Question

37 yo F evaluated for a 6 year hx of difficulty initiating sleep and significant sleepiness. She works as a RN and notes that daytime sleepiness is exacerbated when she works several night shifts in a row at the hospital.Most appropriate management?

Answer 1

The 37-year-old nurse with sleep initiation difficulties should first assess her sleep hygiene and may need a sleep study to rule out narcolepsy or other disorders. Behavioral changes and consistent sleep schedules are important, and cognitive-behavioral therapy could be considered before resorting to pharmacological treatments.

Step-by-step explanation:

Approach to Management of Sleep Difficulties

A 37-year-old female registered nurse is experiencing difficulty initiating sleep and significant daytime sleepiness, exacerbated by working night shifts. The initial step in managing such a case is to evaluate sleep hygiene and underlying conditions. In light of her history and symptoms, a detailed assessment and potential sleep study may be necessary to rule out disorders such as narcolepsy, which can present with excessive sleepiness and other symptoms as seen in McCarty's case study. Given the complexity of sleep disorders and the variable response to treatment, a combination of behavioral strategies and medication, like the use of a stimulant combined with an antidepressant, can be effective.

It is essential to address shift work, which can disrupt the circadian rhythm, leading to symptoms similar to jet lag. Reducing the frequency of rotating shifts or maintaining a consistent sleep schedule, even on days off, may help improve the nurse's sleep quality. Cognitive-behavioral therapy (CBT) has also proven to be effective and might be considered before pharmacological interventions, which should be used with caution given the potential for overmedicalization and side effects.