Journal of Pharmaceutical Research & Reports

A Case Study of Parasomnia with Concurrent Insomnia and Zolpidem Sensitivity

The patient presented with soliloquy episodes that were precipitated by partial arousals 1-3 hours after sleep onset. Structured clinical interview findings indicated a co-occurrence of increased work stress and new onset of taking z-hypnotic presentation. The patient denied a childhood/adolescent history of sleep disorder/ parasomnia. The clinical interview ruled out psychopathology although some adjustment disorder with Anxiety DSM5-TR criteria were met. The patient stated the reason for referral was difficulty falling asleep. He stated that the Insomnia was at sleep onset with intervals of forty to ninety minutes to fall asleep for the two months prior to intake. And, concurrently, he had just received a promotion at work that moderately increased his responsibilities and time commitment to work related tasks. He reported feeling ambivalent about the new job in that he had to reduce his time with his two school-aged children, time with his wife and family in the evening and bike rides. No medical history, illness or other prescription was reported by the patient. Thus, his referral reason also included situational stress. The patient had received a three- month prescription of Zolpidem 10mg HS the day before the intake interview and stated that he planned to take the medication. Weekly session of Cognitive Behavior Therapy was started and included sleep log, tracking of prescription with heavy focus on Insomnia and stress management. One specific intervention was the teaching of Mindfulness meditation for the patient to use as a strategy to relax for sleep and to dissipate the workday stress. Disruptions in sleep that occur alongside sleep are termed parasomnias [1]. Non-Rapid Eye Movement (nREM) parasomnia disorder typically evokes from Stage 3/4 deep sleep. Complex, clinical behaviors occur during these arousals. Table 1 lists the NREM parasomnia and associated behavior.

Table 1: Non-REM Parasomnia Description

Clinical Findings

The patient responded to the CBTi intervention. He reported satisfaction in learning the strategy and found the application of mindfulness meditation to be effective and satisfying. Table 2 reflects the patient’s sleep log and prescription monitoring within the context of soliloquy disruptions in sleep. Thus, a focus of what additional factors may be or had been activating, perturbing within the first week of CBT when he was concurrently taking the Zolpidem prescription. It has been considered that an activity circumstance was occurring. Researchers have identified, in basic research, a possible activating component of Zolpidem as inhibiting cortical signals may be occurring [2,3].

Table 2: Patient Parasomnia Symptom, Sleep Efficiency

Conclusion

A possible activating effect from the prescribed Ambien in a patient referred for Insomnia treatment is considered as a compensatory response to the initial hypnotic state induced by the pharmakinetics of the medicine. Further, it seems that the arousal from stress that the patient, is, as it commonly occurs, a twenty-four-hour response and thus the sopheric effect of the prescribed Ambien was only sufficient for sleep induction as intended and then nighttime arousals, once freed from the pharmacological bridle, set forth. This patient responded well to the mindfulness relaxation training in the CBT approach to his care. A lesson of this clinical case is a reminder of the twenty-four states of psychological conditions-a daily tension ridden day and night where peaceful restorative sleep is perturbed by arousals in this patient’s case, soliloquy vocalizations [4].

References

1. Sexton Radek K, Graci G (2022) sleep disorders. https:// bloomsbury.com/uk/sleep-disorders-9781440864452/.
2. Seiber J, Aton SJ, Jha SK, Coleman T, Dumoulin MC, et (2008) The non-Bennzodiazepam hypnotic Zolpidem impairs sleep-dependent cortical plasticity. Sleep 31: 1381-1391.
3. Zhang J, Yetton B, Whitehurst LN, Maji M, Mednick SC (2002) The effect of zolpidem on memory consolidation over a night of sleep. Sleep 43: 1-12.
4. Hrozanøva M, Morrison I, Riha RL (2019) Adult NREM parasomnia: An update. Clocks & Sleep 1: 87-104.