Substance Abuse and Abuse Q 34
Which of the following short-term goals is most appropriate for a client with bipolar disorder who is having difficulty sleeping?
A. Obtain medication for sleep
B. Work on solving a problem
C. Exercise before bedtime
D. Develop a sleep ritual
Correct Answer: D. Develop a sleep ritual
A sleep ritual or nighttime routine helps the client to relax and prepare for sleep. At night, encourage warm baths, soothing music, and medication when indicated. These may promote relaxation, rest, and sleep. Avoid giving the client caffeine. A handful of experimental studies and case studies have reported that induced sleep deprivation is associated with the onset of hypomania or mania in a proportion of patients. Wehr, Goodwin, Wirz-Justice, Breitmaier, and Craig (1982) sleep-deprived nine rapidly cycling patients who were in a depressed phase stay for 40 hours (i.e., one night’s sleep deprivation). This triggered mania or hypomania in seven of the nine individuals.
Option A: Obtaining sleep medication is a temporary solution. Several of the current psychosocial treatment approaches include a component that targets sleep disturbance, including interpersonal and social rhythm therapy (Frank, Swartz, & Kupfer, 2000; Frank et al., 1999), family therapy (e.g., Miklowitz & Goldstein, 1997; Simoneau, Miklowitz, Richards, Saleem, & George, 1999), and cognitive behavior therapy administered individually (Lam et al., 2003) or in groups (Patelis-Siotis et al., 2001).
Option B: Working on problem-solving may excite the client rather than tire him. Preliminary studies indicate that aggressive readjustment of the sleep/wake cycle may be of particular help for treatment-resistant rapid cycling bipolar disorder. Such therapy may begin by enforcing complete light and sound deprivation for as many as 14 hours per night, which can be gradually reduced once a person’s moods are seen to stabilize.
Option C: Exercise before retiring is inappropriate. Keep the client in areas of low stimulation. Promotes relaxation and minimizes manic behavior. Encourage frequent rest periods during the day. Lack of sleep can lead to exhaustion and death.