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Insomnia Nursing Guide

Insomnia General Overview 

Insomnia is a common sleep disorder that involves difficulty falling asleep, staying asleep, or waking too early and not being able to return to sleep. It can be acute (short term) or chronic (lasting for more than three months). Insomnia affects daily functioning, causing fatigue, mood disturbances, and cognitive impairments. It’s linked to various mental and physical health conditions, including anxiety, depression, cardiovascular disease, and impaired quality of life. Nurses help assess, manage, and educate patients about insomnia to enhance sleep quality and overall well-being. 

Insomnia etiology and epidemiology 

Insomnia has multiple causes and can be primary or secondary to other medical conditions. Common causes include: 

  • Psychological factors: Stress, anxiety, depression 
  • Medical conditions: Chronic pain, asthma, heart failure, gastroesophageal reflux disease (GERD) 
  • Medications: Stimulants, antidepressants, corticosteroids 
  • Lifestyle factors: Poor sleep hygiene, irregular sleep schedules, use of caffeine or alcohol 
  • Environmental factors: Noise, light, uncomfortable sleeping conditions 

Epidemiology: 

  • Insomnia affects up to 30% of the adult population, with chronic insomnia affecting 10%. 
  • It is more common in women, older adults, and individuals with comorbidities like depression and anxiety. 
  • Prevalence increases with age, and it is often underreported and untreated. 

ICD-10 code 

The ICD-10 code for insomnia is: 

  • G47.00 — Insomnia, unspecified  

Insomnia Diagnosis 

The diagnosis of insomnia is primarily based on a thorough patient history and sleep assessment. Key diagnostic criteria include difficulty beginning or maintaining sleep, early morning awakenings, and daytime side effects, such as fatigue, impaired concentration, or mood disturbances. Nurses should also assess underlying medical conditions, medication use, and lifestyle factors contributing to sleep disturbances. 

  • Sleep diaries and questionnaires (e.g., Pittsburgh Sleep Quality Index) are useful tools to evaluate sleep patterns. 
  • Polysomnography may be indicated to rule out other sleep disorders, such as sleep apnea, in complex cases. 

Insomnia management 

Management of insomnia includes non-pharmacological and pharmacological approaches. Nurses should focus on patient education regarding lifestyle modifications and cognitive-behavioral interventions before considering medication. 

Non-pharmacological approaches: 

  • Cognitive behavioral therapy for insomnia (CBT-I): Often considered the gold standard treatment, this focuses on identifying and altering thoughts and behaviors that worsen insomnia. 
  • Sleep hygiene education: Encourage a regular sleep schedule, avoid stimulants close to bedtime, and create a comfortable sleep environment. 
  • Relaxation techniques: Deep breathing exercises, progressive muscle relaxation, meditation. 
  • Stimulus control therapy: Reinforce the association between a person’s bed and sleep by limiting non-sleep activities in bed. 

Pharmacological treatments: 

  • Benzodiazepines and non-benzodiazepine hypnotics: Short-term use to initiate sleep. 
  • Melatonin or melatonin receptor agonists: Useful for circadian rhythm-related insomnia. 
  • Sedating antidepressants: Low doses of trazodone or mirtazapine may be used when insomnia is linked to depression or anxiety. 

Insomnia nursing care plan 

Nursing considerations 

Nurses should be vigilant about assessing the patient's sleep patterns, understanding their lifestyle, and identifying any potential causes of insomnia. Patient education and behavioral interventions are central to the management plan. 

Assessment 

  • Evaluate the patient's sleep history, including onset, duration, and frequency of insomnia symptoms. 
  • Assess for stressors, anxiety, depression, and any underlying medical conditions. 
  • Review current medications and substances that may contribute to sleep disturbances. 
  • Identify environmental factors that may be impacting sleep (e.g., noise, light). 

Nursing diagnosis/risk for 

  • Insomnia related to stress, anxiety, or medical conditions as evidenced by difficulty falling asleep and reports of daytime fatigue. 
  • Fatigue related to chronic sleep deprivation. 
  • Risk for impaired cognitive function related to prolonged lack of restorative sleep. 

Interventions 

  • Promote sleep hygiene. Educate the patient on consistent sleep-wake times, avoiding stimulants, and ensuring a conducive sleep environment. 
  • Use CBT-I techniques. Guide the patient through behavioral modifications and coping strategies to address dysfunctional sleep beliefs. 
  • Consider relaxation training. Teach techniques such as deep breathing and meditation before bedtime. 
  • Monitor medication use.  Provide education on proper use of sleep aids, potential side effects, and the risk of dependence. 
  • Support environmental adjustments. Suggest modifications such as using earplugs, blackout curtains, or white noise machines. 

Expected outcomes 

  • The patient reports improved sleep quality and duration; however, this depends on treatment and severity of the condition.  
  • The patient demonstrates understanding and use of effective sleep hygiene techniques. 
  • The patient experiences reduced daytime fatigue and cognitive impairments. 
  • The patient’s mood and quality of life improve with better sleep. 

Individual/caregiver education 

  • Sleep routine: Establish and maintain regular sleep-wake times. 
  • Avoid stimulants: Limit caffeine, nicotine, and alcohol, especially leading up to bedtime. 
  • Stress management: Encourage the use of relaxation techniques and cognitive reframing to reduce anxiety and pre-sleep stress. 
  • Medication education: Ensure the patient understands the appropriate use of sleep aids, their side effects, and the importance of short-term use. 

FAQs

Common Sleep Disorders

The goal of this course is to provide nursing and respiratory therapy professionals with knowledge of the importance of sleep assessment in the clinical setting and to provide clinical assessment strategies and common assessment/diagnostic tools for impaired sleep and sleep disorders.

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Additional Information

Course Contributor

Ann M. Dietrich, MD, FAAP, FACEP, Professor of Pediatrics and Emergency Medicine for the University of South Carolina School of Medicine Greenville, has over 30 years of experience in pediatric emergency medicine. Throughout her career, Dietrich has helped educate medical students, residents, fellows, and junior attendings, including as an educator at Ohio State University and the American College of Emergency Physicians. She also collaborated on several research projects, including one on concussions and one on improving mental healthcare for children. Dietrich helped develop guidelines on the impact of concussions on children and worked with trauma surgeons to enhance care for pediatric trauma patients.

Resources 

References 

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