This article explores the causes, assessment, nursing diagnoses, interventions, and management strategies for disturbed sleep patterns from a nursing perspective. It also highlights evidence-based approaches to improving sleep quality in both hospital and home environments.
What Are Disturbed Sleep Patterns?
A disturbed sleep pattern is defined as a disruption in the quantity, quality, or timing of sleep that negatively affects an individual’s functioning and health. According to the North American Nursing Diagnosis Association (NANDA), “Disturbed Sleep Pattern” is a recognized nursing diagnosis characterized by a disruption in the natural sleep process.
Sleep disturbances can include difficulty falling asleep (insomnia), frequent awakenings, early morning awakening, excessive daytime sleepiness, or non-restorative sleep. These disruptions may be short-term (acute) or long-term (chronic), depending on the underlying cause.
Causes of Disturbed Sleep Patterns
1. Physiological Factors
- Pain or discomfort due to illness or surgery
- Respiratory problems such as sleep apnea or asthma
- Hormonal changes (e.g., menopause, thyroid disorders)
- Urinary frequency (nocturia)
- Medication side effects (e.g., steroids, diuretics, antidepressants)
2. Psychological Factors
- Stress and anxiety
- Depression
- Post-traumatic stress disorder (PTSD)
- Emotional distress or grief
3. Environmental Factors
- Noise in hospital wards or homes
- Uncomfortable temperature or bedding
- Bright lighting or interruptions by staff during rest periods
4. Lifestyle and Behavioral Factors
- Caffeine, nicotine, or alcohol consumption
- Irregular sleep schedules
- Shift work (especially night shifts)
- Excessive screen time before bed
Nursing Assessment for Sleep Disturbance
Nurses play a key role in assessing sleep patterns to identify potential causes and impacts. A thorough assessment should include both subjective and objective data.
Subjective Assessment:
- Patient’s description of sleep habits (bedtime, wake time, naps)
- Quality of sleep (e.g., “I keep waking up,” “I don’t feel rested”)
- Presence of nightmares, snoring, or breathing difficulties
- Emotional state before bedtime (stress, fear, pain)
Objective Assessment:
- Observations of restlessness, yawning, or daytime fatigue
- Use of sleep diaries or questionnaires (e.g., Pittsburgh Sleep Quality Index)
- Monitoring of vital signs or oxygen saturation in at-risk patients
Nursing Diagnosis (NANDA)
According to NANDA, the nursing diagnosis for disturbed sleep is:
Disturbed Sleep Pattern related to environmental disturbances, anxiety, pain, or hospital routine as evidenced by verbal reports of difficulty falling asleep, frequent awakenings, and fatigue.
Other related nursing diagnoses may include:
- Fatigue
- Sleep Deprivation
- Anxiety
- Ineffective Coping
Nursing Goals and Expected Outcomes
The overall goal of nursing care is to help the patient achieve adequate rest and restorative sleep. Specific objectives include:
- Patient reports improved quality and duration of sleep.
- Patient appears relaxed and alert during the day.
- Vital signs and mood indicate improved restfulness.
- Patient identifies personal habits that promote better sleep.
Nursing Interventions for Managing Disturbed Sleep Patterns
Nursing interventions should focus on non-pharmacological approaches first, promoting a supportive sleep environment and healthy habits. Medication should only be used when necessary and prescribed by a physician.
1. Promote Sleep Hygiene
- Maintain a consistent sleep and wake schedule.
- Avoid caffeine, alcohol, and nicotine at least 4 hours before bedtime.
- Create a comfortable, dark, and quiet sleeping environment.
- Engage in relaxing activities before sleep (reading, meditation, light stretching).
2. Manage Environmental Factors
- Reduce noise and dim lights in hospital rooms at night.
- Ensure the patient’s bed is comfortable and clean.
- Limit nighttime disturbances for vital signs or medication, unless essential.
3. Address Physical Discomfort
- Provide pain relief before bedtime.
- Offer back rubs or relaxation massages.
- Assist with toileting needs to reduce nighttime interruptions.
4. Manage Psychological Factors
- Encourage expression of fears, anxiety, or worries.
- Provide emotional support or therapeutic communication.
- Teach relaxation techniques like deep breathing or guided imagery.
5. Educate on Healthy Lifestyle
- Promote balanced nutrition and regular exercise (but not close to bedtime).
- Limit mobile device or television use before sleep.
- Encourage exposure to natural light during the day.
6. Collaboration with the Healthcare Team
- Discuss sleep issues with physicians or specialists.
- Evaluate medications that may affect sleep.
- Refer to a sleep specialist if needed.
Pharmacological Management (If Needed)
While non-drug methods should always be prioritized, in some cases, short-term pharmacological interventions may be required:
- Sedative-hypnotics (e.g., zolpidem, temazepam)
- Melatonin supplements
- Antidepressants with sedative effects (e.g., trazodone)
Nurses must monitor for side effects such as drowsiness, confusion, or dependence, especially in elderly patients.
Complementary and Alternative Approaches
- Aromatherapy: Lavender or chamomile oil to induce relaxation.
- Music Therapy: Calming music to reduce anxiety.
- Mindfulness Meditation: To calm the mind and improve sleep.
- Herbal Teas: Chamomile or valerian root (with physician approval).
Case Example
A 56-year-old postoperative patient reports, “I haven’t been able to sleep since surgery. The pain and hospital noise keep me awake.”
- Administered prescribed pain medication before bedtime.
- Reduced environmental noise and adjusted lighting.
- Provided relaxation techniques and repositioned patient for comfort.
- Encouraged consistent sleep schedule.
Outcome: After two days, the patient reported sleeping 6 hours uninterrupted and felt more energized.
Evaluation of Nursing Care
- Assess if patient’s sleep duration and quality have improved.
- Evaluate patient’s alertness and mood.
- Modify care plan if needed.
Conclusion
Sleep is a fundamental human need, and nurses play an essential role in helping patients maintain healthy sleep patterns. Understanding the causes, assessment, and interventions for disturbed sleep allows nurses to deliver holistic care that promotes healing and well-being.
References
- NANDA International (2021). Nursing Diagnoses: Definitions and Classifications.
- Potter, P. A., & Perry, A. G. (2020). Fundamentals of Nursing.
- Townsend, M. C. (2022). Essentials of Psychiatric Mental Health Nursing.
- American Academy of Sleep Medicine (AASM). (2021). Sleep Disorders and Nursing Care Guidelines.
