A disruption in the amount and quality of sleep that impairs func-
• Observed changes in affect
• Reports difﬁculty falling asleep
• Observed lack of energy, difﬁ-
and staying asleep
• Reports dissatisfaction with
• Increased work or school
• Reports early morning awak-
• Reports changes in mood
• Reports decreased health status,
• Reports nonrestorative sleep
quality of life
• Activity pattern
• Inadequate sleep hygiene
• Intake of stimulants
• Environmental factors
• Intake of alcohol
• Gender-related hormonal shifts
• Physical discomfort
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
The patient will
• Identify factors that prevent or promote sleep.
• Achieve sleep for ___ hours without interruption.
• Report feeling well-rested.
• Be free from signs of sleep deprivation.
• Alter diet and habits to promote sleep, such as reducing caffeine
and alcohol intake before bedtime.
• Not exhibit sleep-related behavioral symptoms, such as
restlessness, irritability, lethargy, and disorientation.
• Perform relaxation exercises at bedtime.
SUGGESTED NOC OUTCOMES
Anxiety Level; Fear Level; Mood Equilibrium; Personal Well-Being;
INTERVENTIONS AND RATIONALES
Determine: Assess patient’s daytime activity and work patterns;
travel history; normal bedtime; problems associated with sleep; qual-
ity of sleep; sleeping environment; personal beliefs about sleep; use
of alcohol, caffeine, hypnotics, and nicotine. Assessment information
will assist in selecting appropriate interventions.
Perform: Ask patient to help make changes in the environment that
would promote sleep. This allows patient to have an active role in
Administer medications on a schedule that will allow for
maximum rest. Disturbing for medication administration during rest
periods will disrupt sleep patterns. If the patient requires diuretics
in the evening, give far enough in advance to allow peak effect
before bedtime. Other medications that may interfere with sleep are
-blockers, MAO inhibitors, and phenytoin.
Provide patient with sleep aids, such as pillows, bath before sleep,
food or drink, and reading materials to promote ease in falling
asleep. Milk and some high-protein snacks, such as cheese and nuts,
contain L-tryptophan, a sleep promoter. Personal hygiene and
prebedtime rituals promote sleep in some patients.
Develop a sleep log with the patient describing sleep disturbances
and the effect on daytime functioning. The log will help both
patient and nurse to evaluate progress in evaluating sleep patterns.
Inform: Teach patient relaxation techniques such as guided imagery,
deep breathing, meditation, aromatherapy, and progressive muscle
relaxation. Practice with the patient at bedtime. Purposeful
relaxation efforts usually help promote sleep.
Instruct patient to eliminate or reduce caffeine and alcohol intake
and avoid foods that interfere with sleep (e.g., spicy foods). Foods
and beverages containing caffeine consumed fewer than 4 hr before
bedtime may interfere with sleep. Alcohol disrupts normal sleep,
especially when ingested immediately before retiring.
When anxiety is a factor in sleep deprivation, teach coping tech-
niques to reduce the frustration of being unable to sleep.
Attend: Listen to the patient’s description of insomnia. Allow time for
the patient to talk about his frustration. Being able to have a sensitive
listener may help reduce some of the frustration and may lead to new
ideas about how to help the patient resolve his sleep issues.
Ask the patient each day to describe the quality of his sleep. Patients
are sometimes unaware of the periods in which they do sleep.
Manage: Refer to case manager/social worker to ensure that follow-
up is provided.
SUGGESTED NIC INTERVENTIONS
Biofeedback; Calming Techniques; Coping Enhancement; Energy
Management; Security Enhancement; Simple Relaxation Therapy;
Holcomb, S. S. (2006, February). Recommendations for assessing insomnia.
The Nurse Practitioner, 3(2), 55–60.