Insomnia Nursing Diagnosis and Nursing Care Plans

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.

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.

• 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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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 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.

• 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 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.

• 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 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 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.

• 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.

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

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.

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.