Case Example: Anxiety Disorder with Sleep Disorder (Follow-Up) NRNP 6635 – Week Assignment
Case: Anxiety Disorder with Sleep Disorder (Follow-Up)
A 34-year-old African American female with Panic Disorder and Chronic Insomnia returned for follow-up. She reports waking up multiple times during the night due to panic attacks characterized by a racing heart and shortness of breath. She describes feeling constantly on edge during the day, with difficulty focusing and irritability. She denies recent changes in diet, substance use, or significant life stressors.
Plans include continuing psychotherapy focused on panic management, introducing diaphragmatic breathing exercises for nighttime anxiety, and discussing the potential use of a low-dose sedative for acute sleep disruptions. Follow-up is scheduled in four weeks to reassess symptoms and evaluate the need for additional interventions.
1. Introduction
Patient: 34‑year‑old African American female.
Diagnoses: Panic Disorder and Chronic Insomnia.
Clinical Context: Follow‑up visit after initial treatment planning.
Presenting Concerns:
Waking up multiple times at night due to panic attacks.
Panic attacks characterized by racing heart and shortness of breath.
Constant daytime hyperarousal, difficulty focusing, irritability.
Denies recent changes in diet, substance use, or major stressors.
Preceptor Plan:
Continue psychotherapy focused on panic management.
Introduce diaphragmatic breathing exercises for nighttime anxiety.
Discuss potential use of low‑dose sedative for acute sleep disruptions.
Follow‑up in four weeks to reassess symptoms.
2. Panic Disorder
Definition
An anxiety disorder characterized by recurrent, unexpected panic attacks and persistent concern about future attacks or their consequences.
Panic attacks involve sudden surges of intense fear or discomfort, peaking within minutes.
DSM‑5 Criteria
Recurrent unexpected panic attacks.
At least one attack followed by ≥1 month of persistent worry about additional attacks or maladaptive behavioral changes.
Not attributable to substance use or another medical condition.
Not better explained by another mental disorder.
Clinical Features in Case
Nocturnal panic attacks waking patient from sleep.
Somatic symptoms: racing heart, shortness of breath.
Daytime hypervigilance, irritability, difficulty focusing.
Functional impairment due to disrupted sleep and anxiety.
Risk Factors
Female gender.
Family history of anxiety disorders.
Stressful life events.
Neurobiological vulnerability (dysregulation of amygdala, serotonin, norepinephrine).
Assessment Tools
Panic Disorder Severity Scale (PDSS).
Beck Anxiety Inventory (BAI).
DSM‑5 criteria checklist.
Treatment
Pharmacological: SSRIs (sertraline, paroxetine), SNRIs (venlafaxine), benzodiazepines (short‑term).
Psychotherapy: CBT (panic management, exposure therapy, cognitive restructuring).
Lifestyle: Relaxation techniques, exercise, sleep hygiene.
3. Chronic Insomnia
Definition
Difficulty initiating or maintaining sleep, or waking too early, with associated daytime impairment.
Chronic insomnia persists ≥3 nights per week for ≥3 months.
Clinical Features in Case
Multiple nighttime awakenings due to panic attacks.
Difficulty returning to sleep.
Daytime fatigue, irritability, poor concentration.
Chronic pattern of disrupted sleep.
Risk Factors
Co‑occurring psychiatric disorders (panic disorder, depression, PTSD).
Female gender.
Stressful life events.
Poor sleep hygiene.
Hyperarousal and anxiety.
Assessment Tools
Insomnia Severity Index (ISI).
Sleep diaries.
Polysomnography (if needed).
Treatment
CBT‑I (Cognitive Behavioral Therapy for Insomnia):
Sleep restriction therapy.
Stimulus control (bed only for sleep).
Cognitive restructuring (challenge maladaptive sleep beliefs).
Relaxation training.
Pharmacological (short‑term): Non‑benzodiazepine hypnotics, low‑dose sedatives, melatonin.
Lifestyle: Sleep hygiene, mindfulness, relaxation techniques.
4. Comorbidity: Panic Disorder and Insomnia
Interaction:
Panic attacks disrupt sleep, leading to insomnia.
Insomnia increases vulnerability to panic attacks by reducing resilience.
Hyperarousal perpetuates both conditions.
Clinical Implications:
Must treat both disorders concurrently.
Integrated approach essential.
Challenges:
Nighttime panic attacks resistant to treatment.
Risk of dependence on sedatives.
Functional impairment due to fatigue and anxiety.
5. Psychotherapy for Panic Disorder
Cognitive Behavioral Therapy (CBT)
Psychoeducation: Understanding panic attacks and anxiety.
Cognitive restructuring: Challenging catastrophic thoughts.
Exposure therapy: Gradual exposure to feared sensations or situations.
Relaxation training: Breathing exercises, mindfulness.
Application in Case: Focus on nocturnal panic attacks, daytime hyperarousal, coping strategies.
6. Diaphragmatic Breathing Exercises
Definition
Deep breathing technique engaging diaphragm to promote relaxation and reduce anxiety.
Slows heart rate, reduces hyperventilation, calms nervous system.
Application in Case
Practice before bedtime to reduce nighttime anxiety.
Use during nocturnal panic attacks to regain control.
Incorporate into daily routine for stress management.
7. Pharmacological Considerations
Low‑dose sedatives: May be considered for acute sleep disruptions.
Risks: Dependence, tolerance, daytime sedation.
Alternatives: Non‑benzodiazepine hypnotics, melatonin.
Clinical Decision: Use short‑term, lowest effective dose, monitor closely.
8. Monitoring and Follow‑Up
Four‑week follow‑up: Assess panic frequency, sleep quality, adherence to therapy.
Progress Indicators:
Reduced nocturnal panic attacks.
Improved sleep onset and maintenance.
Decreased daytime fatigue and irritability.
Adjustments:
Medication initiation if needed.
Intensify therapy if symptoms persist.
Family involvement if appropriate.
9. Nursing and Clinical Implications
Assessment: Monitor panic attacks, sleep patterns, daytime functioning.
Intervention: Support CBT, teach diaphragmatic breathing, encourage adherence.
Education: Explain panic‑insomnia link, benefits of therapy.
Support: Encourage social support, family involvement.
Safety: Monitor for suicidality, relapse risk, medication side effects.
10. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.
Consent: Informed consent for treatment.
Stigma: Address stigma of anxiety and sleep disorders.
Cultural Sensitivity: Respect patient’s African American background and beliefs about mental health and healing.
11. Summary
Patient presents with comorbid panic disorder and chronic insomnia.
Nocturnal panic attacks disrupt sleep, leading to daytime fatigue and irritability.
Integrated treatment plan includes psychotherapy, diaphragmatic breathing, possible sedative use.
Follow‑up scheduled to monitor progress.
Goal: Reduce panic attacks, improve sleep, enhance functioning and quality of life.
📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.
What are the patient’s diagnoses? a) Depression and OCD b) Panic Disorder and Chronic Insomnia c) Bipolar Disorder and ADHD d) PTSD and GAD
What symptom wakes the patient at night? a) Hunger b) Panic attacks with racing heart and shortness of breath c) Pain d) Noise
What therapy is planned to address panic disorder? a) Psychoanalysis b) CBT focused on panic management c) ECT d) Dialysis
What breathing technique is introduced for nighttime anxiety? a) Hyperventilation b) Diaphragmatic breathing c) Rapid shallow breathing d) None
What is the patient’s age? a) 30 b) 34 c) 40 d) 45
Which medication type may be considered for acute sleep disruptions? a) Low‑dose sedative b) Antipsychotic c) Antibiotic d) Stimulant
Which tool assesses insomnia severity? a) ISI b) PCL‑5 c) CAPS‑5 d) Y‑BOCS
Which therapy is gold standard for panic disorder? a) CBT b) Psychoanalysis c) EMDR d) DBT
Which lifestyle intervention supports sleep? a) Sleep hygiene b) Smoking c) Alcohol use d) Excess caffeine
Which symptom is common in both panic disorder and insomnia? a) Nighttime awakenings b) Hallucinations c) Delusions d) Mania
What is scheduled in four weeks? a) Hospitalization b) Follow‑up appointment c) Family therapy d) Court hearing
Which relaxation technique reduces hyperarousal? a) Diaphragmatic breathing b) Smoking c) Alcohol use d) Excess caffeine
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
