DISTURBED SLEEP PATTERN

Tsaabitah Rizqilla Anwar, 1706039156, Basic Nursing Class A

Sleep pattern disturbance is defined as the state in which an individual experiences or is at risk of
experiencing a change in the quantity or quality of his or her rest pattern as related to the person’s
biological and emotional needs. (Carpenito, 2010)
DEFINING CHARACTERS (Doenges, 2008)

 Subjective
Daytime drowsiness; decreased ability to function
Malaise; lethargy; fatigue
Anxiety
Perceptual disorders (e.g., disturbed body sensation, delusions, feeling afloat); heightened
sensitivity to pain

 Objective
Restlessness; irritability
Inability to concentrate; slowed reaction
Listlessness; apathy
Fleeting nystagmus; hand tremors
Acute confusion; transient paranoia; agitation; combativeness; hallucinations
RELATED FACTORS (Carpenito, 2010)
Pathophysiologic
Related to frequent awakenings secondary to:
- Impaired Oxygen Transport  Respiratory disorders, Circulatory disorders
- Impaired Elimination; Bowel or Bladder  Diarrhea, Retention, Constipation, Incontinence
Frequency
- Impaired Metabolism  Hyperthyroidism, Hepatic disorders, Gastric ulcers
Treatment-Related
 Related to difficulty assuming usual position secondary to (specify)
 Related to excessive daytime sleeping or hyperactivity secondary to (specify medication) 
Tranquilizers, Sedatives, Amphetamines, Monoamine oxidase inhibitors, Antidepressants,
Corticosteroids, Antihypertensives
Situational (Personal, Environmental)
 Related to excessive hyperactivity secondary to: Bipolar disorder, Attention-deficit disorder,
Panic anxiety, Illicit drug use
 Related to excessive daytime sleeping
 Related to depression
 Related to inadequate daytime activities
 Related to pain
 Related to anxiety response
 Related to discomforts secondary to pregnancy
 Related to lifestyle disruptions  Occupational, Emotional, Social, Sexual, Financial
 Related to environmental changes (specify)  Hospitalization (noise, disturbing roommate,
fear), Travel
 Related to fears
 Related to circadian rhythm changes
Maturational
 Children
Related to fear of dark
Related to fear
Related to enuresis
Related to inconsistent parenteral responses
Related to inconsistent sleep rituals
 Adult Women
Related to hormonal changes (e.g., perimenopausal)

ALTERATION IN SLEEP PATTERNS (DeLaine & Ladner, 2002)

1. Insomnia
Insomnia refers to the chronic inability to sleep or inadequate quality of sleep due to sleep
prematurely ended or interrupted by periods of wakefulness. Insomnia is not a disease, but it may
be a manifestation of many illnesses. Perception of sleep quantity can also be important; many
insomniacs actually sleep significantly more than they think they do, so there is a discrepancy
between perception and reality. Sleep disturbances are common for individuals experiencing
chronic pain. Sleep impairment can exacerbate pain, and, thus, a vicious cycle is
established.Treatment for insomnia is best directed at modifying those factors or behaviors that
are causing it. It is impossible to force sleep.

2. Hypersomnia or Narcolepsy

Hypersomnia is an alteration in sleep pattern characterized by excessive sleep, especially in

the daytime. Persons suffering from hypersomnia often feel that they cannot get enough sleep at
night, and therefore they sleep very late into the morning and nap several times throughout the
day. Causes of hypersomnia can be physical or psychological; treatment depends on addressing
the underlying cause.
Narcolepsy, another sleep alteration, manifests as sudden uncontrollable urges to fall asleep
during the daytime. Individuals suffering from narcolepsy often achieve adequate sleep at night
but are overwhelmed by sleepiness at unexpected and unpredictable periods during the day.
Effective treatments for narcolepsy include avoiding substances or activities that cause sleepiness,
taking short daytime naps, or taking prescribed stimulant medications.

3. Sleep Apnea

Sleep apnea refers to periods of sleep during which airflow stops for 10 seconds or more. Sleep
apnea gives rise to complications as a result of oxygen desaturation and carbon dioxide retention.
A major problem is daytime sleepiness, which may interfere with functional driving and working.
If untreated, sleep apnea can result in the following:

• Hypertension
• Cardiac arrhythmias
• Right-sided congestive heart failure
• Cerebral vascular accident (stroke)
• Cognitive dysfunction
• Death

The first line of defense against apnea is treating its cause (emotional, cardiac, or respiratory
alteration). Use of a nasal continuous positive airway pressure (CPAP) device may also give relief.
With some individuals, surgical intervention is the cause of the apnea.

4. Sleep Deprivation

Sleep deprivation is a term used to describe prolonged inadequate quality and quantity of sleep,
either of the REM or the NREM type. Sleep deprivation can result from age, prolonged
hospitalization, drug and substance use, illness, and frequent changes in lifestyle patterns. Sleep
and dreaming have a restorative value necessary for mental and emotional recovery, and enhance
the ability to cope with emotional problems. Therefore, sleep deprivation can cause symptoms
ranging from irritability, hypersensitivity, and confusion to apathy, sleepiness, and diminished
reflexes. Treating or minimizing the factors that cause the sleep deprivation is the most effective
resolution.

5. Parasomnias

Parasomnias refer to sleep alterations resulting from “an activation of physiological systems at
inappropriate times during the sleep-wake cycle”. Somnambulism (sleepwalking), sleep-talking,
bed wetting, and bruxism (teeth grinding) are the most common parasomnias. Treatment for
parasomnias varies, and care should be focused on helping the client and family understand the
disorder and its potential safety risks.

References

Carpenito, L.J. (2010). Nursing diagnosis application to clinical practice, 13th edition. USA:
Lippincott Williams & Wilkins.
DeLaune, S.C. & Ladner, P.K. (2002). Fundamentals of nursing: Standards & practice, 2nd
edition. USA: Delmar, Thomson Learning.

Doenges, M.E., et al. (2008). Nursing diagnosis manual: Planning, individualizing, and
documenting client care, 2nd edition. Philadelphia: F.A Davis Company.