Nursing Interventions ^*denotes collaborative interventions

Rationale

Substitute decaffeinated products for coffee, tea, or soda. Discourage use of chocolate and cocoa products.

Chemical stimulants, such as caffeine, will interfere with sleep.

Offer a limited amount of milk as a substitute for other bedtime beverages.

Milk products contain L-tryptophan, which is a natural sedative.

Avoid full meals and foods that cause gastric distress at least 3 hours prior to bedtime.

After 3 hours the stomach has emptied, and the client will not feel uncomfortable. Gastric distress interferes with relaxation.

Provide a light bedtime snack (small amounts of well-tolerated food) for the client.

Hunger can awaken people if they sleep lightly or have difficulty sleeping.

Limit fluid intake for 4 to 5 hours before bedtime.

Limiting fluid intake can eliminate awakening due to a full bladder.

If the client smokes, advise him or her to have the last cigarette at least 30 minutes before bedtime.

Nicotine is a central nervous system stimulant.

Encourage the client to increase physical activity during waking hours, even though he or she may feel fatigued. However, limit vigorous physical activity for 2 hours prior to bedtime.

The client may avoid physical activity due to a lack of energy, but activity during the day will promote a feeling of physical “tiredness,” which can facilitate sleep. The stimulating effects of physical activity last for several hours and interfere with efforts to relax prior to bedtime.

^*Teach the client about the effects of alcohol on sleep. The client should refrain from alcohol intake until restful sleep patterns are established.

Although alcohol can produce initial drowsiness, when the initial effects wear off, fragmented sleep results. The greater the alcohol intake, the more fragmented the sleep will be.

^*Educate the client about the effects of sleeping medications. If the client has been using sleep medications regularly, it may be best to decrease the frequency and dosage of such medications gradually.

Sleep-inducing medications can become ineffective when used regularly, or the client may feel unrefreshed after sleep due to a decrease in rapid eye movement (REM) sleep resulting from some medications. Abrupt cessation of sleep medications may increase sleep difficulties.

Assist the client to determine the desired number of sleeping hours each night, then designate times to retire and to rise to obtain that amount of sleep.

Regular hours help establish a routine. If the client waits to go to bed until he or she “feels sleepy,” sleep patterns may be erratic.

Encourage the client to avoid naps, unless indicated by age or physical condition.

Daytime napping may interfere with the ability to sleep an adequate number of hours at night, unless there is a physiologic need for additional sleep.

Limit the client’s attempts to sleep to his or her bed rather than on the couch or in a recliner. The client should use the bed only for sleep-related activities, rather than to talk on the telephone or work and so forth.

These actions will enhance the client’s expectation that going to bed facilitates sleep and ability to sleep.

Provide an atmosphere conducive to sleep (e.g., dim light, quiet).

External stimuli or disturbances interfere with sleep.

Assist the client to identify factors that induce relaxation, either former habits that were effective or new behaviors.

The client may not have experience in purposeful relaxation before retiring.

^*Teach the client progressive relaxation techniques and encourage practice. The use of an audio relaxation program may be helpful.

Relaxation techniques frequently are helpful in facilitating sleep, but need to be practiced to be fully effective.

Suggest that the client try a warm bath, reading, or other nonstimulating activities for relaxation.

The client may have to try several activities to determine which ones are effective.

If the client does not feel drowsy 20 minutes after retiring, suggest that he or she get up and engage in 20 minutes of a quiet activity that is boring for the client (e.g., reading or knitting), then return to bed. This should be repeated until the client begins to feel ready for sleep.

Lying in bed for extended periods can increase the client’s focus on and frustration with sleeping difficulties. Monotonous activities can facilitate drowsiness.

Encourage the client to practice these techniques and maintain the bedtime routine consistently for a minimum of 2 weeks, even if there seems to be no benefit.

A minimum of 2 weeks may be needed to fully evaluate the effectiveness of newly initiated sleep-promoting activities.

^*Educate the client’s family or significant others about sleep, relaxation, and the need for bedtime routines. Enlist their support for the client’s efforts.

The client’s family or significant others may have little or no knowledge about these areas and may unwittingly interfere with the client’s sleep.

^*Encourage the client to seek treatment for problems that may adversely affect sleep.

Sleep disturbances are associated with many physical and psychiatric problems and may not entirely be resolved without treatment of the associated problem.