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Sleep Pattern Disturbance

Sleep is a complex cycle consisting of different stages that varies between individuals. Disturbances can be caused by environmental factors like noise or medications and affect recovery. The document outlines assessing sleep patterns, identifying interfering factors, and implementing interventions like maintaining a consistent schedule, relaxing before bed, and ensuring a quiet environment to promote optimal sleep.

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609 views

Sleep Pattern Disturbance

Sleep is a complex cycle consisting of different stages that varies between individuals. Disturbances can be caused by environmental factors like noise or medications and affect recovery. The document outlines assessing sleep patterns, identifying interfering factors, and implementing interventions like maintaining a consistent schedule, relaxing before bed, and ensuring a quiet environment to promote optimal sleep.

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Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sleep Pattern Disturbance - Insomnia

Sue Galanes, RN, MS, CCRN


Meg Gulanick, RN, PhD

NANDA: Disruption of sleep time causes discomfort or interferes with


desired lifestyle
Sleep is required to provide energy for physical and mental activities. The sleep-wake cycle
is complex, consisting of different stages of consciousness: rapid eye movement (REM)
sleep, non-rapid eye movement (NREM) sleep, and wakefulness. As persons age the amount
of time spent in REM sleep diminishes. The amount of sleep that individuals require varies
with age and personal characteristics. In general the demands for sleep decrease with age.
The elderly sleep less during the night, but may take more naps during the day to feel
rested. Disruption in the individual's usual diurnal pattern of sleep and wakefulness may be
temporary or chronic. Such disruptions may result in both subjective distress and apparent
impairment in functional abilities. Sleep patterns can be affected by environment, especially
in hospital critical care units. These patients experience sleep disturbance secondary to the
noisy, bright environment, and frequent monitoring and treatments. Such sleep disturbance
is a significant stressor in the intensive care unit (ICU) and can affect recovery. Other
factors that can affect sleep patterns include temporary changes in routines such as in
traveling, jet lag, sharing a room with another, use of medications (especially hypnotic and
antianxiety drugs), alcohol ingestion, night-shift rotations that change one's circadian
rhythms, acute illness, or emotional problems such as depression or anxiety. This care plan
focuses on general disturbances in sleep patterns and does not address organic problems
such as narcolepsy or sleep apnea.
Related Factors

Pain/discomfort

Environmental changes

Anxiety/fear

Depression

Medications

Excessive or inadequate stimulation

Abnormal physiological status or symptoms (dyspnea, hypoxia, neurological


dysfunction, and others)

Normal changes associated with aging

Defining Characteristics

Verbal complaints of difficulty falling asleep

Awakening earlier or later than desired

Interrupted sleep

Verbal complaints of not feeling rested

Restlessness

Irritability

Dozing

Yawning

Altered mental status

Difficulty in arousal

Change in activity level

Altered facial expression (e.g., blank look, fatigued appearance)

Expected Outcomes
Patient achieves optimal amounts of sleep as evidenced by rested appearance, verbalization
of feeling rested, and improvement in sleep pattern.

Ongoing Assessment
Actions/Interventions/Rationale
Key:

(i) independent
(c) collaborative
(i) Assess past patterns of sleep in normal environment: amount, bedtime rituals,
depth, length, positions, aids, and interfering agents.
Sleep patterns are unique to each individual.
(i) Assess patient's perception of cause of sleep difficulty and possible relief
measures to facilitate treatment.
For short-term problems, patients may have insight into the etiologic factors of the
problem: fear over results of a diagnostic test, concern over a daughter getting
divorced, depression over the loss of a loved one, and other events. Knowing the
specific etiologic factor will guide appropriate therapy.
(i) Document nursing or caregiver observations of sleeping and wakeful behaviors.
Record number of sleep hours. Note physical (e.g., noise, pain or discomfort,
urinary frequency) and/or psychological (e.g., fear, anxiety) circumstances that
interrupt sleep.
Often, the patient's perception of the problem may differ from objective evaluation.
(i) Identify factors that may facilitate or interfere with "normal patterns."

Considerable confusion and myths about sleep exist. Knowledge of its role in
health/wellness and the wide variation among individuals may allay anxiety, thereby
promoting rest and sleep.
(i) Evaluate timing or effects of medications that can disrupt sleep.
In both the hospital and home care setting, patients may be following medication
schedules that require awakening in the early morning hours. Attention to changes
in the schedule or changes to once a day medication may solve the problem.

Therapeutic Interventions
Actions/Interventions/Rationale
Key:

(i) independent
(c) collaborative
(i) Instruct patient to follow as consistent a daily schedule for retiring and arising
as possible.
This promotes regulation of the circadian rhythm, and reduces the energy required
for adaptation to changes.
(i) Instruct to avoid heavy meals, alcohol, caffeine, or smoking before retiring.
Though hunger can also keep one awake, gastric digestion and stimulation from
caffeine and nicotine can disturb sleep.
(i) Instruct to avoid large fluid intake before bedtime.
For patients may need to void during the night.
(i) Increase daytime physical activities as indicated
To reduce stress and promote sleep.
Instruct to avoid strenuous activity before bedtime.
Overfatigue may cause insomnia.
(i) Discourage pattern of daytime naps unless deemed necessary to meet sleep
requirements or if part of one's usual pattern.
Napping can disrupt normal sleep patterns. However the elderly do better with
frequent naps during the day to counter their shorter nighttime sleep schedule.
(i) Suggest use of soporifics such as milk.
Which contains L-tryptophan that facilitates sleep.
(i) Recommend an environment conducive to sleep or rest (e.g., quiet, comfortable
temperature, ventilation, darkness, closed door). Suggest use of earplugs or eye
shades as appropriate.
(i) Suggest engaging in a relaxing activity before retiring, such as warm bath,
calm music, reading an enjoyable book, relaxation exercises.
(i) Explain the need to avoid concentrating on the next day's activities or on one's
problems at bedtime.
Obviously, this will interfere with inducing a restful state. Planning a designated time
during the next day to address these concerns may provide permission to "let go" of
the worries at bedtime.
(c) Suggest using hypnotics or sedatives as ordered; evaluate effectiveness.
Use of hypnotic medications should be thoughtfully considered and avoided if less
aggressive means are effective because of their potential for cumulative effects and
generally limited period of benefit. Different drugs are prescribed depending on
whether the patient has trouble falling asleep or staying asleep. Medications that
suppress REM sleep should be avoided.
(i) If unable to fall asleep after about 30 to 45 minutes, suggest getting out of bed
and engaging in a relaxing activity.
The bed should not be associated with wakefulness.

For patients who are hospitalized:


(i) Provide nursing aids (e.g., back rub, bedtime care, pain relief, comfortable
position, relaxation techniques).
To promote rest.
(i) Organize nursing care.
To promote minimal interruption in sleep or rest.

Eliminate nonessential nursing activities.

Prepare patient for necessary anticipated interruptions/disruptions.

(i) Attempt to allow for sleep cycles of at least 90 minutes.


Experimental studies have indicated that 60 to 90 minutes are needed to complete
one sleep cycle, and the completion of an entire cycle is necessary to benefit from
sleep.
(i) Move patient to room farther from the nursing station if noise is a contributing
factor.
(i) Post a "Do not disturb" sign on the door.

Education/Continuity of Care
Actions/Interventions
Key:

(i) independent
(c) collaborative
(i) Teach about possible causes of sleeping difficulties and optimal ways to treat
them.
(i) Instruct on nonpharmacological sleep enhancement techniques.

NIC
Sleep Enhancement

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