Insomnia & Sleep Deprivation Nursing Care Plan and Management

Sleep and well-being work hand in hand, and getting good sleep is actually vital to the overall health of an individual as eating healthy and exercising regularly. Think of your body as a factory. Sleep is required to regain energy for physical and mental activities. If an individual can’t sleep, he or she may have insomnia.

Insomnia is a complicated condition and may be temporary or chronic. Short-term insomnia may occur in response to variations in work schedules, overnight stressors, or travel beyond different time zones. Long-term insomnia is linked to substance abuse such as drugs and alcohol, and other factors like chronic pain, chronic depression, obesity, and aging.

Sleep patterns can be affected by the environment, especially in the hospital setting where noise, lighting, frequent monitoring, and treatments are always present. The harm caused by not getting enough sleep can be immediate, so nursing care is crucial. Nurses should be aware of insomnia and how they can help patients to get a good sleep. The focus should be on educating patients with insomnia about its proper management and ways how to avoid such conditions.

Causes

Here are some factors that may be related to insomnia:

• Abnormal physiological symptoms (e.g., hypoxia, dyspnea, neurological dysfunction)
• Aging
• Anxiety
• Chronic stress
• Depression
• Emotional or physical discomfort
• Environmental variations
• Excessive stimulation
• Medications
• Pain
• Substance abuse

Signs and Symptoms

The following signs and symptoms characterize insomnia:

• Awakening earlier or later than desired
• Decreased health status
• Decreased quality of life
• Dissatisfaction with sleep pattern
• General tiredness
• Interrupted sleep
• Irritability
• Lack of energy
• Problems with concentration and memory
• Sleepiness during the day
• Verbal reports of difficulty falling asleep

Goals and Outcomes of Insomnia

The following are the common goals and expected outcomes for Insomnia nursing diagnosis:

• The patient will obtain optimal amounts of sleep as evidenced by a rested appearance, verbalization of feeling rested, and improvement in sleep pattern.
• The patient will have an improved sleep experience.
• The patient will understand the proper use of sleep aids or other medications.

Nursing Assessment and Rationales

This assessment may further assist in identifying changes that may lead to a diagnosis of insomnia or troubled sleep patterns that require action by nursing staff. Insomnia must be addressed in the best way possible to stop it from becoming a chronic problem.

1. Determine patterns of sleep in the past in a normal environment: amount, bedtime routines, depth, length, positions, aids, and other interfering factors.
Each individual has different patterns of sleep. Information about this topic provides baseline data for evaluating means to improve the patient’s sleep.

2. Take note of observations of sleep-wake behaviors. Take down notes on the number of hours the patient is asleep.
This provides baseline data for the evaluation of insomnia.

3. Note physical or psychological circumstances that hinder sleep such as noise, pain, discomfort, urinary frequency, fear, and anxiety.
The patient’s perception of insomnia may differ from objective evaluation.

4. Evaluate the patient’s knowledge of the cause of sleep problems and potential relief measures to facilitate treatment.
The patient may have insights about the existing problems (e.g., anxiety or fear about a certain situation in life). This data will determine the appropriate therapy.

5. Observe and evaluate the timing or effects of medications that can affect sleep.
Following medication schedules that require a lot of attention may affect the sleeping pattern of the patient, especially in the hospital setting.

Nursing Interventions and Rationales

The following are the therapeutic nursing interventions for Insomnia nursing care plan:

1. Educate the patient on the proper food and fluid intake such as avoiding heavy meals, alcohol, caffeine, or smoking before bedtime.
Having full meals just before bedtime may produce gastrointestinal upset and hinder sleep onset. Coffee, tea, chocolate, and colas which contain caffeine stimulate the nervous system. This may interfere with the patient’s ability to relax and fall asleep. Alcohol produces drowsiness and may facilitate the onset of sleep but interferes with REM sleep.

2. Encourage daytime physical activities but instruct the patient to avoid strenuous activities before bedtime.
In insomnia, stress may be reduced by therapeutic activities and may promote sleep. However, strenuous activities may lead to fatigue and may cause insomnia.

3. Encourage the patient to take milk.
L-tryptophan is a component of milk that promotes sleep.

4. Instruct the patient to follow a consistent daily schedule for rest and sleep.
Consistent schedules facilitate the regulation of the circadian rhythm and decrease the energy needed for adaptation to changes.

5. Remind the patient to avoid taking a large number of fluids before bedtime.
This will refrain the patient from going to the bathroom in between sleep.

6. Inhibit the patient from daytime naps unless needed.
Napping can disrupt normal sleep patterns; however, older patients do better with frequent naps during the day to counter their shorter nighttime sleep schedules.

7. Introduce relaxing activities such as warm baths, calm music, reading a book, and relaxation exercises before bedtime.
These activities provide relaxation and distraction to prepare the mind and body for sleep.

8. Tell the patient to write a journal regarding problems before retiring.
Journaling allows the patient to “set aside” problems or any mental activities just before going to sleep.

9. Educate the patient about the use of over-the-counter, herbal, and prescription sleep aids:
These may be beneficial when a patient experiences short-term sleep problems.

• 9.1. Melatonin
  Its main job in the body is to regulate night and day cycles or sleep-wake cycles. Older adults seem to tolerate melatonin with minimal side effects.

• 9.2. Antihistamines
  Many over-the-counter drugs contain antihistamines that can cause drowsiness, which might help the patient fall asleep for a few nights. These drugs produce anticholinergic side effects that may harm older adults.

• 9.3. Prescription sedative-hypnotics, anti-anxiety drugs
  These act through general central nervous system depression and disrupt the normal stages of non-rapid eye movement (NREM) and REM sleep. Long-term use may cause daytime drowsiness, rebound insomnia, and increased dreaming when discontinued.

• 9.4. Valerian, chamomile, lavender, kava
  Tea made by mixing chamomile and Valerian root together makes an excellent bedtime ritual that facilitates stress relief and relaxation. Chamomile acts to facilitate general relaxation rather than as an actual sleep aid, while Valerian causes drowsiness. Using Valerian together with kava may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Extra carefulness is necessary because some herbal products are not regulated by the FDA.

10. Suggest an environment conducive to rest or sleep.
A lot of people sleep better in a cool, dark, quiet environment.

11. Prevent the patient from thinking about the next day’s activities or any distracting thoughts at bedtime.
Providing a designated time for these concerns allows the patient to “let go” of these problems at bedtime.

12. Suggest the patient get out of bed temporarily and perform a relaxing activity if unable to sleep 30-45 minutes in bed.
The bed is not supposed to be used for watching TV, work, or wakefulness. The brain should associate the bed with sleeping.

13. For patients who are hospitalized:

• 13.1. Eliminate any activities that are not important.
  This measure facilitates minimal interruption in sleep or rest.
  
• 13.2. Place the patient in a room away from any distraction or noise such as the nursing station.
  The nursing station is often the center of noise and activity.
  
• 13.3. Provide a “Do not disturb” sign in the patient’s room.
  It is necessary to alert people in this kind of situation to avoid disruption of sleep.
  
• 13.4. Render bedtime nursing care such as back rub and other relaxation techniques.
  These kinds of activities facilitate relaxation and promote the onset of sleep.
  
• 13.5. Attempt to allow for sleep cycles of at least 90 minutes.
  Research shows that 60 to 90 minutes are necessary to complete one sleep cycle and that the completion of an entire sleep cycle is beneficial.
  
• 13.6. Educate patients about their sleep requirements.
  Most people need at least six hours of sleep for normal memory and brain function.
  
• 13.7. Help the patient understand the main cause of sleeping difficulties.
  Misconceptions and myths about sleep exist. Wrong notions about sleep disturbances may cause fear and anxiety.

7 Sleep-Promoting Tips Nurses Must Share to their Clients

Sleep is one thing that is universal to people. It is a human need and in fact, humans spend a third of their lives sleeping. It is vital for optimal psychological and physiological functioning. Sleep is essential to conserve energy, prevent fatigue, and to restore the mind and the body.

While sleep is something that one falls into spontaneously, research studies and health records suggest otherwise. According to 2015 surveillance report of Centers for Disease Control and Prevention (CDC), 50-70 million Americans are estimated to be suffering from sleep or wakefulness disorder. Moreover, nearly half of this report snoring and 35% only have more than seven (7) hours of sleep on a typical 24-hour day. Incidences of drowsy driving and unintentionally falling asleep during the day have been recorded too. Truly, sleep disorders and deprivation are unmet public health problems. Moreover, it is linked to vehicular accidents, occupational and medical errors, and industrial accidents.

Currently, increasing public awareness on this health problem is a priority. Ongoing researches about sleep medicine and somnology (the study of sleep) are being done as well as increase the education and training of healthcare professionals in handling this health problem.

Sleep Hygiene

In promoting sleep, nurses are mainly involved in sleep hygiene, which refers to the set of interventions used to improve and promote sleep. Nurses use nonpharmacologic measures to increase the quantity and quality of clients’ sleep. Sleep hygiene encompasses health education on sleep rituals and habits, restful environment, comfort and relaxation, and occasionally, use of hypnotic medicines.

Individuals should need to realize the importance of sleep and its relation to fulfillment, productivity, and activity. Here are seven sleep-promoting tips nurses must share to their clients:

1. Relief for the Sleep-Challenged

For individuals who have difficulty initiating and maintaining sleep, establishing regular bedtime and wake-up time must be observed strictly. Through this, biologic rhythm is enhanced, and the body slowly falls into the established routine.

For individuals who are unable to sleep, they must get out of bed and spend some time in another room. There, they can start some relaxing activities like reading and listening to soft music. They should continue the activity till they fill drowsy. Bedtime stories can relax children, holding onto a favorite toy or blanket, and a goodnight kiss.

Of course, some individuals are fond of naps. However, there are few considerations about naps. For example, a short daytime nap of 15-30 minutes can be restorative for elders and will not interfere with the nighttime sleep. On the other hand, insomniacs are cautioned to avoid naps.

2. Beating the Hours Before Bedtime

Questions about appropriate activities near bedtime hours are common. In fact, activities are one of the major factors that can affect sleep. As a rule, dealing with office work and family problems should be avoided before bedtime. It is also helpful to establish a regular and relaxing bedtime routine composed of quiet activities like taking a warm bath and reading.

It is important that one associates bedroom for sleep. Therefore, the bedroom should only be used for sleep and sexual activities. Work materials, television, and computers should be taken out of the bedroom. Having television and computers inside the room will only strengthen the association between wakefulness and sleep. Lastly, for individuals who only have the night available for exercising, avoid excessive physical exertion three (3) hours before bedtime.

Rituals can be supported in institutionalized patients by assisting them with a hand and face wash, massage, pillow plumping, and even talking about today’s accomplishments and enjoyable events. These can promote relaxation and peace of mind.

3. Setting Up a Sleep-Inviting Environment

A sleep-conducive environment should have minimal noise, comfortable room temperature, mattress, and pillows, and appropriate ventilation and lighting. According to studies, music is discouraged because it is interesting and will promote wakefulness. Extraneous noise from a fan, air conditioner, and white noise machine must be blocked out. Most people may prefer a darkened environment, but children and individuals in a strange environment would benefit from a low light source.

For patients in the hospital, factors that can prevent sound sleep include staff noise during shift , telephones and call lights, doors, paging systems, and even carts wheeled through corridors. Safety and comfort can be promoted by raising side rails, placing the bed in a low position, and using night-lights.

4. Diet for Good Sleep

For a good quality of sleep, heavy meals should be avoided 2-3 hours before bedtime. Foods that contain alcohol and caffeine (e.g. chocolates, coffee, etc.to easily fall) should be avoided 4 hours before bedtime. Both substances can interfere with sleep because of their diuretic properties. They will cause individuals to feel the need to void during sleep time. If bedtime snack is necessary, a glass of milk or a share of light carbohydrates is recommended. Heavy and spicy foods should be avoided because they can disturb sleep by inducing gastrointestinal distress.

5. Promoting Comfort and Relaxation

These measures are essential to help the client all and stay asleep, especially if an illness is present and interferes with sleep. Nurses and family members should be concerned and caring during these times.

Interventions that can promote comfort and relaxation include assisting with hygienic routines, providing loose-fitting nightwear, encouraging voiding before sleeping, and making sure bed linen is smooth, clean, and dry. Elders are susceptible to feeling cold so encouraging them to wear their own clothing together with socks or leg warmers instead of hospital gowns can help. A prewarmed bath blanket or cotton flannel sheets can also be used.

6. Addressing Emotional Stress

It is nearly impossible for individuals who are emotional to fall easily into a deep slumber. Emotional stress interferes with the individual’s ability to rest, relax, and sleep. Slow and deep breathing techniques for few minutes can alleviate tension and induce calm. Other techniques that can be taught include imagery, yoga, and meditation.

7. Medication for Enhanced Sleep

Sometimes, medications are prescribed on per needed basis. Sedative-hypnotics can induce sleep. Antianxiety or tranquilizers can reduce anxiety and tension. For patients feeling pain, analgesics must be taken before bedtime to relieve aches and pains. Other medications may cause insomnia so a consultation with the provider is encouraged.

Medications are only used as a last resort. Caution is advised on over-the-counter (OTC) drugs because they might have antihistamine components which can cause daytime drowsiness.

These self-promoting measures are actually simple but today’s indulgence for modern technology and other factors can challenge its strict implementation. There is not a more painful thing than not finding solace in an activity that is supposed to re-energize you. This is why nurses must be active in their involvement for sleep promotion. Be a part of someone’s good night sleep by sharing these tips now!

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database ^{MUST READ!}
  Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
  Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

References

Additional references for this insomnia nursing diagnosis.

• Krishnan, P., & Hawranik, P. (2008). Diagnosis and management of geriatric insomnia: a guide for nurse practitioners. Journal of the American Academy of Nurse Practitioners, 20(12), 590-599. [Link]