OASIS C1: Helping patients to identify and manage insomnia will help manage other medical problems, most significantly...
- Atheroschlerotic coronary artery disease
- S/P Myocardial infarction
- Congestive heart failure
- Cardiac arrhythmia
- Cerebrovascular disease
- Diabetes Mellitus
As the home care professional you should should focus on
Educating the patient about good sleeping habits.
Good sleep habits include having a regular sleep schedule, avoiding stimulating activities before bed, and having a comfortable sleep environment.
Cognitive behavioral therapy. This type of therapy helps the patient control or eliminate negative thoughts and worries that keep her/him awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make the patient sick.
Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help the patient control the breathing, heart rate, muscle tension and mood.
Stimulus control. This means limiting the time the patient spends awake in bed and associating the patient'spatient's bed and bedroom only with sleep and sex.
Sleep restriction. This treatment decreases the time the patient spends in bed, causing partial sleep deprivation, which makes her/him more tired the next night. Once her/his sleep has improved, the patient'spatient's time in bed is gradually increased.
Remaining passively awake. Also called paradoxical intention, this treatment for learned insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.
Light therapy. If the patient falls asleep too early and then awakens too early, she/he can use light to push back the internal clock. The patient can go outside during times of the year when it's light outside in the evenings, or the patient can get light via a medical-grade light box.
Educating the patient about prescription medications.
Taking prescription sleeping pills — such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem) — may help the patient get to sleep. Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several medications are approved for long-term use.
Over-the-counter sleep aids. Nonprescription sleep medications contain antihistamines that can make the patient drowsy. Antihistamines may initially make the patient groggy, but they may also reduce the quality of sleep, and can cause side effects such as daytime sleepiness, dizziness, urinary retention, dry mouth and confusion. These effects may be worse in older patients. Antihistamines also can worsen urinary problems, causing the patient to get up to urinate more during the night.
No matter what the patient's age, insomnia usually is treatable.
The key often lies in changes to the her/his routine during the day and when she/he goes to bed. Good sleep habits promote sound sleep and daytime alertness.
adapted from the Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/insomnia/basics/tests-diagnosis/con-20024293