Nursing Care Plan: Sleep Pattern Disturbance

Sleep Pattern DisturbanceNursing Care Plan for Sleep Pattern Disturbance.  Nanda defines the nursing diagnosis of sleep pattern disturbance as time limited disruption of sleep (natural,periodic suspension of consciousness), amount, and quality

Sleep Pattern Disturbance Related To (Etiology)

  • Depression
  • Fear
  • Anxiety
  • Fear of insomnia
  • Fatigue
  • Inadequate sleep hygiene
  • Biochemical agents
  • Nightmares
  • Obsession thoughts
  • Fears (e.g., dark, intrusion,death)
  • Adrenaline rush related to high levels of anxiety
  • Panic attacks
As Evidenced By (Assessment Finding/Diagnostic Cues)
  • Early morning awakenings
  • Arising earlier or later than desired
  • Verbal complaints of difficulty falling asleep
  • Verbal complaints of not feeling well-rested
  • Three or more nighttime awakenings
  • Decreased ability to function

Sleep Pattern Disturbance Nursing Care Plan Outcome Criteria

  • Develops an uninterrupted sleep pattern 5 to 8 hours per night
  • Reports feelings of being rejuvenated after sleep
  • Establishes an effective sleep routine
Long-Term Goals
Client will:
  • State he/she begins to see improvement in quality of sleep and pattern of sleep after 2 weeks
  • State that the relaxation exercises (tapes) are useful sleep aids by (date)
  • Work with nurse to review and revise plan if sleep pattern has not improved after 2 weeks
Short-Term Goals
Client will:
  • Identify personal habits that disrupt sleep pattern and those things that could augment quality of sleep after first interview
  • Form a “sleep plan” with nurse that the client is willing to try within 2 days
  • Identify any other issues that might need attention that are contributing to sleep pattern disturbance, and be open for referrals

Sleep Pattern Disturbance Interventions and Rationales

1. Assess client and family usual sleep pattern, any changes that have occurred, and what was happening at the time. Identify if there was a precipitating event around onset of sleep problem or if it is chronic. R: Information from both client and family clarifies specific sleep disturbance.

2. Identify the client’s usual sleep patterns including the following:
  • Bedtime rituals
  • Time of rising, time of retiring
  • Use of alcohol and/or caffeine before sleep
  • Use of sleep aids (prescribed or over-the-counter medications)

R: Establish a baseline and help identify problems:

  • Sleeping medications and alcohol interfere with rapid eye movement (REM) sleep.
  • Caffeine and exercise before retiring can interfere with sleep.
    3. Review sleep hygiene measures with the client. Determine if the client does any of the following: refrains from naps, alcohol and caffeine at night; follow a regular retiring and arising schedule; exercise pattern. R: Identifying baseline helps target needed interventions.
    4. Develop a sleep relaxation program with client (e.g., self-hypnosis, progressive muscle relaxation,imagery). R: Employing both physical and mental relaxation can help minimize anxiety and promote sleep.
    5. Demonstrate and rehearse these techniques with client until client feels relaxed and is able to practice them at bedtime. R: Have client practice chosen relaxation method with nurse. Allow time for client to begin to feel results of relaxation.
    6. Suggest use of relaxation tapes. R: If client has racing thoughts or is troubled by a problem, tapes can help the client focus on relaxation.
    7. Encourage client  to:
    • Use decaffeinated beverages until sleep pattern improves.
    • Limit fluid intake 3 to 5 hours before retiring.
    • Increase physical activity during the day, even if fatigued.
    • Avoid daytime naps.
    • Establish regular times of retiring and waking.
    R: These are known sleep aids.

    8. Establish with client a sleep program that incorporates the elements of good sleep hygiene and relaxation tools. R: Client is more likely to follow plan if he/she is involved with the incorporation of known effective techniques.
    9. Suggest to client that if he/she does not feel drowsy after 20 minutes, get up and engage in a quiet activity that is “boring”–not stimulating. R: Waiting for sleep that will not come can increase anxiety and frustration. Doing something monotonous at bedtime might help the client become drowsy.
    10.Encourage client to practice the agreed-upon bedtime routine for 2 weeks even if there does not seem to be a benefit. R:It might take 2 weeks or longer for habits to settle in.
    11.Encourage client to simultaneously work on any issues that might be adversely affecting sleep (e.g., anxiety disorders, social or personal problems, job related issues, interpersonal difficulties). Offer referrals when appropriate.
    R: Disturbances in sleep are often secondary to other issues, either emotional or physical. If such issues are present, they need to be addressed.
    You can use this Nursing Care Plan for Sleep Pattern Disturbance for patients suffering from depression and anxiety.

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