Coryn has been referred to the PMHNP because she has a significant sleep disorder that has not been responsive to typical primary care strategies
Answer: Coryn has been referred to the PMHNP because she has a significant sleep disorder that has not been responsive to typical primary care strategies
Although the use of sedative hypnotics, improving sleep hygiene and avoiding daytime naps have all been helpful in getting her to get some sleep, none of these strategies seem to be helping Coryn with her primary problem. It is important to keep an eye on the sleep patterns during the first few months of use to monitor for excessive drowsiness/sleepiness/lightheadedness. In this initial phase, continue to monitor for signs that the medication is masking a deeper issue. If it does not become less frequent or less severe, we may need to consider alternative medication options.
But what is the solution? Who can help improve her sleep? The PMHNP draws from years of scientific research and consulting practice to provide recommendations for treatment as individualized as each patient. Give your patient a copy of Helping Your Patient Sleep, or ask your local hospital for a copy. Caffeine has been shown to disrupt the circadian rhythm in many patients, which only worsens their sleep problems. And don’t forget that caffeine may work synergistically with many other medications, such as anti-anxiety drugs. Upping the dosage may be necessary to achieve a positive effect. Some patients try taking melatonin supplements to enhance their sleep, but researchers have repeatedly demonstrated that no effective differences exist between melatonin and placebo. There are reports of success with taking these medications in low doses at bedtime; others need higher doses. Coryn has tried all of these strategies without success so far, so there must be something she is missing in order for them to work. A thorough eye examination is indicated to exclude any obvious pathology that might explain her sleeping problem—or to detect it just in case one is present and needs treatment. What about going to a sleep specialist who can prescribe medication if conventional strategies fail? The PMHNP feels
Coryn, I understand that you are frustrated with your chronic sleep problem and would like to resolve this issue. I will do my best to address your problem with a plan of action that is simple, safe and effective. Unfortunately, as you probably know, there is no cure for most circadian rhythm sleep disorders. I do recommend a number of strategies to help improve sleep when your circadian rhythm is disturbed. Most importantly, you must make consistent lifestyle changes to help improve your quality of life and stay healthy over the long term. Your main objectives should include the following:
The following strategies have been noted to help people with the following problems: Melissa, Johnny, Matt. She has been advised to try each of the following strategies for one week before meeting with her nurse practitioner again:
If you’re like most people, sleep is the one thing that you take for granted. But your body isn’t ‘doing it right’ if it is causing problems in your life or relationships. It takes an experienced sleep specialist to make sure that your sleep is as good as it can be. At Lakewood Sleep Medicine, we give highly qualified professional advice for both psychological and physiologic causes of abnormal sleeping patterns. We’re here when you need us – just call us at (442) 937-6331 anytime and you will always get a live person from our team who are experienced in circadian rhythm disorders, including delayed sleep phase syndrome (DSPD). We can help you put your best foot forward – even if you feel tired or have difficulty waking up at the same time every morning, we have strategies to help overcome these problems. We work together with you and your physician to find a solution that works best for you and your family.
At the end of each day, you will have difficulty getting up and functioning. You will nap all day if you are not careful, and you will be continually fatigued. Sleep can never be better for you in the long-term without treatment. Such a situation means you have a serious sleep disorder that your medical practitioners do not recognize. I am offering my services as a sleep therapist, who can help you restore regular sleep habits in a manner that is both sustainable and successful. Here are some suggestions that may assist you:
Coryn has been referred to the PMHNP because she has a significant sleep disorder that has not been responsive to typical primary care strategies. She has tried sedative hypnotics, improving sleep hygiene, avoiding daytime naps, melatonin, and almost anything else suggested. She has always had trouble sleeping “like normal people,” but she is newly married and her sporadic sleep patterns are beginning to cause stress in the marriage. Her history suggests a circadian rhythm sleep disorder. When counseling Coryn, the PMHNP advises her that all the following strategies have demonstrated success except: