NURSING DIAGNOSIS: Sleep pattern disturbance

related to decreased physical activity, fear, anxiety, inability to assume usual sleep position, frequent assessments or treatments, unfamiliar environment, and discomfort resulting from current illness/injury.

Desired Outcome
The client will attain optimal amounts of sleep as evidenced by:
  1. statements of feeling well rested
  2. usual mental status
  3. absence of frequent yawning and dark circles under eyes.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of a sleep pattern disturbance (e.g. statements of difficulty falling asleep, not feeling well rested, or interrupted sleep; irritability; disorientation; lethargy; frequent yawning; dark circles under eyes).
  2. Determine the client's usual sleep habits.
  3. Implement measures to promote sleep:
    1. perform actions to reduce fear and anxiety (see Diagnosis 13, action b)
    2. discourage long periods of sleep during the day unless signs and symptoms of sleep deprivation exist or daytime sleep is usual for client
    3. perform actions to relieve discomfort if present (e.g. reposition client; administer prescribed analgesics, antiemetics, or muscle relaxants
    4. encourage participation in relaxing diversional activities during the evening
    5. discourage intake of foods and fluids high in caffeine (e.g. chocolate, coffee, tea, colas) in the evening
    6. offer client an evening snack that includes milk or cheese unless contraindicated (the L-tryptophan in milk and cheese helps induce and maintain sleep)
    7. allow client to continue usual sleep practices (e.g. position; time; presleep routines such as reading, watching television, listening to music, and meditating) whenever possible
    8. satisfy basic needs such as comfort and warmth before sleep
    9. encourage client to urinate just before bedtime
    10. reduce environmental distractions (e.g. close door to client's room; use night light rather than overhead light whenever possible; lower volume of paging system; keep staff conversations at a low level and away from client's room; close curtains between clients in a semi-private room or ward; keep beepers and alarms on low volume; provide client with "white noise" such as a fan, soft music, or tape-recorded sounds of the ocean or rain; have sleep mask and earplugs available for client if needed)
    11. ensure good room ventilation
    12. encourage client to avoid drinking alcohol in the evening (alcohol interferes with REM sleep)
    13. encourage client to avoid smoking before bedtime (nicotine is a stimulant)
    14. if possible, administer medications that can interfere with sleep (e.g. steroids, diuretics) early in the day rather than late afternoon or evening
    15. administer prescribed sedative-hypnotics if indicated
    16. perform actions to reduce interruptions during sleep (80 - 100 minutes of uninterrupted sleep is usually needed to complete one sleep cycle)
      1. restrict visitors
      2. group care (e.g. medications, treatments, physical care, assessments) whenever possible.
  4. Consult appropriate health care provider if signs and symptoms of sleep deprivation persist or worsen.