Last updated on May 16th, 2022 at 09:46 pm
Insomnia Nursing Care Plans Diagnosis and Interventions
Insomnia NCLEX Review and Nursing Care Plans
Insomnia is defined as the inability to obtain or stay asleep. This can also cause the affected individual to wake up too early and have trouble falling back to sleep.
However, when the individual affected by insomnia wakes up, his or her body may still be in a state of exhaustion. If insomnia remains unmanaged, it can negatively affect a person’s well-being, general performance, and overall quality of life.
Signs and Symptoms of Insomnia
- Not feeling rested following a night’s rest
- Waking or getting out of bed in the middle of the night
- Waking or getting out of bed too early
- Daytime drowsiness or exhaustion
- Persistent concerns about a lack of sleep
- Anxiety
- Depression
- Inability to concentrate, pay attention, or recall information
- Fatigue
Causes of Insomnia
Insomnia may be the primary issue, or it may also be a secondary problem. It can be treated by addressing the underlying cause, although it can linger for years depending on the severity.
Common causes of insomnia are as follows:
Unsatisfactory or inadequate sleeping habits. Some examples of having a poor sleeping routine are:
- Uncomfortable sleeping conditions
- Irregular bedtime schedules, napping,
- Stimulating activities in the hours leading up to bedtime
- Using the bed to work, eat, or watch TV
Excessive consumption of food late in the evening. Even while it’s acceptable to have a small snack or meal before going to bed, consuming copious amounts can make it difficult to fall asleep. Following overconsumption of meals, many people suffer from heartburn. As a result, sleep is impeded.
Travel or inconsistent work commitments. Circadian rhythms serve as a kind of internal clock, regulating processes like metabolism, body temperature, and most of all, the person’s sleep-wake cycles. If the circadian rhythm is thrown off (due to jet lags, inconsistent shifts, working early or late hours), this can cause insomnia.
Stress. Sleep deprivation and insomnia can be increased by persistent worrying about certain events or the days ahead. Employment, work, school, family, income, and health-related problems contribute to stress and anxiety. When faced with a stressful situation, such as a traumatic event, the death of a family member or a close friend, illness, divorce, being fired, or losing one’s job, insomnia may set in.
Consumption of alcohol, caffeine, and nicotine. These are stimulants that can disrupt sleep and keep one awake.
Medical conditions such as gastroesophageal reflux disease, overactive thyroid, Parkinson’s disease, and Alzheimer’s disease.
Mental and behavioral health issues. Depression is often accompanied by insomnia. Stress and anxiety can also lead to insomnia. It can also be a symptom of mental health conditions such as bipolar disorder.
With age, the prevalence of insomnia increases. The following are causes of age-related insomnia:
- Changes in sleep schedules. Getting to sleep and staying asleep is much more challenging for the elderly. And because the internal clock advances with age, elderly patients may grow exhausted sooner in the evening and awake earlier in the morning. The risk of being roused by noise or other environmental disturbances is also increased.
- Chronic pain from disorders such as arthritis or back difficulties can disrupt sleep. For individuals with bladder or prostate problems, the need to urinate increases during the night, and because of this, sleep is impaired. Repetitive leg movements (RLS) and other sleep disorders grow increasingly common as people age.
- Use of additional medications. Older individuals are more likely to take prescription drugs, which increases the risk of insomnia.
- The shift in one’s daily routine or activities – If there is a marked decrease in the amount of time spent socializing or exercising, this may potentiate the development of sleeping issues. Getting a good night’s sleep may be tough if one isn’t moving much. Aside from that, those who are less active are more inclined to take midday naps, disrupting their normal sleep patterns.
Risk Factors of Insomnia
- Gender. Insomnia can be caused by changes in the hormonal balance throughout menopause and the menstrual cycle. Night sweats and hot flashes are common side effects of menopause can also cause sleep disturbances.
- Underlying mental or physical condition. Alterations in mental and physical well-being can negatively impact the ability to fall or stay asleep.
- Stress. Temporary insomnia can result from stressful times and situations. On the other hand, chronic insomnia can develop due to severe or prolonged stress.
- Irregular schedule. Changes in the work schedule or going on a business trip might throw off the sleep-wake cycle.
Diagnosis of Insomnia
- Physical examination. The handling physician may perform a physical exam to look for any indicators of underlying health issues that might be linked to insomnia, especially if the cause is not yet identified.
- Sleep history
- Blood tests. In some cases, a blood test may be requested to screen for thyroid disorders or other illnesses that may be linked to sleep deprivation.
- Sleep Study. This non-invasive overnight evaluation allows physicians to monitor the brain and bodily processes during sleep. Spending the night in a sleep center may be required if the exact cause of insomnia is unknown. This is done to rule out any sleep disorders (e.g., restless leg syndromes and sleep apnea). When conducting a sleep study, experts keep track of everything from respiration, heartbeat, to eye movements.
Treatment for Insomnia
One of the most effective strategies to achieve a decent night’s sleep is to correct bad sleeping habits and address any underlying health issues that may be causing insomnia in the first place.
- Cognitive Behavior Therapy. The attending physician may recommend cognitive behavioral therapy (CBT) or medication to help the patient relax and achieve better sleep quality. CBT-I can help manage or remove negative thoughts and negate insomnia-related activities. This is usually the first line of treatment for insomnia and is considered as effective as sleep medicine.
- Stimulus-control therapies. This strategy aids in overcoming mental obstacles to sleep. In order to achieve consistency in the sleeping routine, it is advised to use the bed for sleeping or having intercourse. If there is trouble falling asleep after 20 minutes, get out of bed and come back when ready to sleep/drowsy.
- Use of relaxation techniques. Stress reduction, anxiety alleviation, and relaxation can be achieved via the regular practice of relaxation techniques such as progressive muscle relaxation, breathing techniques, and biofeedback.
- Phototherapy. Certain types of sleep disorders can be addressed using light therapy, an alternative treatment that doesn’t involve drugs. Regular light therapy may help the quality and sleep routine by resetting the body’s internal clock.
- Prescription drugs. Doctors may recommend using medications in the case of chronic insomnia when other approaches have failed to alleviate the condition. In the short term, this can be useful; however, long-term pharmaceutical use can result in a range of negative side effects (e.g., impaired mental processes, disorganized thinking, night wandering, excessive tiredness, and anxiety.
Insomnia Nursing Diagnosis
Insomnia Nursing Care Plan 1
Nursing Diagnosis: Disturbed Sleep Pattern related to a disturbance in the environment and physiologic element, secondary to insomnia, as evidenced by daytime sleepiness, verbalized difficulty of falling asleep, poor quality of sleep, and reduced level of functioning.
Desired Outcome: The patient will be able to get and maintain a good night’s sleep.
| Insomnia Nursing Interventions | Rationale |
| Analyze the patient’s sleeping pattern in the past. Take note of the quantity, depth, length, bedtime routine, posture, and other interfering elements. | Each individual has a unique sleeping routine. To find ways to enhance the patient’s sleep quality, gathering information on his/her sleeping pattern is a good starting point. |
| Take note of any medical or psychological reasons that may limit the patient’s sleep (e.g., noise, urinary frequency, fear, or anxiety). | There may be discrepancies between what the patient thinks about their insomnia and what objective evaluation reveals. |
| Encourage patients to avoid heavy meals, coffee, or smoking before bedtime. Inform his/her of the right dietary and fluid intake guidelines. | Before sleeping, a heavy meal can cause gastrointestinal distress and delay sleep onset. The patient’s ability to relax and fall asleep may also be hindered by caffeine-rich beverages (e.g., coffee, tea, cola, and chocolate), which induce a stimulant effect. On the other hand, alcohol induces tiredness, and while it may initially aid in sleep, it disrupts rapid eye movement (REM) sleep. |
| Inform the patient to avoid excessive fluid intake before bedtime. | The patient’s disturbed sleep pattern may be caused by urinary frequency. Reminding the patient to avoid excessive liquid consumption will prevent frequent bathroom visits in the middle of the night. |
| Advise the patient to drink milk before bedtime. | Milk contains L-tryptophan, a sleep-inducing amino acid. Not only is it shown to aid in sleep, but it also alleviates stress. It also helps produce serotonin, a sleep-inducing neurotransmitter. |
| Discourage the patient from fretting, worrying, or focusing on thoughts that could keep them awake at night. | By designating a specific time for these concerns, the patient is able to let go of these issues before going to sleep at night. |
| Keep the patient from taking naps during the day unless in cases of medical need. | Napping throughout the day usually causes sleep disturbances. But for geriatric patients, regular daytime naps can help compensate for their shorter sleep cycle. |
Insomnia Nursing Care Plan 2
Nursing Diagnosis: Fatigue related to the inability to replenish sufficient energy, secondary to insomnia, as evidenced by reports of exhaustion, difficulty to carry out normal daily activities, lethargy, and increased sleep needs.
Desired Outcomes:
- The patient will be able to sleep soundly without being disturbed.
- The patient will report feeling less fatigued due to increased energy stores and the ability to accomplish desired activities.
| Insomnia Nursing Interventions | Rationales |
| Examine the patient’s account of fatigue (e.g., by asking or using a scale of 1-10) to determine whether there are any changes in intensity over time, aggravating and mitigating factors. | It is vital to monitor the patient’s weariness and determine whether there has been a change in his/her condition over time. Employing a system of evaluation, such as a scale and a patient’s descriptive statement, will aid in determining the level of exhaustion experienced by the patient. |
| Promote daily exercises and the use of relaxation techniques. Note: Avoid exercises close to bedtime. | The use of cardio and muscle-strengthening exercises can help alleviate fatigue caused by deconditioning—which may be brought on by a period of inactivity, trauma, or lengthy bed confinement. |
| Assess the patient’s initiative to participate in programs and activities to minimize fatigue. Take note of the patient’s level of social and familial support. | Chronic insomnia is characterized by severe exhaustion or fatigue, severely limiting one’s ability to carry out daily tasks. Analyzing the patient’s willingness to become involved and take part in the management, evaluation, and planning process will aid in determining where the focus should be placed (i.e., addressing the underlying cause, such as insomnia). Also, adjustments to lessen exhaustion are easier to apply if the patient is on board with the treatment plan. |
| Develop a regular workout and rest routine with the patient. Ascertain that regular rest intervals are maintained. | The patients’ fatigue can be alleviated by incorporating rest intervals into their daily routines. This assists the patient in establishing a state of balance, allowing them to carry out their everyday obligations more effectively. At the same time, regular sleep schedules are beneficial in combating fatigue. |
| Check the patient’s sleeping routine. Make a note of any changes in his/her sleep and wake-up cycles, including changes in their mental processes and behavioral pattern. | Lack of sleep or having a sleep disorder (e.g., insomnia) contributes to the development of fatigue. As a result, variations in the patient’s usual sleep schedule can indicate daytime weariness. |
| Educate the patient on energy-saving measures. | Patients can accomplish more tasks with less effort if they learn how to delegate chores and manage their time efficiently. |
Insomnia Nursing Care Plan 3
Nursing Diagnosis: Anxiety related to change in one’s state of health or environment, secondary to insomnia, as evidenced by increased stress, apprehension, tension, sympathetic stimulation, restlessness, impaired concentration, and preoccupation.
Desired Outcomes:
- The patient will develop healthy coping mechanisms and methods for expressing anxiety.
- The patient will feel at ease and sleep soundly that night.
| Insomnia Nursing Interventions | Rationale |
| Understand and assist in communicating the patient’s anxiety and concerns. | Insomnia can be triggered by anxiety, which can make it difficult to fall and remain asleep. In order to reduce anxiety, it is important to aid the patient in recognizing and dealing with their own emotions and issues. |
| Encourage the patient to keep a journal of their anxiety attacks. Assist the patient in describing what he/she has encountered and the circumstances surrounding their anxiety. | Recognition and examining the factors that cause or alleviate anxiety are critical steps in establishing new ways of responding to anxiety. Anxiety is often accompanied by unresolved emotional issues that the patient is unaware of; hence, healthcare providers (upon the patient’s consent to share anxiety log) can aid the patient in developing effective coping mechanisms. |
| Use straightforward and basic words or phrases when communicating with the patient. | Sleep is necessary to replenish the body and mind’s energy stores. Therefore, a lack of sleep can lead to cognitive and linguistic difficulties. Even more so, patients with moderate to severe anxiety are unable to follow lengthy or complicated instructions due to difficulty thinking. |
| Assist the patient with breathing and relaxation exercises. | This could help elevate abnormal or impaired physiological responses due to lack of sleep. |
| Maintain a peaceful atmosphere by reducing background noise. | A patient suffering from insomnia is more sensitive to noise; thus, providing him/her with a sleep-inducing atmosphere can aid in the reduction of stress and anxiety and promote healthier sleep. |
| Reduce sensory overload by creating a calm and serene atmosphere. | Anxiety can rise to a panic state if there is too much noise, chatter, or medical devices around the patient. Similarly, auditory and visual stimulation can impede the onset of sleep. |
| Eliminate causes of stress or anxiety wherever possible. | Anxiety is a typical reaction to risk, whether real or imagined, and it subsides as soon as the danger is gone. |
Insomnia Nursing Care Plan 4
Nursing Diagnosis: Risk for Injury related to daytime sleepiness, secondary to insomnia, as evidenced by ineffective motor function, difficulty maintaining balance, decreased muscle and eye-hand coordination
Desired Outcome: The patient will not sustain injury and will be free from harm.
| Insomnia Nursing Interventions | Rationale |
| Assess the patient’s level of consciousness. | A patient suffering from insomnia may be less receptive to external stimuli and have a reduced level of attentiveness. As a result, determining his/her degree of consciousness could reduce the likelihood of an accident or injury. |
| Ensure a safe environment for the patient. Make sure the walkways are free of obstructions by moving furniture against a wall, removing small rugs, and either locking or removing the wheels from the furniture. If necessary, install handrails. | A patient with insomnia has poor motor coordination. In order to ensure the patient’s safety, all potential and evident dangers should be eliminated. The risk of injury or falls will greatly be reduced with the added protection. |
| Provide easy access to the patient’s urinal and other frequently used items. | Patients who suffer from insomnia have trouble sleeping, recurrent urinary urgency, and frequently wake during the night. As a result, the patient wakes up feeling groggy and tired all day long. Having a sudden surge of sleepiness during daytime activities can force the body to go into shutdown mode, resulting in injuries and harm to the patient. |
| When necessary, assist the patient with ambulation. | Supervising the patient’s ambulation may be necessary to prevent falls and injuries. This is also done to assist the patient if he/she becomes disoriented or loses balance. |
| Perform a risk assessment of the patient’s living or care environment to identify potential dangers and implement changes. | The nurse conducts environmental risk assessment to assure the patient’s safety and eliminate potential hazards. |
| Monitor the patient for signs of fatigue. | Patients with insomnia often report feeling fatigued. For most patients, fatigue has a negative impact on their capacity to perform basic daily tasks or ADLs (e.g., eating, walking, performing hygiene, and toileting). |
| Ensure that the patient’s views and concerns about environmental dangers are heard and taken into consideration. | When a nurse validates a patient’s concerns or statements, it shows the patient that the nurse has taken the time to hear and understand them. It also helps foster positive patient-nurse relations. |
Insomnia Nursing Care Plan 5
Nursing Diagnosis: Disturbed Thought Processes related to chronic shift in the normal sleep cycle, secondary to insomnia, as evidenced by reduced attention span, difficulty concentrating, lack of clarity, and reduced cognitive capacity.
Desired Outcomes:
- The patient will evaluate information and make rational choices.
- When making plans with the nurse, the patient will show an improved capacity to make sound judgments.
- The patient will demonstrate a well-organized mental process.
| Insomnia Nursing Interventions | Rationale |
| Determine the patient’s cognitive ability by asking him/her or close family members for information, as well as by reviewing previous medical records. | A decline in cognitive performance is usually evident in patients suffering from insomnia. To assess the patient’s progress, creating a baseline of data will aid in evaluating and monitoring changes in sleep patterns. |
| Use straightforward and basic words or phrases when communicating with the patient. | Sleep is necessary to replenish the body and mind’s energy stores. Therefore, a lack of sleep can lead to cognitive and linguistic difficulties. When this happens, it is better to use simple terms when communicating with the patient as his/her comprehension is impaired owing to slowed thinking and trouble concentrating. |
| Assist the patient in delaying the need to make a critical life decision. | Individuals who don’t get enough sleep are more likely to make mistakes, suffer memory loss, fail to absorb new knowledge and make poor decisions. For this reason, the ability to make rational decisions necessitates a high level of psychophysiological functioning (which is lost in the case of patients with insomnias). |
| Ensure that the patient has more time to complete his/her daily routines (or ADLs), such as dressing and eating. | Rushing the patient to perform his/her daily ADLs is usually counterproductive since it will just make them more anxious and hinder their capacity to think properly. |
| Ensure that the patient has plenty of time to process information and formulate thoughtful responses. | One of the main symptoms attributed to insomnia is slowed thinking. As a result, patients who suffer from insomnia require additional time to formulate an effective response. |
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. (2022). 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
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