The nurse recognizes that a client is experiencing insomnia when the client reports. Select all that apply.
A. Extended time to fall asleep.
B. Falling asleep at inappropriate times.
C. Difficulty staying asleep.
D. Feeling tired after a night’s sleep.
E. Nocturia
Correct Answer: A, C, and D.
Insomnia is the most common sleep disorder in the United States affecting about one-third of the general population. According to the third edition of the International Classification of Sleep Disorders (ICSD-3), insomnia is characterized by difficulty in either initiating sleep, maintaining sleep continuity, or poor sleep quality. These symptoms are often reported by clients with insomnia. Clients report nonrestorative sleep.
Option A: A detailed sleep history is essential for the evaluation of insomnia. The clinician should be able to identify if the sleep disturbances are from difficulty in initiating sleep or maintaining sleep or both. Sleep logs are used to determine the total sleep time (TST), wakefulness after sleep onset (WASO), sleep efficiency (SE), and circadian rhythm disturbances. The only major limitation associated with the sleep log is the reliability and validity of its documentation.
Option B: Individuals who have difficulty coping with a stressful situation or those who report being habitual light sleepers have an elevated propensity to develop chronic insomnia. There is a high rate of association between insomnia and psychiatric disorders like depression, anxiety, and post-traumatic stress disorder.
Option C: Patients with underlying depression may have symptoms of waking up too early in the morning (early morning insomnia) and should be screened for the same. Sleep logs/diaries are reliable and cost-effective ways to assess the sleep-wake cycle in an individual. Sleep logs are maintained for 2 to 4 weeks and also include documentation of alcohol and caffeine consumption, bedtime activities, and daytime napping.
Option D: Chronic insomnia can adversely affect the health, quality of life, academic performance, increase the risk of motor vehicle accidents, decrease productivity at work, irritability and increase daytime sleepiness.
Option E: Arising once at night to urinate (nocturia) is not in and of itself insomnia. Comorbid medical issues like restless legs syndrome, chronic pain, gastroesophageal reflux disease (GERD), respiratory issues, and immobility are associated with the risk of chronic insomnia. Developmental issues during childhood, for example, separation anxiety, may predispose a child to develop sleep problems.
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