{
  "name": "Insomnia & Sleep Deprivation",
  "slug": "insomnia",
  "url": "https://nursingplex.com/care-plans/insomnia",
  "category": "Basic Nursing & General Care Plans",
  "summary": "Difficulty falling or staying asleep affecting daytime function; sleep hygiene and environment come before hypnotics.",
  "nursing_diagnoses": [
    "Insomnia",
    "Sleep deprivation",
    "Fatigue"
  ],
  "overview": [
    "Insomnia is difficulty falling asleep, staying asleep or achieving restorative sleep despite adequate opportunity, with daytime consequences such as fatigue, irritability and impaired concentration. Sleep deprivation is the cumulative physiologic result.",
    "In hospital, insomnia is close to universal: noise, light, vital-sign checks, pain, anxiety, unfamiliar beds and medications all interrupt sleep architecture. Chronically, insomnia is maintained by conditioned arousal — the bed becomes associated with wakefulness and worry.",
    "First-line treatment is behavioral, not pharmacologic. Cognitive behavioral therapy for insomnia outperforms hypnotics long-term, and sedatives in older adults raise the risk of falls, delirium and dependence."
  ],
  "key_facts": [
    {
      "label": "First-line therapy",
      "text": "CBT-I — stimulus control, sleep restriction, relaxation and cognitive restructuring."
    },
    {
      "label": "Stimulus control",
      "text": "Use the bed only for sleep and intimacy; leave the bed after about 20 minutes awake."
    },
    {
      "label": "Hospital care clustering",
      "text": "Grouping night interventions can create uninterrupted blocks of several hours."
    },
    {
      "label": "Screen and secondary causes",
      "text": "Screen for sleep apnea, restless legs, pain, nocturia, depression and caffeine or alcohol use."
    }
  ],
  "nursing_priorities": [
    "Identify and treat contributing physical and psychological causes.",
    "Optimize the sleep environment and daily rhythm.",
    "Cluster care to protect uninterrupted night-time sleep.",
    "Teach behavioral sleep strategies before considering medication.",
    "Monitor daytime function and safety."
  ],
  "assessment": {
    "subjective": [
      "Reports of difficulty falling or staying asleep, or early morning waking",
      "Complaints of daytime fatigue, irritability or poor concentration",
      "Reports of worry or racing thoughts at bedtime",
      "History of caffeine, nicotine, alcohol or screen use before bed",
      "Reports of pain, nocturia or breathing pauses disturbing sleep"
    ],
    "objective": [
      "Sleep diary showing prolonged sleep latency or frequent awakenings",
      "Observed dozing during the day, yawning, slowed responses",
      "Irritability, poor memory or reduced participation in care",
      "Elevated blood pressure or increased pain scores",
      "Polysomnography findings if obtained"
    ],
    "related_factors": [
      "Environmental noise, light and frequent care interruptions",
      "Pain, dyspnea, nocturia or pruritus",
      "Anxiety, depression or acute stress",
      "Stimulants, corticosteroids, diuretics at night, or alcohol",
      "Irregular schedule, shift work or excessive daytime napping"
    ]
  },
  "goals": [
    "The client will report improved sleep quality and duration.",
    "The client will fall asleep within about 30 minutes of retiring.",
    "The client will demonstrate at least three sleep-hygiene behaviors.",
    "The client will report improved daytime alertness."
  ],
  "interventions": [
    {
      "title": "Assess sleep",
      "points": [
        "Keep a sleep diary documenting bedtime, latency, awakenings and total sleep.",
        "Screen for apnea, restless legs, depression and untreated pain.",
        "Review medication timing — move diuretics and stimulants earlier in the day."
      ]
    },
    {
      "title": "Protect the sleep environment",
      "points": [
        "Dim lights, reduce alarms and conversation, and offer earplugs or eye masks.",
        "Cluster medications, vital signs and treatments to allow uninterrupted blocks.",
        "Provide a comfortable temperature, clean linens and a bedtime routine.",
        "Offer warm non-caffeinated drinks, back rub or relaxation audio."
      ]
    },
    {
      "title": "Behavioral strategies",
      "points": [
        "Teach stimulus control: bed for sleep only, get up if awake beyond 20 minutes.",
        "Encourage consistent wake times, daytime light exposure and daily activity.",
        "Limit naps to 20–30 minutes before mid-afternoon.",
        "Teach relaxation breathing, progressive muscle relaxation or guided imagery.",
        "Reserve hypnotics for short-term use and monitor for falls and confusion."
      ]
    }
  ],
  "patient_teaching": [
    "Explain that behavioral change works better than sleeping pills long-term.",
    "Advise avoiding caffeine after midday, alcohol near bedtime and screens in bed.",
    "Encourage a fixed wake time even after a poor night.",
    "Advise reporting loud snoring or witnessed apneas for sleep study evaluation."
  ]
}