Causes of Insomnia
The most common causes are:
- stress, anxiety or depression
- noise
- a room that's too hot or cold
- uncomfortable beds
- alcohol, caffeine or nicotine
- recreational drugs like cocaine or ecstasy
- jet lag
- shift work
Types of Insomnia
Insomnia can come and go, or it may be an ongoing, longstanding issue. There is short term insomnia and chronic insomnia:
- Short term insomnia tends to last for a few days or weeks and is often triggered by stress.
- Chronic insomnia is when the sleep difficulties occur at least three times a week for three months or longer.
Symptoms of Insomnia
Insomnia symptoms may include:
- Difficulty falling asleep at night
- Waking up during the night
- Waking up too early
- Not feeling well-rested after a night's sleep
- Daytime tiredness or sleepiness
- Irritability, depression or anxiety
- Difficulty paying attention, focusing on tasks or remembering
- Increased errors or accidents
- Ongoing worries about sleep
Assessment
A brief sleep history incorporated into the routine review of systems can be helpful in detecting patients with insomnia. Direct inquiry is important because more than one half of patients who believe that they have chronic insomnia have never discussed the problem with a physician.
It is helpful for patients to keep a sleep diary for one to two weeks. Sleep diaries usually record bedtime, total sleep time, time until sleep onset, number of awakenings, use of sleep medications, time out of bed in the morning and a rating of quality of sleep and daytime symptoms. The sleep diary provides a night-to-night account of the patient's sleep schedule and perception of sleep. Moreover, it may serve as a baseline for assessment of treatment effects. Completing the diary each morning and using estimates rather than exact times should minimize the likelihood that the process itself will be disruptive to sleep.
Assessment should include questions that address both sleep and daytime functioning, since sleep needs vary markedly from person to person. For example, one patient who sleeps six hours may feel totally unrefreshed, while another who sleeps six hours might have no sleep-related complaints during the day.
Although the ability to maintain sleep decreases with age, the need for sleep does not change significantly. A patient who complains of not sleeping “a full eight hours” but whose sleep is otherwise restorative is within the bounds of normal behavior, and reassurance may be all that is needed. However, a patient who complains of severe insomnia or excessive daytime sleepiness should be evaluated, regardless of age.
Nursing Diagnosis : Insomnia r.t Anxiety
Goals and Outcome
NOC (p. 616)
- Anxiety level
- Stress level
After nursing actions for 3x 24 hours, insomnia is resolved with the following criteria:
- Increased sleep time
- Regular sleep pattern
- Improved sleep quality
- Nightmares are starting to disappear
- It's not hard to sleep anymore
Nursing Intervention
Sleep Enhancement (NIC page 348)
- Monitor/record the patient's sleep pattern and the number of hours of sleep
- Instruct the patient to monitor sleep patterns
- Monitor participation in tiring activities while awake to prevent excessive fatigue
- Help to relieve stress before bed
- Teach patient and loved ones about contributing factors
- the occurrence of disturbances in sleep patterns (e.g., physiological, psychological,
- life, frequent shifts of work, rapid time zone changes, long and excessive working hours, and other environmental factors).
- Provide pamphlets with information on techniques to improve sleep.
Source :
- https://en.wikipedia.org/wiki/Insomnia
- https://www.nhs.uk/conditions/insomnia/
- https://my.clevelandclinic.org/health/diseases/12119-insomnia
- https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167
- https://www.aafp.org/afp/1999/0601/p3029.html
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