Insomnia is a common condition that plagues many individuals. It can be caused by stress, anxiety, depression, and other factors. Many interventions can help with insomnia, including meditation and relaxation techniques.
This blog post will address nursing diagnosis for insomnia, the care plan, and what kind of intervention should be used based on different situations, as a guide to nursing students.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
What is Insomnia?
Insomnia is defined as difficulty falling asleep, staying asleep, or both. The American Academy of Sleep Medicine defines insomnia as a sleep disorder that affects up to 10% of the population. The World Health Organization (WHO) identified it as one of the most burdensome diseases.
Insomnia can be classified as:
Difficulties falling asleep (initial insomnia) where the person experiences difficulties getting to sleep or staying asleep for more than 1 hour despite having enough opportunity to sleep.
Insomnia with awakenings is when a person awakens several times at night and may have difficulty returning to sleep once they are awakened.
Insomnia is further classified as:
Dyssomnias, which are disorders in the amount, quality, or timing of sleep. They include:
- Primary insomnia (having had problems sleeping for at least one month)
- Secondary insomnia (difficulty sleeping that is caused by another health problem including pain and other sleep-related disorders)
Stressful life events, which financial difficulties can cause, family problems, and emotional stress.
Insomnia and its symptoms can vary widely from person to person. The signs and symptoms for insomnia include;
- Difficulty to fall asleep
- Awakening earlier or later than usual
- Disruption of the sleep-wake cycle
- Waking up frequently during the night
- Taking more than 30 minutes to fall asleep
- Feeling tired during the day despite sleeping well
- Waking up feeling exhausted
- Having no energy to do things you usually enjoy
- Having difficulty concentrating and remembering things
- Disturbed sleep pattern related to mental health
- Disturbed sleep pattern related to an environmental factor
- Sleep deprivation
- Anxiety based on insufficient coping skills for stressors
- Potential impaired social functioning and well-being due to lack of sleep (NANDA International, 2014).
The nursing diagnosis for insomnia include:
- Insufficient sleep hygiene related to an environmental factor
- Insomnia related to insufficient coping skills for stressors
- Impaired sleep-related to pain
- Sleep deprivation
- Inadequate sleep hygiene
Nursing care plan for insomnia includes;
- The nurse should evaluate the patient’s sleep hygiene
Sleep hygiene is a term used to describe the steps you follow to ensure that you get a good night’s sleep. It involves:
- Spending time in bed relaxing even if you are too excited to sleep.
- Going to bed and getting up at the same time every day, including weekends.
- Avoiding alcohol, nicotine, caffeine, and heavy meals close to bedtime.
- Writing down any worries before going to bed.
- Relaxing with a book or taking deep breaths of fresh air.
- Having a regular exercise routine.
- Avoiding daytime naps.
If this is not effective, an alternative measure could be using relaxation techniques such as yoga or meditation while focusing on breathing, mantras, or visualizations (NANDA International, 2014).
- The nurse should also assess for underlying psychiatric conditions such as depression or anxiety disorders
- Assess for any pain syndromes that might interfere with the patient’s sleep patterns
- Provide education about good sleep habits to promote better sleep quality (e.g., maintain a regular bedtime routine)
- Assess for symptoms of depression that may interfere with sleep patterns
- Monitor progress and reinforce positive changes in behavior
The nursing interventions for insomnia include:
Patient Risk Assessment and Management
Provide education to patients and families on the different ways of helping the child achieve good sleep and the impact of lack of sleep.
- Management of environmental factors that may be impacting the patient’s ability to obtain restorative sleep.
- Assessment and management of anxiety if a patient has difficulty falling asleep or staying asleep
- Encouraging the patient to set realistic sleep goals, as well as monitoring progress on these goals
- Assisting parents in understanding possible triggers for their child’s insomnia, including stress at school, conflict with friends or siblings, divorce, and death of a close family member
- Development of activities that can be done with a patient to promote relaxation before bedtime
- Assessment and management of any underlying chronic condition that may affect sleep.
Promote Sleep Hygiene
- The nurse should advise patients to avoid caffeine, nicotine, or alcohol close to bedtime
- Reduce stimulation from computers, television, etc. before retiring to sleep
Ensure that the patient’s bedroom is dark and quiet and the room’s temperature is comfortable for sleeping.
- Encourage patients to develop a relaxing bedtime routine through reading or listening to music.
- Advise patients to avoid smoking, drinking alcohol, or taking any medication close to bedtime and ensure they are not hungry before going to bed.
Instill a Sense of Control
The nurse needs to help the patient learn how to control their thoughts and feelings, so they do not become helpless and give up on trying to change their behavior.
The patients should be encouraged to think about what changes could be made in their behavior to help them sleep better. E.g., they could avoid going on the computer for an hour before bedtime or spending time watching TV in a darkened room just before bedtime. Patients should be encouraged to follow their sleeping pattern as close as possible, even if it is not the most convenient option for them or others.
- As a nurse, it’s crucial to be aware of possible underlying physical causes of the condition
- Establish a bedtime routine to help patients develop healthy sleep patterns.
- Use light therapy if patients are sensitive to sunlight in the morning or evening.
- Encourage patients to exercise during the day as it helps reduce anxiety and improves moods which may contribute to a better quality of sleep at night.
- Discuss with patients any changes in their diet or medication use that could be contributing to their symptoms and make recommendations for modifications accordingly.
Insomnia can have adverse effects on your health, including increased risk for cardiovascular disease and obesity, impacting your quality of life and productivity.
Treatment for people with chronic insomnia can include behavioral therapy, cognitive-behavioral therapy, or medications.
Behavioral therapy is a short term treatment that targets the behaviors associated with having insomnia.
It helps patients fall asleep faster and stay asleep longer by teaching them how to avoid stimulating activities for 2 hours before bedtime, reduce daytime napping, develop sleep rituals and go to bed at the same time every night. The therapist will also help the patient to identify and manage any problems or worries that are preventing them from sleeping.
Cognitive-behavioral therapy is a short-term treatment for insomnia with 3 phases:
1) Sleep restriction, 2) stimulus control training, 3) cognitive therapy (Nursingcenter 2014).
Phase 1 sets the goal to have the patient fall asleep in 30 minutes or less for a period of 7 nights.
Phase 2 is designed to help the patient learn how to sleep at the desired time by making certain changes, including going to bed only when they feel tired and not as a way to avoid problems, going outside for 20 minutes if they cannot sleep, and staying in bed even if they are not asleep.
The final phase is designed to improve sleep quality and reduce the likelihood of insomnia recurring in the future. The patient will be taught how to cope with problems or worries that may cause them difficulty sleeping, round-the-clock wakefulness, feelings of restlessness, or trouble getting out of bed when sleep is desired.
- The patient may require the help of a sleep specialist to measure their insomnia severity and develop appropriate strategies for treatment.
Patients who suffer from chronic or severe insomnia will likely need medications to fall asleep.
A doctor should be consulted before taking any medication since there are many options, and each one has different side effects.
- Benzodiazepines (diazepam, alprazolam, lorazepam) are the most commonly used sleep medications. They help people fall asleep faster and stay asleep longer, but they can cause rebound insomnia if taken regularly. They should only be taken for 7-10 days.
- Non-benzodiazepines (zopiclone, zolpidem) are similar to benzodiazepines, but they do not have the side effects and can be taken for longer than 10 days.
- Bupropion (Wellbutrin) is an antidepressant drug that has been approved by the FDA for the treatment of both depression and insomnia.
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Insomnia is a symptom of an underlying illness or condition. Therefore it is important to ensure that the patient is receiving the correct treatment for these conditions.
The nurse should educate the person with insomnia about proper sleep hygiene. This may include avoiding stimulants and alcohol at night, keeping a regular schedule for going to bed and waking up every day, exercising regularly but not within three hours of bedtime, eliminating daytime naps if possible, and writing down worries before going to sleep to help the person de-stress and relax.
If you are having trouble sleeping, see a doctor as soon as possible to help determine what the underlying condition is. Treatment for insomnia can range from behavioral therapy to medications.
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