Sleep Disorders Nursing Care Plans Diagnosis and Interventions
Sleep Disorders NCLEX Review and Nursing Care Plans
Sleep disorders are a group of medical conditions that involve the impairment of one’s sleep pattern. Sleep disorders are becoming more common worldwide, whether caused by a medical condition or excessive stress.
Most people have occasional sleeping problems due to stress, heavy workloads, and other external influences. If these frequent issues cause significant distress, they may imply a sleeping disorder. Thus, people with sleep disorders may have trouble falling asleep and may feel utterly exhausted throughout the day, depending on what type of sleep disorder.
Sleep deprivation can harm energy, emotions, ability to focus, and general wellbeing.
A sleep disorder can also be a clinical manifestation of another medical or mental health condition in some cases. Once the underlying cause is treated, these sleeping problems may eventually disappear.
However, when another condition does not cause sleep disorders, they are usually treated with medical interventions and lifestyle modification. Furthermore, if the patient suspects that he has a sleep disorder, it is critical to get a diagnosis and treatment as soon as possible.
When left untreated, the deleterious effects of sleep disorders can have far-reaching repercussions for one’s health. Thus, sleep disorders can also impact work performance, cause a burden in relationships, and hamper the ability to carry out daily tasks.
Signs and Symptoms of Sleep Disorders
The symptoms vary according to the intensity and form of the sleeping disorder. They may also differ when another medical situation causes sleep disorders.
General symptoms of sleep disorders include:
- Having trouble falling or staying asleep
- Fatigue during the day
- Strong desire to nap during the day
- Atypical breathing patterns
- Strange or uncomfortable urges to move while sleeping
- Atypical movement or other sleep-related experiences
- Unintended shifts in the sleep/wake cycle
- Anxiety or irritability
- Lowered productivity at work or school
- Inability to concentrate
- Gaining weight
Types of Sleeping Disorders
Insomnia is the most frequently reported sleep disorder, regularly affecting about 20-30% of adults. It causes the patient to be unable to get enough sleep to feel rested and causes the patient to yawn throughout the day. Insomnia can manifest itself in a variety of ways. Some people have difficulty falling asleep, defined as staying in bed for more than 20 to 30 minutes before falling asleep. Others wake up frequently or awaken hours too early and cannot fall back asleep. Some people are a mix of different types.
Insomnia can be acute (short-term) or chronic (long-term). Chronic insomnia can be diagnosed if it occurs at least three nights per week for at least three months. There are many other types of insomnia, including fatal familial insomnia, which is a particular type that, as the name implies, runs in families and can impede sleep so severely that it is life-threatening.
Snoring may appear to be harmless, except for the fact that it keeps the bed partner awake. It can be caused by the closing of the throat while sleeping. If it is severe enough to stop breathing for a few seconds, it results in sleep apnea, a persistent and possibly life-threatening medical condition.
A patient with sleep apnea may struggle to breathe numerous times per hour for 10 seconds and repeat at a time. The oxygen levels in the blood decline as a result, and when the body detects this, it tries to pull the patient out of deep sleep to breathe again.
Breathing pauses, or apneas, can be exacerbated by:
- Obstructive sleep apnea (OSA) is a condition in which a constriction of the upper airway causes breathing to stop.
- Central sleep apnea (CSA) is a potentially fatal condition caused by brain impairment.
Parasomnia. Parasomnias, which derive from the Latin word for “around sleep,” are sleep disorders caused by poor sleep behaviors or physiological events during particular sleep phases.
Examples of common forms of parasomnia include:
- Terrors in the night
- Eating while sleeping
- Sleep sex
- REM (rapid eye movement) behavior disorder
Restless Legs Syndrome (RLS)
Restless legs syndrome (RLS) is a neurological movement disorder characterized by intense pain in the legs and a solid desire to move. RLS may manifest as:
- Pain and numbness
- Leg clinging sensation
Sleep paralysis is the sensation of being awake but unable to move. It happens while a patient is transitioning between stages of consciousness and sleep. They may be unable to speak or move for a few seconds to several minutes throughout these shifts. Some patients may also experience pressure or choking.
Other causes that could contribute to sleep paralysis include:
- Sleep deprivation
- Changing sleep schedule
- Stress and bipolar disorder are two examples of mental illnesses.
- Other sleep issues include narcolepsy and nightly leg cramps.
- The use of some drugs, such as those used to treat ADHD
- Abuse of substances
Circadian Rhythm Disorders
Circadian rhythm disorders occur when the internal biological clock is out of sync with external time cues, such as the natural dark-light cycle.
The following factors can contribute to being out of sync.
- Complete blindness
- Jet lag or shift work
- Syndrome of advanced or delayed sleep phase
- Insomnia or extreme sleepiness (hypersomnia) at unsuitable periods may result from the mismatch.
Narcolepsy is a type of sleep disorder that causes excessive daytime sleepiness. This condition can have serious consequences, including falling asleep in inappropriate contexts, such as when working or driving a car.
Other common symptoms are as follows:
- Cataplexy. Also known as “sudden loss of muscle tone,” cataplexy causes the patient to physically break down in response to stimuli such as being frightened, stimulated, giggling, or experiencing a powerful emotion. While standing, the knees may buckle, or the patient may drop to the ground and remain immobilized for several moments.
- Sleep paralysis. This involves a lack of movement upon waking or falling asleep while fully alert.
- Hypnagogic hallucinations. These are hallucinations that occur when the patient is attempting to sleep. It is as if he is dreaming, yet they are still alert and aware of the environment. They are frequently terrifying and include visual, auditory, or tactile sensations.
Causes of Sleep Disorders
Sleep disorders can be caused by various ailments, diseases, and disorders. In many cases, sleep disturbances arise due to an underlying medical condition.
- Allergies and breathing difficulties. Allergies, common colds, and upper respiratory infections all make sleeping difficult. Sleeping problems can also be caused by an inability to breathe through the nose.
- Urination occurs frequently. Frequent urination might cause the patient to wake up during the night and disrupt sleep. Hormonal imbalances and urinary tract illnesses may contribute to the growth of this condition.
- Chronic discomfort. It can be tough to sleep if in constant pain. It may even wake the patient up after they have fallen asleep. The following are some of the most prevalent causes of pain:
- Chronic fatigue syndrome
- IBD (Inflammatory Bowel Disease)
- Chronic headaches
- Consistent lower backache
In some circumstances, sleep disturbances can aggravate chronic pain. For example, experts believe that sleeping disorders may lead to the development of fibromyalgia.
Anxiety and stress. Anxiety and stress frequently have a great impact on sleep quality. The patient may find it difficult to rest or remain asleep. Night terrors, sleep talking, or sleepwalking can all interfere with sleep.
Risk Factors to Sleep Disorders
- Sleeping patterns are erratic. Sleep can be improved by going to bed and waking up simultaneously every day.
- Environment for sleeping. The bedroom should be quiet and dark, with no bright lights. Blue light from televisions, laptops, and phones boosts alertness and should be minimized several hours before bedtime.
- Excessive coffee or alcohol consumption. These beverages can impair one’s ability to fall or remain asleep.
- Drugs. Some prescription drugs, such as diuretics, increase the desire to use the restroom, which can cause patients to wake up in the middle of the night. Sleep aids, whether OTC or recommended by a specialist, can cause daytime drowsiness and other harmful impacts.
- Snoring. While some snoring is acceptable, severe snoring can disrupt the patient’s or partner’s sleep. This kind of snoring could be a sign of obstructive sleep apnea (OSA)
- Impaired mental health. Insomniacs are more likely to suffer from depression and anxiety disorders. These can result in anxious thoughts or an incapacity to calm and sleep soundly at night.
- Age 60 or above
- Traveling long distances frequently
- Shift work
Diagnosis of Sleep Disorders
Healthcare providers use several non-invasive tests to diagnose sleep problems, which include:
- Polysomnography (sleep study): Polysomnography, often known as a sleep study, is a thorough examination for diagnosing sleep problems. During the study, polysomnography captures the brain waves, the oxygen level in the blood, the breathing and heart rate, and the eye and leg movements.
- Overnight oximetry: This approach aims to monitor oxygen levels and heart rate.
- Titration studies use a CPAP and are frequently performed in conjunction with polysomnography.
- Multiple sleep latency testing. The patient is given 4-5 opportunities to sleep during the multiple sleep latency test (MSLT) during regular awake periods. The specialist uses the test to determine the level of drowsiness (how fast the patient falls asleep in each nap, also known as sleep latency) and how swiftly REM sleep commences.
- Actigraphy. A little wristwatch-like gadget that examines sleep-wake cycles and movements over time.
- Home sleep study. A study is conducted at home to evaluate obstructive sleep apnea and other sleep disorders.
Treatment for Sleep Disorders
Medical treatment. Any of the following medical treatments may be used to treat sleep disorders:
- Sleeping aids
- Medication for allergies or colds
- Medications to treat any underlying health problems
- Surgery or a breathing device (usually used for sleep apnea)
- Dental shield (usually for teeth grinding)
- Insomnia cognitive-behavioral therapy (CBTI)
Lifestyle modifications. When combined with medical therapies, lifestyle changes can significantly enhance sleep quality. Below are some examples:
- Including more veggies and seafood in the diet, as well as limiting the sugar consumption
- Exercising and stretching can help reduce tension and anxiety.
- Establishing and adhering to a regular sleeping routine
- Consuming less water before going to bed
- Decreasing the caffeine use, particularly in the late afternoon or evening
- Reducing the usage of cigarettes and alcohol
- Consuming smaller low-carbohydrate meals before going to bed
- Keeping a healthy weight following the doctor’s advice
Prevention of Sleep Disorders
Some sleeping issues can be avoided by practicing excellent sleep habits, sometimes known as sleep hygiene. Here are a few ideas to avoid sleep disorders.
- Attempt to go to bed and wake up simultaneously every day. Naps throughout the day should be avoided because they can cause less drowsiness at night.
- Limit the intake of caffeine, nicotine, and alcohol: Caffeine and nicotine are stimulants that can make it difficult to fall asleep.
- Alcohol can result in waking up at night and may disrupt sleep quality.
- Exercise regularly: Avoid exercising close to bedtime because it can stimulate the body system and make it difficult to sleep. Experts advise against exercising 2 to 3 hours before going to bed.
- Do not eat a big dinner before going to bed; Eating a heavy meal before bedtime will result in difficulty sleeping due to a full stomach.
- Make the sleeping environment comfortable: it should be dark, quiet, and not too hot or cold. If the light causes bother, consider using a sleep mask.
- Before going to bed, establish a pattern that allows the body to unwind and rest, such as reading books, playing music, or having a bath.
Sleep Disorders Nursing Diagnosis
Nursing Care Plan for Sleep Disorders 1
Disturbed Sleep Patterns
Nursing Diagnosis: Disturbed Sleep Pattern related to anxiety, long-term stress, depression, discomfort, either emotional or physical, and abuse of substances secondary to sleep disorders as evidenced by getting up earlier or later than desired, health status deterioration, reduced quality of life, sleeping pattern dissatisfaction, fatigue, and sleep disruption.
Desired Outcome: The patient will get enough sleep, as demonstrated by a relaxed appearance, verbalization of feeling refreshed, and an improvement in sleeping habits.
|Nursing Interventions for Sleep Disorders||Rationale|
|Educate the patient on correct food and hydration intake, such as avoiding large meals, alcohol, caffeine, or smoking before going to bed.||Having a full meal right before bedtime may cause stomach distress and delay sleep onset. Caffeine-containing beverages such as cappuccino, teas, cocoa, and carbonated beverages stimulate the neurological system. These drinks may impair the patient’s ability to calm down and sleep. Alcohol causes drowsiness and may aid in the initiation of sleep, but it disrupts REM sleep.|
|Increase muscle strength during the day, but encourage the patient to avoid intense activities before sleeping.||Stress can be minimized, and sleep can be promoted through therapeutic activities in people who suffer from sleep disorders. On the other hand, Strenuous activities might cause weariness and disrupt sleep habits. Therefore, avoid vigorous activities prior to heading to bed.|
|Teach the patient to establish a constant daily sleep and rest pattern.||Having regular schedules of sleep aid in stabilizing the circadian rhythm and reducing the amount of energy required for adjustment to variations.|
|Teach the patient to manage his time well, so there would be no need to do work during bedtime.||This intervention aims to avoid working late at night, therefore, it will help the patient to have a regular schedule of sleep.|
|Unless necessary, prohibit the patient from taking naps during the day.||Napping can interfere with the standard sleep patterns; nevertheless, older individuals benefit from numerous naps during the day to compensate for their shorter nightly sleep habits.|
Nursing Care Plan for Sleep Disorders 2
Nursing Diagnosis: Fatigue related to not having enough rest and a wide range of mental and emotional conditions secondary to sleep disorders, as evidenced by a persistent sense of tiredness and a limited capacity to do daily activities.
Desired Outcome: The patient will be able to get enough time to sleep and increase his energy and ability to undertake activities of daily living (ADLs).
|Nursing Interventions for Sleep Disorders||Rationale|
|Limit external stimuli, especially during relaxation and sleeping times.||In the patient’s physical environment, illumination, noises, guests, multiple interruptions, and litter can inhibit relaxation, disrupt rest or sleep, and add weariness.|
|Assist the patient in setting a daily exercise and rest regimen. Discuss the need to take frequent breaks.||A strategy that mixes periods of activity with rest intervals can help the patient complete desired activities while reducing fatigue levels. There is nothing wrong with executing daily tasks as long as they do not interfere with the patient’s sleeping pattern.|
|Support the patient in prioritizing preferred activities and daily tasks.||Establishing priorities is an energy conservation technique that allows the patient to use the energy available to fulfill vital tasks. Achieving desired goals can improve a patient’s mood and sense of mental wellbeing. This strategy seeks to increase the patient’s time to sleep through effective time management.|
|Encourage adequate nutritional intake to the patient.||A well-balanced diet of fats, carbohydrates, proteins, vitamins, and minerals promotes adequate sleep and avoids fatigue.|
|Assist the patient in developing behaviors that encourage healthy rest or sleep patterns.||Encouraging relaxation before sleep and allowing for several hours of unbroken sleep can help restore energy, avoid fatigue, and prevent the acquisition of sleep disorders.|
Nursing Care Plan for Sleep Disorders 3
Disturbed Thought Process
Nursing Diagnosis: Disturbed Thought Process related to Environmental stimuli and obstructive sleep apnea secondary to sleep disorders as evidenced by sleep disruption, having trouble falling asleep, and getting up early
- The patient will be able to achieve and sustain quality sleep.
- There will be no behavioral indications such as agitation, impatience, or apathy in the patient.
|Nursing Interventions for Sleep Disorders||Rationale|
|Examine the patient’s sleeping habits and variations, naps and frequency, activity level, sedentary state, number and time of nighttime awakenings, and complaints of exhaustion, lethargy, apathy, and impotence.||Provide information on which to base a treatment strategy for sleep deficit correction. Sun downing syndrome, in which the patient’s day and night are jumbled up, may be a challenge if the patient sleeps during the day. Sleeping at night may be restored by keeping the patient awake during the day.|
|Ascertain that the patient’s sleeping environment is peaceful, calming, and pleasant.||External stressors, such as frequent awakenings, can make it difficult to fall asleep and may disturb thought processes.|
|Before bedtime, provide customary rituals such as a hot beverage, additional covers, clean bedding, or warm baths.||This method improves disturbed thought processes while promoting comfort and relaxation prior to sleep.|
|Backrubs, music, and other relaxation techniques should be provided to patients.||This intervention improves disturbed thought processes, reduces anxiety and stress, and aids in relaxation before sleep. Therapeutic touch works successfully for patients with a sleep disorder.|
|If necessary, provide equipment to patients who experience disturbed thought processes due to sleep apnea.||This method aims to ensure that all stages of sleep are completed, resulting in restful sleep.|
Nursing Care Plan for Sleep Disorders 4
Nursing Diagnosis: Impaired Memory related to alterations in cognitive ability and brain chemical imbalance secondary to sleep disorder as evidenced by sleeping pattern modification and extreme exhaustion.
Desired Outcome: The patient will acquire functional ability at his optimum level with adaptations and alterations within his surroundings to compensate for sleep inadequacies.
|Nursing Interventions for Sleep Disorders||Rationale|
|Conduct comprehensive person-centered evaluations on a regular basis and interim assessments on a timely basis.||Assessments should be performed at least every six months to uncover concerns that will assist the person suffering from a sleep disorder to live fully.|
|Examine the patient’s general cognitive performance and memory.||Cognitive evaluation methods such as the General Practitioner Assessment of Cognition (GPCOG) can be utilized to evaluate the patient’s cognitive performance. The assessment findings are utilized further to examine the patient’s sleep disorder and therapy.|
|Examine the patient for sleep deprivation, CNS medications used concurrently, inadequate nourishment, dehydration, infection, or other concomitant illness processes.||Examine all elements that could lead to disorientation and a shift in sleeping patterns.|
|Workout, guided contemplation, and massage are supplementary and alternative therapy examples.||These activities can aid in the reduction of stress and the prevention of sleep disorders; stress can increase impaired memory and cause sleep disturbances. That is why alternative remedies are advantageous.|
|Keep an eye out for early indicators of impaired memory and sleep disruptions.||Early detection of difficulties leads to timely intervention to encourage rest or remove the patient from the circumstance triggering the sleep disorder.|
Nursing Care Plan for Sleep Disorders 5
Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective Breathing Pattern related to impaired regulation secondary to sleep disorder of an infant as evidenced by sleeping apnea, variations in respiratory depth, cyanosis, and pallor.
Desired Outcome: The infant’s respiratory state will remain within baseline criteria for rhythm rate, depth, and ease.
|Nursing Interventions for Sleep Disorders||Rationale|
|Examine the regularity and rhythm of breathing; look for apnea and alterations in heart rate.||Infants with apnea experience a spell of no breathing for more than 15 to 20 seconds, followed by bradycardia.|
|Set up an apnea monitor and a pulse oximeter for the infant.||Recognize apnea-related changes in chest movement, heart rate, and oxygen saturation.|
|Adjust the infant’s neck and head to a neutral posture.||Breathing might get obstructed if the neck bends too far forward or backward.|
|Avoid using suction for an extended period; avoid taking rectal temperatures and tube feedings.||Vagal stimulation can cause bradycardia, which can lead to apneic episodes.|
|If necessary, use nasal continuous positive airway pressure (CPAP).||When the infant continues to suffer apnea episodes, opt to use CPAP.|
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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