The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
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Notes -
The way you write suggests to me that what I'm about to say may already be known to you, so mostly throwing out additional context for others-
Patient reported sleep issues are more about subjective experience in most cases (as opposed to objective). This is a big piece of why benzos can be popular while melatonin often isn't, since benzos effectively make you pass out more than they make you sleep but to patients that seems like a good deal.
Paradoxical agitation due to benzo administration in a hospital setting is a known quantity and dare I say it, the norm. However what to do about this becomes a complicated and long running fight. Yes, in some settings getting any sleep at all is the way to go (most classically: helping to abort a manic episode or substance induced insomnia) but more commonly we see nursing staff demanding benzo administration until the medical team or a consulting team gives up and recommends it to make nursing shut up.
Nursing isn't entirely wrong since an agitated patient takes away from others and can be dangerous in a variety of ways, but the literature suggests this is typically a bad idea.
For Quetiapine, Mirtazapine, and TCAs- for these managing the side effects is the primary problem. In the US we don't really use Quetiapine anymore because of concerns of weight gain, even in the setting of psychiatric comorbidity. Mirtazapine still has weight gain concerns but ultimately is better on that front so you see it more often. TCAs are a bit more complicated but probably the most commonly used option in settings where cost is a big factor.
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