Jun 25, 2019 in Health

Diagnosis & Treatment of Insomnia


Diagnosis of disorders requires specialized diagnostic tools, such as Diagnostic and Statistical Manual of Mental Disorders commonly referred to as DSM. This tool is a means of classifying disorders in human beings by issuing specific codes to them for effective understanding of the disorders. The material is important for the health professionals such as doctors and nurses in identifying the scope, by which the diseases affect the human population. This paper talks about the issues related to the disorders, mainly investigating a case study, and also discusses the issues associated with the cultural effects on the choice of the medical diagnosis of the disorders. The main case study for this paper concerns cases of sleep associated or sleep-wake disorders.

Sleep disorders have risk issues that may result in the consequential development of some mental conditions. Also, these are potential signs that warn about critical medical problems. Sleep interference can indicate a presence of problems related to the mind and neurological system (Hales, Yudofsky, & Roberts, 2014). They include Parkinson's disease, heart failure, and osteoarthritis, among others. Some of the sleep-wake disorders include insomnia, sexsomnia, and narcolepsy. Their diagnosis follows a detailed assessment that may include a look at the history of the patient, clinical testing, questionnaires, physical examinations and their sleeping diary.


Case Study

The case study for this topic revolves around a woman, 66 years old who had a primary complaint of lack of sleep for about eight months. Initially, the lady had a difficulty of staying asleep for more than three nights per week (Medscape, 2008). The matter has worsened since her health further deteriorated to a point that she has to wake up at least thrice per night for almost every night in the week (Medscape, 2008). She has always been a poor sleeper during times of stress, but the situation nearly always improved after a few day (Medscape, 2008)

Focusing on the medical history of the lady, it is evident that she underwent hypertension, mild stroke and osteoarthritis (Medscape, 2008). These attacks happened ten years ago, and she lost her perfect speech. However, the symptoms were never recurrent, and, therefore, she came back to an average life (Medscape, 2008). Also, the woman has undergone depressions during her 30s due to failing to hold a baby in her womb as a result of miscarriages. Apart from that, the woman has a medical history of drugs consumption such as atenolol, ibuprofen, hydrochlorothiazide, and diphenhydramine, among others (Medscape, 2008).

Identification of hallmark symptoms related to DSM criteria

The DSM criteria help in evaluating the diagnosis of a disease as far as the hallmark symptoms are concerned. For instance, using the case study of primary insomnia, the main symptom predominantly expressed is the condition where for a whole month, a person experiences difficulty in the initiation and maintenance of regular sleep. In some occasions, the person undergoes a form of non-restorative sleep (Hales, Yudofsky, & Roberts, 2014). Another criterion is the point where the patient has a sleep disturbance or occasionally has fatigue throughout the day. This fatigue builds up and causes clinically significant stress and results in problems related to occupational or social areas (Hales, Yudofsky, & Roberts, 2014).

The third criterion analyzes the sleep disturbance that is not present exclusively to other sleeping challenges such as narcolepsy, sleep disorders related to breathing, parasomnia, and the others. The next criterion to detect primary insomnia is through the point that the disturbance does not associate with the course of another mental disorder. The last approach is the idea that the disease does not associate with substances that give direct physiological impacts on the body such as drug abuse or even medication. According to the description above, the lady in the case study has conditions that match with the symptoms realized in diagnostic tools (Hales, Yudofsky, & Roberts, 2014).

Apart from the Diagnostic and Statistical Manual of Mental Disorders diagnostic tool, the International Classification of Sleep Disorders or the ICSD–2 classifies primary insomnia into three distinct categories. They include Psychophysiological, which is the fear of not failing to sleep, Paradoxical, and Idiopathic insomnia. This tool is also as significant as the Diagnostic and Statistical Manual of Mental Disorders, and it clearly describes the basics regarding the way insomnia should be handled.

DSM 5 & other diagnostic tools’ classification with numerical codes

The Diagnostic and Statistical Manual of Mental Disorders 5 classification is an improvement for the DSM-IV that contains information about disorders with codes assigned to them. For instance, in this scenario, the lady had different types of medical conditions in terms of signs and symptoms. Therefore, the DSM 5 puts the numerical code for each and every disorder. For instance, in this case, DSM-5 significantly assigns insomnia through a code of F51.01, and the ICDM-9-CM has the numerical codes: for example, the code of 307.42 (American Psychiatric Association, 2014). These formulations are important in addressing the patients that pertain to the particular characteristics of the patient in terms of the duration of lack of sleep (American Psychiatric Association, 2014).

Treatment Plan for Insomnia

There are two primary objectives of treating insomnia, and other related sleep-wake disorders include the improvement of the quality of sleep and also improving daytime-related impairments (Chawla, 2015). However, treatment strategies may vary because of the differences in etiology. Therefore, insomnia should be treated. There is the need to have both psychological and behavioral interventions when handling the insomnia treatment (Chawla, 2015).

There are different aspects considered when checking on how to correct the situation without interfering in the sociological aspects of life. She complains about alleviating the challenges. Therefore, the woman needs to meet medical professional works so that they can help in the mental therapy of the disorder. Some of the issues that can be sorted out through having a consultative meeting with the doctors include the effect of being a poor sleeper. 

Another issue to be checked is the medical history. The doctors need to conduct numerous diagnostic tests on the lady to identify such issues as the type of medication used during the time she was still young. Along with that, the issue of miscarriage may have traumatized her, and, therefore, this may have brought a mental problem in her life. Medical professionals should be able to help her with therapy as she overcomes the past depression. Another aspect that can be used is the type of medical disorders that can expose the lady patient into, and the effects of the drugs.

Multicultural factors affecting Mental Disorders

The family is a social set up that brings hope and leads a person to success. Being there for the loved ones was the best option for the woman in the case study. However, due to the challenge, she was not able to do so. As a matter of fact, her husband complained about the short time that he has to spend with her due to her sickness, and she disturbed his peace. Therefore, the best way of using this information in the assessment of the health of the lady is allowing her to take time for diagnosis according to the coding system of the mental disorder systems. 

There are many areas in the case study that make the woman undergo diagnosis and found issues related to insomnia. The use of the diagnostic tools discussed above presents the question about the remedies of solving such problems. The lady has to undergo various processes so that she can undergo treatment under the rules of the diagnostic interpretation. One of them includes conducting a consultative process between the patient and the professionals involved. 

However, it is first important to know the severity of insomnia. Acute insomnia lasts for about eight weeks, and it needs multifactorial tools to diagnose. Some of the interventions required for the treatment of the lady include nonpharmacological sleep hygiene therapy and sleep- restriction therapy. Medical professionals are necessary at this stage; the medical staff needs to ensure that the woman acquired proper treatment and therapy that aims at reducing the effects explained in the market. Also, insomnia patients can also be handled by a medical practitioner. 

Another form of treatment would be the administration of pharmacological therapies that will be able to counter the effects of the disorder. Some of these drugs include benzodiazepines, melatonin, and antidepressants. These drugs are functional in that they target the benzodiazepine and melatonin receptors in the living systems. Therefore, the selection of these drugs will depend on the factor specificities such as age, proposed treatment duration, and cost. It may also vary according to the historical background related to the use of medicines and illegal substances (Vorona, 2009). 

A culture is a set of norms put in place in a particular society, which makes the community conduct their activities in a different way as compared to another society. There is a typical relationship between the aspects of culture and medical phenomena (Bhugra & Bhui, 2007). One such instance is the measure of mental disorders that have both social and medical effects on the people involved. In fact, management of patients can be achieved through cultural psychiatry. 

Cultural psychiatry is a branch of social science that can relate the society with the medical issues involved, especially the mental challenges that affect the productivity of the community (Bhugra & Bhui, 2007). Culture can be able to affect the way people with insomnia are treated. Insomnia is an unpredictable disorder, and, therefore, it has to be handled by dealing with both medical and social factors. Thus, it is important to analyze the multicultural effects on disorders such as insomnia. One of the aims of this branch of psychiatry is the elucidation and delineating the paths that convert socially derived stresses into syndromes and symptoms. This discipline is necessary for most of research work if there is the need to understand the underlying medical truths such as the variations in the prevalence of the major mental disorders. The evaluation of these psychiatric challenges depends on a given ethnic population, race, and migratory status, among other societal matters (Bhugra & Bhui, 2007).

A medical professional should have the capability of fully understand the cultural background of his or her patients and be able to learn the basics of that culture with respect to the patient. Various multicultural factors influence psychopathology. For instance, basing on the argument of the 66-year-old woman, she had a normal lifestyle even before she became sick by insomnia. She lived happily with her family although when the disorder weakened her, she had queer behaviors such as being irritated when there was no motivation at work (Medscape, 2008). 

Most importantly, the patient never smoked but could take about two glasses of wine while taking dinner with her family. Besides, she has a stable family, with two children and a grandchild. From this scenario, it is clear that giving support to those who have mental disorders is one of the best cultural behaviors in the community. The patients need their families to stand by them. Her husband did not abandon his wife (Medscape, 2008).

When comparing the cultural backgrounds of people in different regions, it can be noted that in most cultures of the world, people do not wish to see their family members suffer. Therefore, they will do everything possible to keep them at home. There is the point of brotherhood, and, therefore, the diagnosis and the treatment of these patients can be made easier (Bhugra & Bhui, 2007). 


Diagnosis and treatment of mental disorders require a great deal of seriousness in all life spheres of influence. There are different means of diagnosing disorders, and some of them include DSM and ICDM-9-CM. With such tools as coded systems, the treatment of psychiatric challenges such as insomnia can be alleviated. Insomnia is one of the mental problems that cause lack of sleep. Without proper direction on its treatment, there is no success in reaching the targets of stopping disorders. Even culture affects the processing of this disorder. In such a way, the case study was relevant to the major topic of the studies about mental disorders.


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