The Problems Associated With Insomnia


082509

Due to the recent death of Michael Jackson, the problems associated with insomnia have been in the media. As a nurse, it is easy to research and provide links to information that may be of some use; as an insomniac it is less easy to find or to give any concrete assistance.

Insomnia is defined not as an actual disorder but rather a symptom of a deeper problem or disorder. In other words, in order to treat he insomnia the person must discover the reason for the insomnia in the first place. Well, "easier said than done."

There are three specific types of insomnia, transient, chronic, and short-term. However, knowing the kind of insomnia you are experiencing may be helpful but it is not the ultimate answer. The ultimate answer still lies in defining the cause of the insomnia in the first place.

For some people this may lead to an unwelcome path of self discovery, especially if the signposts along the way spell out "alcoholism," "drug abuse" or "psychiatric problems." If so, this may be as far as the ordinary person on the street suffering with insomnia will pursue the cause and the relief for the cause. That is the most heartbreaking truth of all; that persons with insomnia continue to "suffer" because they cannot face their own reflection in a mirror and thus, change that reflection.

The reason for the insomnia may well be different from person to person or from instance to instance. As someone affected by insomnia most of my life the reasons change depending on the circumstances. Stress at work or at home, fear of the unknown, anxiety over an assignment or a grade or a test, all of these produce the inability to sleep. Then being sleep deprived causes whatever was causing the sleeplessness to worsen, and the cycle repeats itself.

If the person has access only to over the counter or herbal remedies the person may cause harm to themselves. An antihistamine such as diphenhydramine (Benadryl) is one popular sleep aide. Antihistamines can be dangerous for use by patients with heart or blood pressure problems as the vessels become constricted and the blood pressure can rise. Continuous use causes the effects to decreas, which can cause the user to repeatedly increase the dosage and this of course causes the potential for harm to rise.

Another over the counter drug for insomnia is Doxylamine (Unisom)

This drug can cause excessive sleepiness, which can definity become a problem is your commute time is over 20 minutes. If you wake up groggy, still sleepy then chances are the longer you are at the wheel on the way to work, the more likely you will be to fall asleep at the wheel. Not a good start to any day!

If the person with insomnia has access to a physician or a group of physicians the potential for harm increases exponentially. If the patient will not allow the current physician access to the previous physicians notes, if the patient tries to bulldoze the current physician, if the patient has so much "clout" the current physician feels unable escape the situation, then again, potential for great harm will ensue. However, it should be noted here that any physician and indeed, any patient has the RIGHT to “discontinue services” at any time. The physician must give a letter stating their services will be discontinued within thirty days and this allows the patient time to find another physician. The patient, on the other hand, does not need a letter nor does the patient need to give a thirty day notice.

The one thing that strikes this nurse as unusual in the Michael Jackson case is that the media states the physician asked for information about the other physicians’ orders and medications but that Michel Jackson refused to give this information. According to the JCAHO patient rights act, this release of information is signed before services are rendered at any physician office. However, HIPAA (Health Insurance Portability and Accountability Act) also states the patient has the right NOT to sign this form and that the patient will NOT be retaliated against by NOT signing this form or by filing a complaint or grievance against anyone who that patient feels has violated these patient rights. This may make a difference in the way this form is viewed in the future.

The important thing to remember this that BOTH the physician and the patient are protected, in some form, to some degree by their rights. The one that is most important as far as a physician, or a nurse, is the axiom they stand by; that of “First, do no harm.” The most difficult thing for any nurse to do is to stand up to a superior and say, “I do not feel comfortable with this order.”

There are multiple sites that will assist with ways to deal with insomnia.

There are multiple clinics, so named sleep centers, which will assist with insomnia.

There are multiple physicians that will or will not assist with any prescription medication available for insomnia.

The one person that will be of most benefit to the person with insomnia is the person with insomnia.

The above information is given to you, the reader, not only as one insomniac to another, not only as one curious onlooker into the Michael Jackson demise to another, but as one good nurse attempting to assess and instruct. (AKA mean nurse that will not tell you what you’d really like to here like how to find a doc that will give you the really good stuff!)

The above information is give to you, the reader, as an insomniac who found the best physician in the world, who finally told me all that I have just written (AKA mean doc that wouldn’t give the really good stuff!)

Sleep tight; don’t let the bed bugs bite!

Hey! I could have told you what my Daddy always told me when I complained of not having the time or not being able to sleep or not knowing what was going to happen etc. He would just say

“What are you doing at two o’clock in the morning anyway? You could be UP Doing Something!”

And my physician wonders why I have problems sleeping…geez!
barbara bethard