Disturbed Sleep Pattern Nursing Diagnosis and Care Plans

Disturbed Sleep Pattern Nursing Care Plans Diagnosis and Interventions

5 Nursing Care Plans for Disturbed Sleep Pattern NCLEX Review

Disturbed Sleep Pattern is a NANDA nursing diagnosis that involves a disturbance in a person’s regular circadian or sleep pattern. This may encompass several environmental, biological (e.g., insomnia, sleep disorders), or physiologic factors (e.g., distress).

In some cases, this can also stem from lifestyle choices or daytime activities that may otherwise hinder or interfere with sleep, such as unrecognized tendencies of micro-sleep. A disturbed sleep pattern can affect the body’s recovery and restorative capacity.

It may also potentiate the development of medical issues such as the risk of Alzheimer’s if changes in the typical sleep pattern are not addressed immediately. 

Causes of Disturbed Sleep Pattern

Many agents could contribute to a disturbed sleep pattern, but aging is often one of the most predominant causes, especially in geriatric patients. Apart from aging, disturbed sleep patterns may be due to the following instigative agents:

  • Presence of distress and anxiety
  • Excessive stimulation or physiologic stressors
  • Altered physiologic status
  • Abnormal presentation of physical capability
  • Medications

Related Factors to Disturbed Sleep Pattern

  • Environmental variations 
  • Physical variations (e.g., daytime activities, medications)
  • Physiologic variations (e.g., overthinking, changes in mood or temperament, depression, hormonal shifts, anxiety)
  • Lifestyle choices (e.g., alcoholism, hygiene, dietary intake such as excessive caffeine consumption)

Signs and Symptoms of Disturbed Sleep Pattern

  • Verbalization of difficulty falling asleep
  • Verbalization of inadequate rest
  • Restlessness
  • Awakening at an earlier time or sometime later on than what is desired or considered normal
  • Struggle with arousal

Diagnosis of Disturbed Sleep Pattern

  • Physical examination
  • Thorough medical history (e.g., presence of sleep disorders, Alzheimer’s disease)
  • Investigation on the characteristics and patterns of sleep (e.g., CBT for Insomnia)

Treatment of Disturbed Sleep Pattern

The management of Disturbed Sleep Pattern may vary from managing secondary complications to active prevention of sleep interruption and disturbance. But often, proper management and control would likely re-establish restorative sleep, and these include:

  • Relaxation training
  • Maintenance of good sleep hygiene
  • Sleep medications as prescribed
  • Adherence to the periodic sleep schedule
  • Improving bedroom environment

Nursing Care Plans for Disturbed Sleep Pattern

Nursing Care Plan for Disturbed Sleep Pattern 1

Insomnia

Nursing Diagnosis: Disturbed Sleep Pattern related to dysfunction of the environment or physiologic factor, secondary to insomnia, as evidenced by the decreased quality of sleep, disturbed sleep, sleepiness during the day, difficulty falling asleep. 

Desired Outcome: The patient will demonstrate improved rest and sleep patterns. 

Nursing Interventions for Disturbed Sleep PatternRationale
Assess the patient’s sleep pattern and take note of the following: the amount of sleep, position, sleep routine, position, depth, extent, and interferences. Sleep patterns may vary for each individual. Evaluating these patterns will provide general information and details on certain areas of sleep that need to be addressed or improved.    
Observe for any signs of sleep-wake problems. Note the patient’s hours of sleep. To attain baseline information for the investigation of insomnia. 
Take note of the physical (e.g., background noise, discomfort, frequent urination during bedtime, pain) or physiologic factors (e.g., fear, anxiety) that hinders sleep. To aid with insomnia evaluation and help with its management.
Educate the patient on several measures for sleep promotion, such as avoiding heavy meals, smoking before bedtime, caffeine-containing beverages, and alcohol. Also, mention proper fluid and food intake.  It is important to mention the needed precautions and reminders to better promote sleep. Beverages such as tea, chocolate, colas, and coffee contain caffeine that activates and energizes the nervous system. Whereas taking full meals before bedtime may induce indigestion or an upset stomach, hindering sleep onset. Alcohol should also be avoided, albeit its ability to induce sleep, since it hampers REM sleep. 
Encourage the patient to adhere to a dedicated and consistent sleep and rest schedule. Suggest drinking a glass of milk. Adhering to a consistent sleep and rest schedule helps regulate and manage the circadian rhythm. It is also likely to reduce energy fluctuations or consumption required for adaptation to alterations. Meanwhile, drinking a glass of milk has been correlated with sleep promotion, mainly because of its L-tryptophan component. 
Suggest a rest or sleep conducive environment.The patient’s environment heavily influences his/her rest or sleep onset. If the environment is disorderly and noisy, the chances of sound sleeping are slim. Keeping the patient in a quiet, still, cool, dimly lit environment helps the patient sleep better. 
Disallow active stimulation of the mind by preventing the patient from engrossing his/herself with distracting thoughts. Instead, ensure a designated time for such concerns. Encourage journaling problems before entering periodic rest.The patient may exhibit evidence of concern about the next day’s activities or tasks. Unfortunately, this behavior is not conducive to sleep. Allotting a specific day or schedule to address those concerns enables the patient to be less likely to worry about these problems before bedtime. Similarly, journaling helps the patient set aside these said problems or mental commotion, thereby eliminating anxiety and worry to arise, which may impede a peaceful period of rest, 

Nursing Care Plan for Disturbed Sleep Pattern 2

Allergic Rhinitis

Nursing Diagnosis: Disturbed Sleep Pattern related to nasal obstruction or irritation secondary to allergic rhinitis, as evidenced by constant sneezing, itching, nasal congestion, and postnasal drainage. 

Desired Outcomes: 

  • The patient will report ease of breathing.
  • The patient will report a better sleep cycle. 
Nursing Interventions for Disturbed Sleep PatternRationale
Recognize the varieties of allergens that may affect the patient. Identify the presence of such in the patient’s environment.  Identifying the types of allergens and eradicating them can ensure the patient’s safety and comfort. For instance, a dust mite allergen can cause an allergic reaction when propagated. Ensuring that the patient is in an environment that is free from any irritating substance or matter helps improve sleep before and during bedtime—for example, closing the windows to prevent airborne allergens from entering.
Assess the patient’s history for allergies and previous instances of allergic rhinitis.Knowing the patient’s seasonal allergies or provocative substances can prevent and lead to fast recovery from an allergic reaction if recognized immediately. A thorough medical history check helps identify the type of allergen the patient may be susceptible to.
Encourage the significant use of nasal sprays and educate the patient on their proper usage.It is important to inform the patient on the proper use of nasal sprays since it helps alleviate their symptoms of allergic rhinitis. Spraying should be done first by instructing the patient to blow out their nose to clear out mucus. Providing guidance and education would help bring back relaxation and assurance, decreasing worry and concerns that would likely plague the mind during bedtime. 
Suggest adherence and follow through with a cleaning routine to minimize the vulnerability of acquiring dust mites.To ensure the patient’s welfare against allergen procurement, encourage the patient to tidy and adopt a housework routine such as thoroughly cleaning furniture or every corner of the house to lessen their exposure to dust and other pollen. Minimizing provocative substances would help deter allergic reactions from arising. 
Follow and administer the prescribed medication.To provide assurance when it comes to medication, a quick check-up to a physician can ease dilemmas, including the sense of anxiety (that may otherwise impede sleep if not addressed).

Nursing Care Plan for Disturbed Sleep Pattern 3

Alzheimer’s Disease

Nursing Diagnosis: Disturbed Sleep Pattern related to changes and disturbance in the circadian rhythm, secondary Alzheimer’s disease, as evidenced by disturbed sleep, difficulty falling asleep, fatigue, weakness, sleeplessness, and morning headache

Desired Outcome: The patient will demonstrate recuperative restful sleep. 

Nursing Interventions for Disturbed Sleep Pattern Rationale
Assess the patient’s sleep pattern in a normal atmosphere and take note of the varying changes or manner particularly: frequency of sleep, amount and time of awakenings in the middle of the night or sleep, patient’s outcry of apathy, fatigue, weakness, and impotence, inactivity, and amount of activity.   It is important to determine whether the sleeping pattern correlates with the guidelines or indicators of Alzheimer’s. Acquiring information on these parameters helps establish a care plan or intervention to correct sleep. In some instances, if you find the patient frequently sleeping during the day, Sundowning syndrome is likely suspected. This causes irritability and restlessness to arise, especially when daylight tones down. By ensuring the patient’s wakefulness during the day, the urge to sleep may return later. 
Observe any sleep interfering factors such as the use of alcohol, medications, or caffeine. Determination of the patient’s alcohol intake, medication, or caffeine would help identify the problem causing sleep deprivation. Certain drugs interfere with REM sleep, causing weakness and irritability. It may also act as a catalyst for a delay in the body’s normal absorption and excretion mechanism in a geriatric patient, which is a problem, especially when there is an increased need to urinate within the period of rest.
Ensure that the patient’s environment is relaxing, comfortable, and free of noise with absent distractions. To promote sleep by eliminating external stimuli that may otherwise induce awakenings during the night. 
Encourage other sleep aids such as drinking warm milk, having extra covers, warm baths just before bed, and having clean linens. To enhance the patient’s sense of comfort and relaxation. It also eliminates any impending or plausible disruption. 
If necessary, provide sleep apnea devices.   To better establish and complete the sleep cycle, recuperate rest or sleep. 

Nursing Care Plan for Disturbed Sleep Pattern 4

Scabies

Nursing Diagnosis: Disturbed Sleep Pattern related to itching and pain from lesions, secondary to scabies, as evidenced by the presence of skin rash, pruritus, itching, scabies rash, and scratching in affected areas such as burrows found in the skin.  

Desired Outcome: The patient will demonstrate reduced itching or scratching, especially at night. 

Nursing Interventions for Disturbed Sleep Pattern Rationale
Perform a physical examination and determine the affected areas of the skin.  Diagnosing scabies should immediately be determined to alleviate itching or pain from lesions that may worsen and persist during the night. 
Perform hand hygiene and similarly educate the patient on proper handwashing. Transmission of scabies is highly plausible. Further infection may also arise from vigorous scratching of an itch; due to this, hand washing should be performed as it will help relieve itching and prevent infection, therefore improving the state of rest or relaxation. 
Monitor the status of the patient’s skin. Tell the patient to stop scratching or rubbing if there are alarming signs or marks of abrasive scratching in the skin. It is important to monitor the affected areas in the patient’s skin as it will be a good indicator of the severity or harshness of scratching tendencies. It would also indicate possible exposure and predisposition to infection, causing complications in the long run. Avoiding infection (made possible by intense rubbing or scratching) should be of paramount importance as it disrupts the routine sleep and rest pattern due to irritability. 
Support the patient in restoring skin integrity.   Practices like careful monitoring of the patient’s choice of soap or cleansing agents, gloves, and frequent cleansing of skin can actively reduce the itching sensation. The nurse should take note of the patient’s self-care practices to further address the lapses in the skin hygiene practices. By promoting skin integrity, the patient’s feelings of satisfaction and comfort would arise, both of which are vehicles in restoring restfulness, positive emotions, and sleep. 

Nursing Care Plan for Disturbed Sleep Pattern 5

Chronic Pain

Nursing Diagnosis: Disturbed Sleep Pattern related to disease and injuring agents, secondary to chronic pain as evidenced by expression or verbalization of pain, change in muscle tone, atrophy, depression, change in routine sleep pattern, restlessness, and fatigue.

Desired Outcomes: 

  • The patient will demonstrate improved relaxation and sleep. 
  • The patient will verbalize the effectiveness of pain relief. 
Nursing Interventions for Disturbed Sleep Pattern Rationale
Assess the patient’s pain characteristics or features (e.g., severity, onset, duration, relieving facets, and location).Noting the features of pain would help provide insight and aid pain management. Managing pain is one way to reduce the patient’s pain experience, associated with impedance and disruption of the sleep cycle or rest periods. Having a better understanding of the nature of pain can help adjust treatment to provide pain relief.
Assess the patient’s past coping strategies to relieve pain.Patients experiencing chronic pain usually employ varying strategies and pharmacologic aid to alleviate and manage their pain. Identifying the patient’s stratagem would provide insight that would help with pain management and the establishment of care plans. 
Talk to the patient and his/her family or guardians. Suggest participating in support and self-help groups for people who also bear chronic pain. To lessen the burden of suffering due to chronic pain and allow a reinforcing support system to help with rest and recreation. 
Suggest nonpharmacologic interventions (e.g., massage, guided imagery, cold applications) to ease the pain. Pain management strategies do not solely center on pharmacologic interventions. It could also be in another form, such as non-pharmacological means. Exploring these options (e.g., massage, guided imagery, progressive relaxation, heat, and cold applications) can provide adequate pain management. These strategies act by reducing pain, muscle tension, and inflammation which can later affect the patient’s sleep, peace, or relaxation if not addressed beforehand. 

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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