-
American Psychiatric Assocation. Diagnostic and statistical manual of mental disorders. 5th edition. Arlington (VA): American Pscyhiatric Assocation; 2013.
- Reynolds AC, Appleton SL, Gill TK, Adams RJ. Chronic insomnia disorder in Australia ‑ a report to the Sleep Health Foundation. Sydney: Sleep Health Foundation; 2019. [cited 2021 Jul 1]
- Buysse DJ, Angst J, Gamma A, Ajdacic V, Eich D, Rössler W. Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep 2008;31:473‑80.
- Bertisch SM, Pollock BD, Mittleman MA, Buysse DJ, Bazzano LA, Gottlieb DJ, et al. Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all‑cause mortality: Sleep Heart Health Study. Sleep (Basel) 2018;41:zsy047.
- Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Basta M, et al. Insomnia with short sleep duration and mortality: the Penn State cohort. Sleep 2010;33:1159‑64.
- Bin YS, Marshall NS, Glozier N. The burden of insomnia on individual function and healthcare consumption in Australia. Aust N Z J Public Health 2012;36:462‑8.
- Daley M, Morin CM, LeBlanc M, Grégoire JP, Savard J, Baillargeon L. Insomnia and its relationship to health‑care utilization, work absenteeism, productivity and accidents. Sleep Med 2009;10:427‑38.
- Hillman D, Mitchell S, Streatfeild J, Burns C, Bruck D, Pezzullo L. The economic cost of inadequate sleep. Sleep (Basel) 2018;41:zsy083.
- Cunnington D, Junge M. Chronic insomnia: diagnosis and non‑pharmacological management. BMJ 2016;355:i5819.
- Klink ME, Quan SF, Kaltenborn WT, Lebowitz MD. Risk factors associated with complaints of insomnia in a general adult population: influence of previous complaints of insomnia. Arch Intern Med 1992;152:1634‑7.
- Morin CM, Bélanger L, LeBlanc M, Ivers H, Savard J, Espie CA, et al. The natural history of insomnia: a population‑based 3‑year longitudinal study. Arch Intern Med 2009;169:447‑53.
- Roth T. Comorbid insomnia: current directions and future challenges. Am J Manag Care 2009;15 Suppl:S6‑13.
- Krakow B, Melendrez D, Ferreira E, Clark J, Warner TD, Sisley B, et al. Prevalence of insomnia symptoms in patients with sleep‑disordered breathing. Chest 2001;120:1923‑9.
- Bower P, Gilbody S. Stepped care in psychological therapies: access, effectiveness and efficiency. Narrative literature review. Br J Psychiatry 2005;186:11‑7.
- Espie CA. “Stepped care”: a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep 2009;32:1549‑58.
- Ree M, Junge M, Cunnington D. Australasian Sleep Association position statement regarding the use of psychological/behavioral treatments in the management of insomnia in adults. Sleep Med 2017;36 Suppl 1:S43‑7.
- Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al.; American Academy of Sleep Medicine. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep 2006;29:1415‑9.
- Fernando A 3rd, Arroll B, Falloon K. A double‑blind randomised controlled study of a brief intervention of bedtime restriction for adult patients with primary insomnia. J Prim Health Care 2013;5:5‑10.
- Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med 2011;171:887‑95.
- Royal Australian College of General Practitioners. HANDI Interventions: Brief behavioural therapy: insomnia in adults. Melbourne: RACGP; 2014. [cited 2021 Jul 1]
- Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta‑analysis. Ann Intern Med 2015;163:191‑204.
- Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA 2009;301:2005‑15.
- Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guidelines for pharmacological treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2017;13:307‑49.
- Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged‑release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res 2007;16:372‑80.
- Lack LC, Wright HR. Treating chronobiological components of chronic insomnia. Sleep Med 2007;8:637‑44.
- Herring WJ, Connor KM, Snyder E, Snavely DB, Zhang Y, Hutzelmann J, et al. Suvorexant in patients with insomnia: pooled analyses of three‑month data from phase‑3 randomized controlled clinical trials. J Clin Sleep Med 2016;12:1215‑25.
- Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF 3rd, Kupfer DJ. Benzodiazepines and zolpidem for chronic insomnia: a meta‑analysis of treatment efficacy. JAMA 1997;278:2170‑7.
- Wiegand MH. Antidepressants for the treatment of insomnia : a suitable approach? Drugs 2008;68:2411‑7.
- Thompson W, Quay TA, Rojas‑Fernandez C, Farrell B, Bjerre LM. Atypical antipsychotics for insomnia: a systematic review. Sleep Med 2016;22:13‑7.
- Vande Griend JP, Anderson SL. Histamine‑1 receptor antagonism for treatment of insomnia. J Am Pharm Assoc (2003) 2012;52:e210‑9.
- Takaesu Y, Utsumi T, Okajima I, Shimura A, Kotorii N, Kuriyama K, et al. Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: A systematic review and meta‑analysis. Sleep Med Rev 2019;48:101214.
- Australasian Sleep Association. Sleep Services Directory. [cited 2021 Jul 1]
Sleep and well-being work hand in hand, and getting good sleep is actually vital to the overall health of an individual as eating healthy and exercising regularly. Think of your body as a factory. Sleep is required to regain energy for physical and mental activities. If an individual can’t sleep, he or she may have insomnia.
Insomnia is a complicated condition and may be temporary or chronic. Short term insomnia may occur in response to variations in work schedules, overnight stressors, or travel beyond different time zones. Long-term insomnia is linked to substance abuse such as drugs and alcohol, and other factors like chronic pain, chronic depression, obesity, and aging.
Sleep patterns can be affected by environment, especially in the hospital setting where noise, lighting, frequent monitoring, and treatments are always present. The harm caused by not getting enough sleep can be immediate, so nursing care is crucial. Nurses should be aware of insomnia and how they can help patients to get a good sleep. The focus should be toward educating patients with insomnia its proper management and ways on how to avoid such condition.
Causes
Here are some factors that may be related to insomnia:
- Abnormal physiological symptoms (e.g., hypoxia, dyspnea, neurological dysfunction)
- Aging
- Anxiety
- Chronic stress
- Depression
- Emotional or physical discomfort
- Environmental variations
- Excessive stimulation
- Medications
- Pain
- Substance abuse
Signs and Symptoms
The following signs and symptoms characterizes insomnia:
- Awakening earlier or later than desired
- Decreased health status
- Decreased quality of life
- Dissatisfaction with sleep pattern
- General tiredness
- Interrupted sleep
- Irritability
- Lack of energy
- Problems with concentration and memory
- Sleepiness during the day
- Verbal reports of difficulty falling asleep
Goals and Outcomes of Insomnia
The following are the common goals and expected outcomes for Insomnia nursing diagnosis:
- Patient obtains optimal amounts of sleep as evidenced by rested appearance, verbalization of feeling rested, and improvement in sleep pattern.
Nursing Assessment for Insomnia
This assessment may further assist in identifying changes that may lead to a diagnosis of insomnia or troubled sleep patterns that require action by nursing staff. Insomnia must be addressed in the best way possible to stop it from becoming a chronic problem.
| Determine patterns of sleep in the past in a normal environment: amount, bedtime routines, depth, length, positions, aids, and other interfering factors. | Each individual has different patterns of sleep. Information about this topic provides baseline data for evaluating means to improve the patient’s sleep. |
| Take note observations of sleep-wake behaviors. Take down notes on the number of hours the patient is asleep. | This provides baseline data for the evaluation of insomnia. |
| Note physical or psychological circumstances that hinder sleep. Physical:
Psychological: | The patient’s perception of the insomnia may differ from objective evaluation. |
| Evaluate the patient’s knowledge on the cause of sleep problems and potential relief measures to facilitate treatment. | The patient may have insights about the existing problems (e.g., anxiety or fear about a certain situation in life). This data will determine appropriate therapy. |
| Observe and evaluate the timing or effects of medications that can affect sleep. | Following medication schedules that requires a lot of attention may affect the sleeping pattern of the patient especially in the hospital setting. |
Nursing Interventions for Insomnia
The following are the therapeutic nursing interventions for Insomnia nursing care plan:
| Educate the patient on the proper food and fluid intake such as avoiding heavy meals, alcohol, caffeine, or smoking before bedtime. | Having full meals just before bedtime may produce gastrointestinal upset and hinder sleep onset. Coffee, tea, chocolate, and colas which contain caffeine stimulate the nervous system. This may interfere with the patient’s ability to relax and fall asleep. Alcohol produces drowsiness and may facilitate the onset of sleep but interferes with REM sleep. |
| Encourage daytime physical activities but instruct the patient to avoid strenuous activities before bedtime. | In insomnia, stress may be reduced by therapeutic activities and may promote sleep. However, strenuous activities may lead to fatigue and may cause insomnia. |
| Encourage patient to take milk. | L-tryptophan is a component of milk which promotes sleep. |
| Instruct the patient to follow a consistent daily schedule for rest and sleep. | Consistent schedules facilitate regulation of the circadian rhythm and decrease the energy needed for adaptation to changes. |
| Remind the patient to avoid taking a large amount of fluids before bedtime. | This will refrain the patient from going to the bathroom in between sleep. |
| Inhibit the patient from daytime naps unless needed. | Napping can disrupt normal sleep pattern; however, older patients do better with frequent naps during the day to counter their shorter nighttime sleep schedules. |
| Introduce relaxing activities such as warm bath, calm music, reading a book, and relaxation exercises before bedtime. | These activities provide relaxation and distraction to prepare mind and body for sleep. |
| Tell patient to write a journal regarding problems before retiring. | Journaling allows the patient to “set aside” problems or any mental activities just before going to sleep. |
| Educate patient about the use of over-the-counter, herbal, and prescription sleep aids: | These may be beneficial when patient experiences short-term sleep problems. |
| Its main job in the body is to regulate night and day cycles or sleep-wake cycles. Older adults seem to tolerate melatonin with minimal side effects. | |
| Many over-the-counter drugs contain antihistamines that can cause drowsiness, which might help the patient fall asleep for a few nights. These drugs produce anticholinergic side effects that may harm older adults. | |
| These act through general central nervous system depression and disrupt the normal stages of non-rapid eye movement (NREM) and REM sleep. Long-term use may cause daytime drowsiness, rebound insomnia, and increased dreaming when discontinued. |
| Tea made from mixing chamomile and Valerian root together makes an excellent bedtime ritual that facilitates stress relief and relaxation. Chamomile acts to facilitate general relaxation rather than as an actual sleep aid, while Valerian causes drowsiness. Using Valerian together with kava may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Extra carefulness is necessary because some herbal products are not regulated by the FDA. |
| Suggest an environment conducive to rest or sleep. | A lot of people sleep better in cool, dark, quiet environment. |
| Prevent the patient from thinking about next day’s activities or any distracting thoughts at bedtime. | Providing a designated time for these concerns allows the patient to “let go” of these problems at bedtime. |
| Suggest patient to get out of bed temporarily and perform a relaxing activity if unable to sleep 30-45 minutes in bed. | The bed is not supposed to be used for watching TV, work, or wakefulness. The brain should associate the bed with sleeping. |
| For patients who are hospitalized: | |
| Eliminate any activities that are not important. | This measure facilitates minimal interruption in sleep or rest. |
| Place patient in a room away from any distraction or noise such as the nursing station. | The nursing station is often the center of noise and activity. |
| Provide a “Do not disturb” sign on the patient’s room. | It is necessary to alert people in this kind of situation to avoid disruption of sleep. |
| Render bedtime nursing care such as back rub and other relaxation techniques. | These kinds of activities facilitate relaxation and promote the onset of sleep. |
| Attempt to allow for sleep cycles at least 90 minutes. | Research shows that 60 to 90 minutes are necessary to complete one sleep cycle and that completion of an entire sleep cycle is beneficial. |
| Educate patient about their sleep requirements. | Most people need at least six hours sleep for normal memory and brain function. |
| Help patient understand the main cause of sleeping difficulties. | Misconceptions and myths about sleep exist. Wrong notions about sleep disturbances may cause fear and anxiety. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
References
Additional references for this insomnia nursing diagnosis.
- Krishnan, P., & Hawranik, P. (2008). Diagnosis and management of geriatric insomnia: a guide for nurse practitioners. Journal of the American Academy of Nurse Practitioners, 20(12), 590-599. [Link]
- Ackley, B. J., & Ladwig, G. B. (2010). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences. [Link]