Last updated on May 22nd, 2022 at 10:53 am
Sleep Apnea Nursing Care Plans Diagnosis and Interventions
Sleep Apnea NCLEX Review and Nursing Care Plans
Sleep apnea is a sleep disorder characterized by abnormal breathing patterns during sleep. It causes multiple breaks in breathing which can affect the oxygen supply and quality of sleep.
Sleep apnea is a common sleep disorder affecting both genders and people of all ages.
Types of Sleep Apnea
There are three main types of sleep apnea depending on the cause:
- Obstructive sleep apnea (OSA) – this occurs when there is an occlusion in the airway, typically due to relaxed throat muscles. The obstruction causes multiple lapses in breathing.
- Central sleep apnea (CSA) – this involves a problem in brain function that can cause lapses in breathing, resulting in slow and shallow breaths.
- Mixed sleep apnea – refers to the combination of OSA and CSA, which may also occur at the same time.
Signs and Symptoms of Sleep Apnea
The different types of sleep apnea share similar signs and symptoms. Most symptoms of sleep apnea are left unnoticed by the affected individual, unless pointed out by another person. The most common signs and symptoms are as follows:
- Loud snoring – it may include gasping or choking, which may briefly wake the person up
- Episodes of pauses in breathing as reported by another person
- Gasping for air when sleeping
- Waking up with a dry mouth
- Headaches in the morning
- Insomnia or difficulty sleeping and staying asleep
- Hypersomnia or excessive daytime sleepiness
- Issues with attention span or difficulty thinking clearly
- Irritability
- Nocturia or frequent urination at night
Causes of Sleep Apnea
Obstructive sleep apnea (OSA), which occurs when the airway is blocked during sleep, has the following common causes:
- Anatomical reasons – The size of the person’s neck, jaw, tongue, tonsils, and surrounding organs can block airflow.
- Obesity – obesity is noted in about 60% of cases of sleep apnea. It contributes to the narrowing of the airway causing airflow problems.
- Sedatives including alcohol use – alcohol and sedatives can relax the muscles of the throat which can directly obstruct airflow.
- Family history – having close relatives with sleep apnea increases the risk of developing the disorder.
- Cigarette smoking – heavy smokers are known to have a higher risk of developing the condition.
- Sleeping in supine position – sleeping on one’s back increases the chances of throat muscles to relax and obstruct the airway.
- Nasal congestion – a reduced ability to breathe through the nose is known to increase the chances of having sleep apnea.
- Hormonal imbalance – some endocrine conditions such as hypothyroidism and acromegaly can cause tissues around the neck to swell and cause blockage to the airway.
Central sleep apnea CSA) is commonly related to a medical condition, such as the following:
- Stroke
- Brain infection
- Brain tumor
- Heart failure
Complications of Sleep Apnea
- Fatigue. The reduced quality of sleep can easily affect the ability to function during the day. It can cause inadequate energy, irritability, and daytime drowsiness which can affect the performance of activities of daily living.
- High blood pressure and/or heart problems. A drop in the blood oxygen level when sleep apnea occurs can trigger the body to compensate by increasing the blood pressure to deliver more oxygenated blood. This adds strain to heart muscles which increases the risk for heart attack and arrhythmias.
- Type 2 diabetes. Sleep apnea is linked to insulin resistance and type 2 diabetes.
- Metabolic syndrome. This refers to a condition characterized by hypertension, high cholesterol levels, high blood sugar levels, and increased waist circumference.
- Complications from medications and surgery. The breathing problem associated with sleep apnea is a concern for people having surgery and those on certain medications.
- Liver conditions. Sleep apnea can affect liver functions and is linked to non-alcoholic fatty liver disease.
- Sleep-deprived partners. Those who sleep with a person with sleep apnea are known to have interrupted sleep due to the loud snoring associated with the condition.
Diagnosis of Sleep Apnea
Once sleep apnea is suspected from the reported signs and symptoms, a referral to a sleep disorder center is further completed. A sleep specialist in the center will help with the diagnosis and determine the need for further tests and evaluation.
Diagnosing sleep apnea may involve an overnight stay at the sleep center to monitor breathing while the person is asleep.
- Nocturnal polysomnography – a machine will be attached to monitor the heart, lungs, brain activity, breathing patterns, arm and leg movements, and blood oxygen levels.
- Home sleep tests – a kit to monitor heart rate, blood oxygen levels, airflow, and breathing patterns can be taken home to use during sleep.
Treatment of Sleep Apnea
Mild forms of sleep apnea may only require lifestyle changes such as smoking cessation and weight loss.
- Air pressure devices and oral appliances. Continuous positive airway pressure (CPAP) is a machine that delivers air through a mask during sleep may be used to maintain airflow. This is a common treatment for sleep apnea; however, some may find the mask straps uncomfortable. Other devices can also be used to deliver air pressure, such as a bilevel positive airway pressure (BiPAP) machine. There are oral appliances can be used to keep the throat open can help prevent airway obstruction.
- Treatment of underlying medical problems. Some medical conditions such as hypothyroidism or obesity can cause sleep apnea.
- Oxygen supplementation. Additional oxygen supply can be given during sleep to support the body’s oxygen need.
- Adaptive servo-ventilation (ASV). This is a newer treatment for sleep apnea that involves the use of an airflow device that records the normal breathing pattern when awake and uses it when the person sleeps.
- Surgical interventions:
- Tissue removal – a surgical procedure called uvulopalatopharyngoplasty involves the removal of some tissues in the airway.
- Tissue shrinkage – the airway can also be widened through radiofrequency ablation.
- Repositioning of the jaw – the jaw can be repositioned to lessen the possibility of obstruction.
- Implants – polyester or plastic rods are implanted in the soft palate to keep the airway open. However, more research is still needed to evaluate its success.
- Nerve stimulation – this involves the stimulation of the nerve controlling the tongue to avoid airway occlusion.
- Tracheostomy – an opening on the neck followed by the insertion of a breathing tube may need to be performed in severe cases of sleep apnea.
Nursing Diagnosis for Sleep Apnea
Sleep Apnea Nursing Care Plan 1
Nursing Diagnosis: Ineffective Breathing Pattern related to impaired regulation secondary to sleep apnea as evidenced by breaks in breathing during sleep, pallor, cyanosis, and shallow breathing, decreased oxygen saturation, or changes in respiratory depth
Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and absence of pallor or cyanosis.
| Sleep Apnea Nursing Interventions | Rationales |
| Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. | To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. |
| Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician. | To increase the oxygen level and achieve an SpO2 value within the target range. |
| Encourage the patient to sleep in a side-lying position and avoid the supine position. | sleeping on one’s back increases the chances of throat muscles to relax and obstruct the airway. |
| Elevate the head of the bed slightly prior to sleep. | Head elevation can help prevent airway obstruction and improve the expansion of the lungs, enabling the patient to breathe more effectively even when asleep. |
| Place the patient on a pulse oximeter and apnea monitor when asleep. | To monitor oxygen saturation levels and other vital signs during sleep. |
| Hook the patient to a continuous positive airway pressure (CPAP) machine, or other devices as prescribed by the sleep specialist. | To maintain airflow during sleep. |
| Administer methyxanthines as prescribed. | These medications can relax the smooth muscles and stimulate the cardiac muscles and central nervous system for spontaneous breathing. |
| With infants, gently rub the soles of the feet or chest wall. | To provide tactile stimulation, which can stimulate spontaneous breathing in infants with mild or intermittent episodes of sleep apnea. |
Sleep Apnea Nursing Care Plan 2
Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply secondary to sleep apnea as evidenced by apnea, oxygen saturation of 85% (hypoxia) during sleep, heart rate below normal (bradycardia) during sleep
Desired Outcome: The patient will demonstrate adequate oxygenation as evidenced by an oxygen saturation and heart rate within the normal range.
| Sleep Apnea Nursing Interventions | Rationales |
| Assess the patient’s vital signs, especially the respiratory rate and depth during sleep. Auscultate the lungs and monitor for wheezing or other abnormal breath sounds. | To create a baseline set of observations for the patient, and to monitor any changes in the vital signs as the patient receives medical treatment. |
| Monitor the color of skin and mucous membrane. Check for any changes in consciousness or presence of irritability and restlessness, especially in infants. | Peripheral cyanosis (bluish discoloration of the skin, ear lobes, or nail beds) may be evident with hypoxia. Central cyanosis involving the mucosa may indicate further reduction of oxygen levels. Changes in the level of consciousness may indicate the state of hypoxia or impaired oxygenation of the brain. |
| Monitor ABG levels. | To consistently check for respiratory function by monitoring the changes in pO2 and pCO2. |
| Provide humidified oxygen as prescribed. | To reduce the risk of drying out the lungs. |
| Reposition the patient by elevating the head of the bed and encouraging him/her to sleep in a side-lying rather than supine position. Encourage pursed lip breathing and deep breathing exercises during waking hours. | To improve the delivery of oxygen in the airways and to reduce shortness of breath and risk for airway collapse. |
| Refer the patient to a sleep specialist. | To enable to patient to receive more information and specialized care in treating sleep apnea and enabling of improved gas exchange. |
| Hook the patient to a continuous positive airway pressure (CPAP) machine, or other devices as prescribed by the sleep specialist. | To maintain airflow during sleep. |
| Administer methyxanthines as prescribed. | These medications can relax the smooth muscles and stimulate the cardiac muscles and central nervous system for spontaneous breathing. |
Sleep Apnea Nursing Care Plan 3
Nursing Diagnosis: Disturbed Sleeping Pattern ineffective breathing secondary to sleep apnea as evidenced by the change in activity level, verbal complaints about interrupted sleep, restlessness, and irritability.
Desired Outcomes:
- The patient will verbalize feeling rested and having an improved sleeping pattern.
- The patient will demonstrate skills to avoid sleep apnea.
- The patient will identify the factors that may cause sleep apnea.
| Sleep Apnea Nursing Interventions | Rationale |
| 1. Ask the patient about their previous sleeping pattern. Ask about the amount of sleep, depths, length, position when sleeping, bed rituals, and factors that may interfere with the pattern of sleep. Ask the patient if he/she experiences sleep apnea that may affect the sleeping pattern. | Each person’s sleeping pattern varies. A person’s sleeping pattern may be affected by the environment and lifestyle. Too much noise, excessive light in the bedroom, excessive consumption of alcohol or caffeine, and sleep apnea may affect the sleeping pattern. Assess the presence of sleep apnea or if the breathing stops during sleep that may affect the sleeping pattern of the patient. |
| 2. Ask the patient about their insight about the cause of sleeping pattern disturbance and probable relief to facilitate treatment. | Assessing the possible etiology that affects the sleep pattern will help formulate interventions to help improve the sleeping pattern. Disturbed sleep can cause health consequences such as fatigue, decreased focus, and altered mood. |
| 3. Identify aspects that may interfere with normal patterns. Ask the patient if he/she is taking any medications that may disturb sleep. | Knowledge of the factors that may affect sleeping patterns should be identified. Patients might be following medication schedules that may affect their sleeping patterns, especially when in the hospital. The patient might need to wake up early or wake up late at night because the patient needs to take medicine that causes the patient to have difficulty going back to sleep. |
| 4. Instruct the patient to avoid taking alcohol, smoking, caffeine, and eating heavy meals, and avoid large fluid intake before sleeping. | Alcohol, caffeine, smoking, and heavy meals before sleeping may disturb sleep because nicotine and caffeine may cause gastric digestion and stimulation. Avoiding large fluid before sleeping will lessen the urge of the patient to void at night. |
| 5. Advise the patient to increase the activities during the daytime as indicated and avoid strenuous activity before bedtime. | Physical activities will promote sleep and will reduce stress. Strenuous activity may cause insomnia due to fatigue. |
| 6. Advise the patient to avoid daytime naps unless needed to meet sleep requirements. | Nighttime sleep problems may occur because of daytime napping, especially in patients with insomnia. Advise the patient that napping is not a permanent solution to reaching the adequate sleeping quota. |
| 7. Provide aids that will help promote rest and sleep such as backrub, bedtime care, pain relief, and relaxation techniques. Advise the patient to sleep in a comfortable position or head slightly elevated. | These aids may help to promote rest and give comfort to the patient and will help avoid sleep apnea. Positioning the head of the patient slightly elevated will reduce snoring and sleep apnea. This position will make the patient breathe through the nose much easier and help take the pressure away from the airway will help to breathe easily. |
| 8. Advise the patient to take soporifics such as milk. | Soporific such as milk is used to induce sleep. Milk contains building blocks of protein called amino acid that promotes sleep. |
| 9. Maintain a quiet and restful environment. Advise the visitors and family to allow the patient to sleep and avoid making noise. | Keeping the room cool, comfortable, quiet, and well-lit makes the patient comfortable and promotes sleep. Minimize noise and light to optimize the bedroom environment. |
| 10. Advise the patient to relax and clear their mind during the evening. Advise activities such as listening to relaxing music, taking a warm bath, deep breathing, and meditation before sleeping. | Techniques of relaxation before sleeping improve the quality of sleep and promote comfort. |
Sleep Apnea Nursing Care Plan 4
Compromised Family Coping
Nursing Diagnosis: Compromised Family Coping related to a persistent stressor secondary to sleep apnea as evidenced by the family’s verbalization of concern and fear about the condition.
Desired Outcomes:
- The family member’s fear about the condition will be reduced.
- The family members will identify healthy coping mechanisms that will help the patient and the family to deal with the situation.
| Sleep Apnea Nursing Interventions | Rationale |
| 1. Check for the anxiety level and erratic behaviors of the family such as anger, and tension, and ask about their perception of the situation and how the family copes with the situation. | Assessing the family’s ability to cope with the situation will help the nurse to know the need of the family to learn additional coping skills. The level of anxiety may be classified into four categories: Mild anxiety. The person is alert and has an increased perceptual field. Can be motivated by learning and can produce personal growth.Moderate anxiety. The person only focuses on immediate concerns and involves narrowing the perceptual field.Severe anxiety. Severe anxiety shows a reduction of the perceptual field and focuses on a specific detail and problem-solving is impaired.Panic anxiety. Inability to function and communicate effectively and has a misperception of the surroundings. Thepatient may impulsively react by running and striking out. |
| 2. Identify the factors that contribute to compromised family coping. Identify beliefs, norms, and values that may affect family coping. | Assess the situation of the family that may contribute to compromising coping. Note other factors that affect the ability of the family members to provide needed for the patient. Beliefs, norms, and values may affect the coping behavior of the family. |
| 3. Advise thefamily to use techniques of coping. Educate them on how to solve problems and how to gain control over the situation. | The nurse should provide the support that will help in problem-solving and handling the situation. Encourage the family members to verbalize their feelings openly and clearly. |
| 4. Allow the patient and the family to express concerns, feeling, and expectations. Maintain a good working relationship with the family and the patient. | A good working relationship with the patient and the family gains trust and may help to facilitate coping. Verbalization of feelings, concerns, and expectations will reduce anxiety and will help develop good communication between the nurse and the family. |
| 5. Express feelings of acceptance, and understanding and avoid false reassurance. | Providing honest relationships facilitates successful coping and problem-solving. Giving false reassurance is not therapeutic. |
| 6. Encourage the family to participate in planning care and scheduling activities for the patient. | Participation in the family promotes social and emotional support. Social and emotional support will help to improve the ability of the family to cope with a stressful situation and will alleviate the effects of the family’s emotional distress. |
| 7. Encourage the patient and the family to use cognitive-behavioral relaxation methods such as music therapy and guided imagery. | Techniques of relaxation and guided imagery will help in coping by increasing their control and decreasing anxiety. |
| 8. Educate the family to assist the patient in a comfortable position and maintain a calm environment to avoid sleep apnea. | Advise the family that providing comfort and a calm environment will promote the patient’s rest and will reduce the risk for sleep apnea. Promoting assistance of family and involvement to care while maintaining the patient’s independence is important. |
| 9. Educate the family about the condition of the patient. Explain the possible cause of the condition and the ways how to prevent and avoid the condition. | Knowledge about the condition will lessen the anxiety of the family and knowledge about the condition will help the family to cope with the situation. |
| 10. Refer the family to appropriate assistance as needed such as counseling, psychotherapy, and financial and spiritual assistance. | Counseling, psychotherapy, and financial and spiritual assistance will help the family cope with the situation. |
Sleep Apnea Nursing Care Plan 5
Risk for Altered Parenting
Nursing Diagnosis: Risk for Altered Parenting related to lack of information about the condition secondary to sleep apnea.
Desired Outcomes:
- The patient’s parents will demonstrate readiness in handling the patient apneic episodes
- The parents will be knowledgeable in assessing the presence of apnea, bradycardia, and cyanosis.
| Sleep Apnea Nursing Interventions | Rationale |
| 1. Check for the history of sleep apnea and other life-threatening conditions history in the family. | Assessing the risk factors associated with sleep apnea will help in the additional assessment of the condition of the patient. Family history may be a risk factor. The inheritance pattern of sleep apnea is unclear but research suggests that sleep apnea may be hereditary. Individuals with a family history of sleep apnea may exhibit an increased risk of having sleep apnea. |
| 2. Ask the parents about the presence of apneic episodes when sleeping, bradycardia, upper respiratory infections, and episodes of cyanosis. | A kind of sleep disorder in which the breathing stops and starts is called sleep apnea. When a person snores loudly and feels tired even after a complete night’s sleep the patient may have sleep apnea. Assessment of the presence of sleep apnea, bradycardia, cyanosis, and upper respiratory infections will help the nurse to develop a plan and goal of care. |
| 3. Ask the parents about their knowledge about monitoring sleep apnea. Explain the definition of sleep apnea and its signs and symptoms. | Parents of a patient with sleep apnea may experience fear and anxiety about the condition which can be a hindrance to learning and interventions. Explain to the parents that sleep apnea is a condition marked by abnormal breathing during sleep. Inform the parents about the signs and symptoms of sleep apnea such as: Excessive sleeping during the daytime Morning headachesIrritabilityDisrupted breathing or the breathing stops for up to a minute at a timeSnoring that is especially loud and with occasional gasping, choking, or snortingDry mouth and painful throat in the morningFrequent need to urinate at night |
| 3. Ask the parents about their perception of sleep apnea and assess their ability to meet and achieve self-expectations. | Knowing the parent’s perception of the condition will decrease the risk of isolation and self-deprivation of the parents. The parent’s perception of the condition will help achieve realistic expectations. |
| 4. Encourage a supportive, calm, and positive environment. Acknowledge positive parental behaviors toward the condition. | Encouraging the parents and acknowledging positive behaviors will help to decrease stress and anxiety which will help enhance learning. Acknowledging the parents helps them to develop new parenting skills and be confident in their abilities and capabilities as a parent. Allow the parents to express their feelings and needs. |
| 5. Instruct the parents on the step-by-step procedures about the ways in monitoring sleep apnea and when to call a medical emergency. | Knowledge about the proper ways of monitoring and when to call a medical emergency will prevent serious health problems. |
| 6. Evaluate the parenting style, characteristics, and behaviors. | The nurse should take note of the following parenting style and behaviors: Emotional climate at homeFailure to support the patients’ needsType of interaction between the parents and the patientLack of knowledge about the patient’s health \Behavioral problems |
| 7. Assess the parent’s available support system that may help in the patient’s condition. | An adequate support system should be available for the parents to achieve their goals. |
| 8. Advise the other significant others of the patient to the parents in monitoring the patient. | This will promote coping because the parent’s continuous responsibility will be decreased when monitoring sleep apnea with the help of significant others. |
| 9. Instruct the parents to position the patient in a comfortable position appropriate for the patient. | Positioning the patient in a proper position will help decrease sleep apnea. According to studies side sleeping with your back straight is the best position for patients experiencing sleep apnea. |
| 10. Evaluate the parents’ understanding after the interventions. Ask them to do a return demonstration about the skills and ways to lessen the risk for sleep apnea. | Reevaluation helps the nurse to assess the parent’s understanding. Evaluation helps the nurse to perform additional interventions as needed |
| 11. Refer the parents to home care agencies and other family members and friends for additional support. | To reduce anxiety and promote social activities it is important to have a range of support and assistance. Home care agencies are also availing to help the parents cope with the condition because this gives professional services safely at home. |
More Sleep Apnea Nursing Diagnosis
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. (2020). 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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