Nursing diagnosis – INSOMNIA



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

culty concentrating

• 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

• Grief

• Anxiety

• Inadequate sleep hygiene

• Depression

• Intake of stimulants

• Environmental factors

• Intake of alcohol

• Fear

• Medication

• Gender-related hormonal shifts

• Physical discomfort

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Coping

• Sleep/rest

• Emotional

• Values/beliefs


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.


Anxiety Level; Fear Level; Mood Equilibrium; Personal Well-Being;



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.


Biofeedback; Calming Techniques; Coping Enhancement; Energy

Management; Security Enhancement; Simple Relaxation Therapy;

Sleep Enhancement


Holcomb, S. S. (2006, February). Recommendations for assessing insomnia.

The Nurse Practitioner, 3(2), 55–60.

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