Nursing Care Plan: Sleep pattern disturbance: frequent awakenings and difficulty falling asleep related to generalized weakness, environmental discomfort, and pain/discomfort.

Scientific Basis:

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-REM sleep, and wakefulness. As persons age, the amount of time spent in REM diminishes. The amount of sleep that individuals require varies with age and personal characteristics. In general, the demands for sleep and wakefulness may be temporary or chronic. Such disruption may result in both subjective distress and apparent impairment in function abilities.

Adequate rest is extremely important but may be difficult to obtain because of distressing symptoms charge in health status interfere with the patient’s normal sleep awake pattern. Discomfort also contributes in sleep. Any conditions that result in discomfort have the potential to disrupt sleep.

Changes in environment health and routine combined with hospital routines interferes with patient normal sleep-wake pattern. Weakness and discomfort can continue to disrupt sleep. Other factors that contribute to sleep fragmentation include stimuli that tend to awaken people in the middle of the night. Internal stimuli such as discomfort are frequent disturbances. Any illnesses that cause physical discomfort can result in sleep problems.

Adequate rest is extremely important but may be difficult to obtain because if distressing symptoms/ change in health status interfere with the patient’s sleep-awake pattern. Any condition that may result in discomfort, injury and environmental factors has potential to disrupt sleep.

Lippincott Williams & Wilkins., 2002; Gulanick, 2007; Kozier, et al, 2007; Black, J & Hawks, J, 2005


Intervention and Rationale

I: Assess past pattern of sleep nature.
R: Different individuals has different pattern of sleeping.

I: Assess possible cause of sleep disturbance.
R: For planning of appropriate intervention.

I: Assess pain-PQRST.
R: An accurate assessment of the client’s pain is necessary for appropriate and effective intervention.

I: Ascertain usual sleep pattern and changes that are occurring, naps, awakenings and frequency and client’s complaints of lack of rest.
R: Provides information to alleviate sleep deprivation in relation to age-related changes and to identify and establish plan of care.

I: Provide calm and quite environment.
R: Helps to promote conducive atmosphere for restful sleep.

I: Establish a regular bedtime and wake up time for all days. Eliminate lengthy naps.
R: To prevent destruction of biologic rhythm.

I: Ensure appropriate temperature and ventilation.
R: To keep environment conducive for sleep.

I: Schedule and plan activities.
R: Enhance client participation and promotes relaxation.

I: Instruct client/SO to avoid caffeinated drinks like cola and coffee.
R: May irritate the bladder which can cause diuresis over stimulation prevents client from falling asleep, delays client falling asleep and shortens the REM part of sleep.

I: Suggest engaging in relaxing activity before retiring such as: warm bath, calm music, reading books and relaxation exercise.
R: Relaxation techniques frequently help promote sleep.

I: Instruct to avoid large amount of fluid intake before bedtime.
R: For clients may need to void during night time.

I: Instruct to avoid strenuous activity before bedtime, end the day peacefully by avoiding exciting TV programs and arguments.
R: To reduce stress and promote sleep.

I: Limit visit hours for 1-2 hours only per day between 9-12 am or 2-4 pm.
R: To promote adequate rest.

I: Provide warm drinks, extra cover prior to bedtime.
R: Ritualistic procedures may prevent breaks in established routines and promote comfort and relaxation prior to sleep.
I: Discourage the consumption of alcohol.
R: Alcohol interrupts will the sleep with the client, and it decreases the REM of sleep.

I: May provide a dark environment prior to sleep.
R: Serotonin plays an important role during sleeping, serotonin increase in a dark environment.

I: Final meal should be light and 3-4 hours before sleeping.
R: An overload digestive system prevents peaceful sleep.

I: Encourage participation in regular exercise program during the day.
R: To aid in stress control/release of energy. Exercise at bed time may stimulate rather than relax patient and actually interfere with sleep.

Gulanick, 2007; Comer, 2003; Doenges, et al, 2002