Nursing Care Plan for Insomia

insomniaWhat is Insomia

Insomnia is the perception or complaint of inadequate or poor-quality sleep because of one or more of the
following:

  1. difficulty falling asleep
  2. waking up frequently during the night
  3. with difficulty returning to sleep
  4. waking up too early in the morning
  5. unrefreshing sleep

Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep.Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability.

Causes of Insomia

Certain conditions seem to make individuals more likely to experience insomnia.

Examples of these conditions include:

  • advanced age (insomnia occurs more frequently in those over age 60)
  • female gender
  • a history of depression

If other conditions (such as stress, anxiety, a medical problem, or the use of certain medications) occur along with the above conditions, insomnia is more likely.

There are many causes of insomnia.

Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

  1. stress
  2. environmental noise
  3. extreme temperatures
  4. change in the surrounding environment
  5. sleep/wake schedule problems such as those due to jet lag or medication side effects

Types of Insomia

Insomnia is considered a disorder only when it causes a signifi cant amount of distress or anxiety, or when it results in daytime impairment. The International Classification of Sleep Disorders, 2nd Edition, documents the following types of insomnia:

Adjustment insomnia:
This is also called acute insomnia or shor t-term insomnia. It is usually caused by a source of stress and tends to last for only a few days or weeks. Epidemiologic indicate that the one-year prevalence of adjustment insomnia among adultsis likely to be in the range of 15-20%. Adjustment insomnia can occur at any age,although establishing a relationship between a particular stress and sleep disturbance may be difficult in infants. Adjustment insomnia is more common in women than men and in older adults than younger adults and children

Behavioral insomnia of childhood:
Two primary types of insomnia affect children. Sleep-onset association type occurs when a child associates falling asleep with an action (being held or rocked), object (bottle) or setting (parents’ bed), and is unable to fall asleep if separated from that association. Limit-setting type occurs when a child stalls and refuses to go to sleep in the absence of strictly enforced bedtime limits.

Idiopathic insomnia:
An insomnia that begins in childhood and is lifelong, it cannot be explained by other causes. Information suggests that this condition is present in approximately .7% of adolescents and 1.0% of very young adults

Inadequate sleep hygiene:
This form of insomnia is caused by bad sleep habits that keep you awake or bring disorder to your sleep schedule. This condition is present in 1-2% of adolescents and young adults. This condition affected 5-10% of sleep-clinic populations.

Insomnia due to drug or substance, medical condition, or mental disorder:
Symptoms of insomnia often result from one of these causes. Insomnia is associated more often with a psychiatric disorder, such as depression, than with any other medical condition. Surveys suggest approximately 3% of the population has insomnia symptoms that are caused by a medical or psychiatric condition.

Paradoxical insomnia:
A complaint of severe insomnia occurs even though there is no objective evidence of a sleep disturbance. The pr evalence in the gene ral population is not known. Among clinical populations, this cond ition is typically found in less than 5% of patients with insomnia. It is thought to be most common in young and middle-aged adults.

Psychophysiological insomnia:
A complaint of insomnia occurs along with an excessive amount of anxiety and worry regarding sleep and sleeplessness. This condition is found in 1-2% of the general population and 12-15% of all patients seen at sleep centers. It is more frequent in women than in men. It rarely occurs in young children but is more common in adolescents and all adult age groups .

Treatments

  1. Cognitive behavioral therapy (CBT): CBT can have beneficial effects that last well beyond the end of treatment. It involves combinations of the following therapies:
    • Cognitive therapy: Changing attitudes and beliefs that hinder your sleep
    • Relaxation training: Relaxing your mind and body
    • Sleep hygiene training:Correcting bad habits that contribute to poor sleep
    • Sleep restriction: Severely limiting and then gradually increasing your time in bed
    • Stimulus control: Going to bed only when sleepy, waking at the same time daily, leaving the bed when unable to sleep, avoiding naps, using the bed only for sleep and sex
  2. Over-the-counter products: Most of these sleep aids contain antihistamine.They can help you sleep better, but they also may cause severe daytime sleepiness. Other products, including herbal supplements, have little evidence to support their effectiveness.
  3. Prescription sleeping pills: Prescription hypnotics can improve sleep when supervised by a physician. The traditional sleeping pills are benzodiazepine receptor agonists, which are typically prescribed for only short-term use. Newer sleeping pills are nonbenzodiazepines, which may pose fewer risks and maybe effective for longer-term use.
  4. Unapproved prescription drugs: Drugs from a variety of classes have been used to treat insomnia without FDA approval. Antidepressants such as trazodone are commonly prescribed for insomnia. Others include anticonvulsants, antipsychotics, barbiturates and nonhypnotic benzodiazepines. Many of these medications involve a significant level of risk.

 

Sources:
National Center on Sleep Disorders Research (NCSDR)
http://www.aasmnet.org
Sleep Health Foundation

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Ncp for Insomnia

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