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Administer a sedative-hypnotic drug if orderedThis should not be the first step. Pharmacologic interventions are considered only after non-drug measures fail due to potential adverse effects and risks such as dependence or oversedation.

Offer tea made with the herbal preparation valerianHerbal remedies may promote relaxation but are not the initial intervention in the hospital. Additionally, herbal supplements may interact with prescribed medications and are generally not given without provider approval.

Encourage the patient to exercise by walking up and down the halls a few times if toleratedExercising before bedtime is not recommended, as it may increase stimulation and make it harder to fall asleep. Physical activity is best encouraged earlier in the day.

Terminal insomniaTerminal insomnia involves waking up too early and being unable to fall back asleep. While problematic, it is not typically associated with vivid nightmares after medication withdrawal.

Transient insomniaTransient insomnia is short-term insomnia related to stress, changes in environment, or situational factors. It does not explain the nightmares and restlessness after stopping triazolam.

Initial insomniaInitial insomnia refers to difficulty falling asleep at the start of the night. It does not match the clinical picture of nightmares and increased restlessness after stopping a sleep medication.

The sedative causes feelings of relaxation and rest, and the hypnotic agent causes feelings of restlessness and anxiety.Hypnotics are not intended to increase restlessness or anxiety—they promote sleep.

The hypnotic agent produces sleep, and the sedative causes no hangover effect.Both sedatives and hypnotics can cause residual drowsiness or a “hangover effect,” especially in older adults. The difference lies in sedation versus sleep induction, not adverse effects.

The hypnotic agent causes feelings of relaxation and rest, and the sedative produces sleep.
This reverses the definitions. Sedatives relax without always producing sleep, while hypnotics directly promote sleep.

Initial insomniaInitial insomnia refers to difficulty falling asleep at the beginning of the night, not frequent nighttime awakenings.

Terminal insomniaTerminal insomnia involves waking too early in the morning and being unable to return to sleep, which is not described in this scenario.

Transient insomniaTransient insomnia is short-term, usually lasting a few days and often related to stress or environmental changes. A duration of one month exceeds the typical definition of transient insomnia.