse reactions to zolpidem. This increased the need for the adoption trazodone to minimize the adverse and side effects while improving the symptoms of insomnia. The decision to begin the patient with zolpidem and not trazodone is that trazodone is largely used in patients with insomnia associated with other disorders. The selection of trazodone proved effective for the patient. There was the elimination of night awakening, feeling knocked out, and having to add beer to enhance his sleep quality. The patient reported feeling sleepy the following day, which necessitated the splitting of the Trazodone 50 mg table into half to address it (Cuomo et al., 2019). This decision led to further improvement in insomnia symptoms and drug tolerance, hence, the effectiveness of the decision. 

Ethical considerations informed the patient’s treatment. Accordingly, the decisions made aimed at ensuring the promotion of safety, efficiency, and quality in the treatment process. The psychiatric mental health nurse practitioner made the decisions with the aim of optimizing benefits while minimizing the potential harm the selected drugs had on the patient. In addition, the principles of justice, autonomy, and beneficence, and non-maleficence informed the decisions made in the case study. For example, by minimizing harm, the nurse ensured the principle of non-maleficence. The use of evidence-based interventions in decision-making aimed at doing good for the patients (Xiang et al., 2021). Therefore, ethics guided the selected decisions in the patient’s treatment.  



Asok, A., Sreekumar, S., TK, R., CC, A., P, U. D., & K, P. (2019). Effectiveness of zolpidem and sleep hygiene counseling in the treatment of insomnia in solid tumor patients. Journal of Oncology Pharmacy Practice, 25(7), 1608–1612. 

Cuomo, A., Ballerini, A., Bruni, A. C., Decina, P., Sciascio, G. D., Fiorentini, A., Scaglione, F., Vampini, C., & Fagiolini, A. (2019). Clinical guidance for the use of trazodone in major depressive disorder and concomitant conditions: Pharmacology and clinical practice. Rivista di Psichiatria, 54(4), 137–149. 

Inoue, Y., Nishida, M., Kubota, N., Koebis, M., Taninaga, T., Muramoto, K., Ishikawa, K., & Moline, M. (2022). Comparison of the treatment effectiveness between lemborexant and zolpidem tartrate extended release for insomnia disorder subtypes defined based on polysomnographic findings. Journal of Clinical Sleep Medicine. 

La, A. L., Walsh, C. M., Neylan, T. C., Vossel, K. A., Yaffe, K., Krystal, A. D., Miller, B. L., & Karageorgiou, E. (2019). Long-Term Trazodone Use and Cognition: A Potential Therapeutic Role for Slow-Wave Sleep Enhancers. Journal of Alzheimer’s Disease, 67(3), 911–921. 

Liang, L., Huang, Y., Xu, R., Wei, Y., Xiao, L., & Wang, G. (2019). Eszopiclone for the treatment of primary insomnia: A systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials. Sleep Medicine, 62, 6–13. 

Pochiero, I., Gorini, M., Comandini, A., Calisti, F., Loreto, G. D., Cattaneo, A., Knight, T., Anastassopoulos, K. P., Patel, R., Baik, R., & Bruni, O. (2022). Real-World Characteristics and Treatment Patterns of Patients With Insomnia Prescribed Trazodone in the United States. Clinical Therapeutics, 44(8), 1093–1105. 

Sharma, M. K., Kainth, S., Kumar, S., Bhardwaj, A., Agarwal, H. K., Maiwall, R., Jamwal, K. D., Shasthry, S. M., Jindal, A., Choudhary, A., Anand, L., Dhamija, R. M., Kumar, G., Sharma, B. C., & Sarin, S. K. (2019). Effects of zolpidem on sleep parameters in patients with cirrhosis and sleep disturbances: A randomized, placebo-controlled trial. Clinical and Molecular Hepatology, 25(2), 199–209. 

Xiang, T., Cai, Y., Hong, Z., & Pan, J. (2021). Efficacy and safety of Zolpidem in the treatment of insomnia disorder for one month: A meta-analysis of a randomized controlled trial. Sleep Medicine, 87, 250–256.