Inability to initiate or maintain sleep, which impairs functioning.

Altered affect

Altered attention

Altered mood

Early awakening

Expresses dissatisfaction with quality of life

Expresses dissatisfaction with sleep

Expresses forgetfulness

Expresses need for frequent naps during the day

Impaired health status

Increased absenteeism

Increased accidents

Insufficient physical endurance

Nonrestorative sleep-wake cycle

Anxiety

Average daily physical activity is less than recommended for age and gender

Caffeine consumption

Caregiver Role Strain

Consumption of sugar-sweetened beverages

Depressive symptoms

Discomfort

Dysfunctional sleep beliefs

Environmental disturbances

Fear

Frequent naps during the day

Inadequate sleep hygiene

Lifestyle incongruent with normal circadian rhythms

Low psychological resilience

Obesity

Stressors

Substance misuse

Use of interactive electronic devices

Adolescents

Economically disadvantaged individuals

Grieving individuals

Individuals undergoing changes in marital status

Night shift workers

Older adults

Pregnant women in third trimester

Rotating shift workers

Women

Level 1 Fundamental Focused Assessment

Refer to Disturbed Sleep Pattern.

Chronic disease

Hormonal change

Pharmaceutical preparations

The individual will report an optimal balance of rest and activity, as evidenced by the following indicators:

• Describes factors that prevent or inhibit sleep.
• Identifies techniques to induce sleep.

Level 1 Fundamental Focused Interventions

• Have the individual keep a sleep-awake diary for 1 month to include bedtime, arising time, difficulty getting sleep, number of awakenings (reason), and naps.

R:Sleep diaries provide data to improve the validity of assessment. Review the diary with the individual.

R:Examining the diary can identify if a sleep problem exists.

• Evaluate if there is a physiologic condition or medication that is interfering with sleep.

Refer to Related Factors under Pathophysiologic and Treatment Related Factors under Disturbed Sleep Pattern. Refer to the primary care provider for management.

• Evaluate if a psychological state is interfering with sleep. Refer to Situational Related Factors. Refer to mental health professions.
• Determine if the lifestyle or life events are interfering with sleep. Refer to other nursing diagnoses if appropriate: Grieving, Stress Overload, Ineffective Coping, or Risk-Prone Health Behavior.

R:Sleep disturbances can have many causes with varied interventions.

Refer to Disturbed Sleep Pattern for interventions to establish a sleep ritual or routine.