A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions that promote sleep. Select all that apply.
A. Eat a heavy snack before bedtime.
B. Read in bed before shutting out the light.
C. Leave the bedroom if you are unable to sleep.
D. Drink a cup of warm tea with milk at bedtime.
E. Exercise in the afternoon rather than the evening.
F. Count backward from 100 to 0 when your mind is racing.
Correct Answers: C, E, and F
Lying in bed when one is unable to sleep increases frustration and anxiety which further impedes sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backward requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.
Option A: Educate the client on the proper food intake such as avoiding heavy meals before bedtime. Having full meals just before bedtime may produce gastrointestinal upset and hinder sleep onset.
Option B: Introduce relaxing activities such as a warm bath, calm music, reading a book, and relaxation exercises before bedtime. These activities provide relaxation and distraction to prepare the mind and body for sleep.
Option C: Instruct the client to follow a consistent daily schedule for rest and sleep. Consistent schedules facilitate regulation of the circadian rhythm and decrease the energy needed for adaptation to changes.
Option D: Educate the client on the proper fluid intake such as avoiding alcohol, caffeine, or smoking before bedtime. Coffee, tea, chocolate, and colas which contain caffeine stimulate the nervous system. This may interfere with the client’s ability to relax and fall asleep.
Option E: Encourage daytime physical activities but instruct the client to avoid strenuous activities before bedtime. In insomnia, stress may be reduced by therapeutic activities and may promote sleep. However, strenuous activities may lead to fatigue and may cause insomnia.
Option F: Suggest the client to get out of bed temporarily and perform a relaxing activity if unable to sleep 30-45 minutes in bed. The bed is not supposed to be used for watching TV, work, or wakefulness. The brain should associate the bed with sleeping.
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