Insomnia

Introduction for Nursing Diagnosis: Insomnia

Insomnia is defined as difficulty in maintaining or initiating sleep, resulting in impaired daytime functioning. It is one of the most commonly reported sleep disorders and affects both adults and children of all ages. Additionally, certain medical conditions can influence or even cause insomnia.

Nursing Diagnosis Definition

The nursing diagnosis “Insomnia” is classified as a Sleep-wake disorder and is defined as: Inability to sleep or to remain asleep for a satisfactory length of time.

Defining Characteristics

• Subjectives: Complaints of difficulty falling asleep, waking frequently during the night, early morning awakening, restless sleep, fatigue, unrefreshing sleep, mood disturbance, impaired concentration.
• Objectives: Failure to initiate or maintain sleep, prolonged awaking, frequently awaking.

Related Factors

• Anxiety
• Depression
• Drug effects
• Environmental factors
• Excessive stimulation
• Illness/discomfort/pain
• Insufficient exercise
• Stress
• Time of Day (circadian rhythm disruption)

Explanation: Insomnia can be caused by any number of physical and mental health issues, such as pain, stress, hormone disturbances, or too much time spent in stimulating environments. It could also be a symptom of a circadian rhythm disruption, which causes people to experience difficulty falling asleep or staying asleep at designated times.

Risk Population

• Elderly
• Women
• People experiencing excessive or irregular levels of stress
• People experiencing depression or anxiety
• People with medical conditions that cause discomfort, such as arthritis, chronic pain or other medical illnesses.

Explanation: Elderly people, women, people experiencing excessive or irregular levels of stress and those experiencing depression or anxiety are particularly prone to developing insomnia, as well as those with medical conditions which cause feeling of discomfort during sleep.

Associated Problems

• Depression
• Decreased alertness
• Mood disturbance
• Excessive fatigue
• Memory impairment
• Reduced overall performance ability
• Reduced quality of life

Explanation: Insomnia can lead to various associated problems, such as depression, decreased alertness, excessive fatigue, memory impairment, reduced overall performance ability and even reduced quality of life.

Suggestions for Use

• Ensure an environment that is conducive to sleep
• Establish a regular routine of sleeping, waking and meals
• Establish regular exercise regimens
• Develop good sleep hygiene habits
• Promote relaxation techniques such as deep breathing, progressive muscle relaxation, visual imagery and yoga
• Limit caffeine, nicotine and alcohol
• Reduce night time worries
• Reduce bedtime distractions such as television, computer time and playing on cell phones

Explanation: In order to make use of the nursing diagnosis “Insomnia”, nurses should strive to provide suggestions for interventions and solutions to help clients relieve their insomnia symptoms. Examples of using this diagnosis include ensuring an environment that is conducive to sleep, establishing a regular routine of sleeping, waking and meals, establishing regular exercise regimens, promoting relaxation techniques, limiting caffeine, nicotine and alcohol, reducing worries before bedtime and reducing bedtime distractions such as TV, computers and cell phones.

Suggested Alternative Nanda Diagnoses

• Excessive Fatigue or Tiredness
• Sleep Pattern Disturbance
• Inadequate Natural Coping Mechanisms
• Ineffective Relaxation
• Confusion

Explanation: If insomnia is not the primary diagnosis, alternative diagnoses such as excessive fatigue or tiredness, sleep pattern disturbance, inadequate natural coping mechanisms, ineffective relaxation or confusion might be used instead. Understanding which alternative diagnoses are most applicable to the patient’s context can help ensure that correct interventions and solutions are provided for their situation.

Usage Tips

• Assess patient for presence of side effects or environmental factors which may contribute to the patient's inability to sleep
• Identify coping strategies already present in the patient
• Discuss risks to patient if insomnia is not treated properly
• Reassess patient regularly to determine if intervention is effective

When implementing the nursing diagnosis “Insomnia”, usage tips should be kept in mind in order to increase the effectiveness of treatments. These tips include assessing the patient for side effects or environmental factors which may cause their insomnia, identifying coping strategies already present in the patient, discussing risks associated with untreated insomnia and reassessing regularly to determine the effectiveness of interventions.

NOC Results

• Sleep/Rest
• Comfort Level
• Fatigue Level
• Physical Mobility
• Tissue Integrity: Skin and Mucous Membranes
• Activity/Rest
• Cardiac Output

Explanation: The nursing diagnosis “Insomnia” can have a number of possible NOC results, including Sleep/Rest, Comfort Level, Fatigue Level, Physical Mobility, Tissue Integrity: Skin and Mucous Membranes, Activity/Rest and Cardiac Output.

NIC Interventions

• Therapeutic Patient Education
• Encourage Sleep/Rest
• Provide Comfort Enhancing Strategies
• Facilitate Environment for Comfort
• Promote Regular Exercise Patterns
• Manage Risk Factors/Unhealthy Behaviors
• Encourage Positive Self-Statement

Explanation: To facilitate interventions, nurses can use a number of NIC interventions, such as Therapeutic Patient Education, Encourage Sleep/Rest, Provide Comfort Enhancing Strategies, Facilitate Environment for Comfort, Promote Regular Exercise Patterns, Manage Risk Factors/Unhealthy Behaviors, and Encourage Positive Self-Statement.

Conclusion

The nursing diagnosis “Insomnia” is a Sleep-Wake disorder which can result in a variety of associated problems, such as depression, decreased alertness, excessive fatigue, and memory impairment. Nurses should strive to provide suggestions for interventions and solutions to help their patients and should keep usage tips in mind in order to increase the effectiveness of treatments. With the nursing diagnosis “Insomnia”, possible NOC results and NIC interventions can be used as measurements of success.

FAQ

• What is the nursing diagnosis “Insomnia”?
  The nursing diagnosis “Insomnia” is classified as a Sleep-Wake disorder and is defined as: Inability to sleep or to remain asleep for a satisfactory length of time.
• What are some possible NOC results of “Insomnia”?
  Possible NOC results include Sleep/Rest, Comfort Level, Fatigue Level, Physical Mobility, Tissue Integrity: Skin and Mucous Membranes, Activity/Rest and Cardiac Output.
• What are some NIC interventions used to treat “Insomnia”?
  NIC interventions used to treat “Insomnia” include Therapeutic Patient Education, Encourage Sleep/Rest, Provide Comfort Enhancing Strategies, Facilitate Environment for Comfort, Promote Regular Exercise Patterns, Manage Risk Factors/Unhealthy Behaviors, and Encourage Positive Self-Statement.