C4 · Unable to sleep well
Actual Comfort and rest
Definition
Trouble falling or staying asleep leaves the person unrefreshed.- Pain
- anxiety
- noise
- caffeine
- illness
- shift work
- Takes long to fall asleep
- wakes often
- tired in the day
- irritable
📋 Scenario
A patient on a busy ward sleeps only three hours a night.
Subjective (S): "I can't sleep with all the noise and I'm exhausted."
Objective (O): Sleeps about 3 hours per night; yawning; irritable; lights and alarms frequent on the ward.
Assessment tools for this scenario: CP-PAIN Pain & Comfort Score
Validated scales to consider: NRS 0–10, FLACC, PAINAD
**CarePath diagnosis:** Unable to sleep well related to ward noise and light, as evidenced by sleeping only 3 hours a night, yawning, and irritability.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Group care to allow rest. | Doing care tasks together leaves longer undisturbed periods, which allows the patient to cycle through deeper, more restful sleep. |
| Reduce noise and light. | Less noise and light make it easier to fall asleep and prevent sudden waking, since the body treats sound and brightness as signals to stay alert. |
| Avoid caffeine late in the day. | Caffeine is a stimulant that can stay active for hours, so avoiding it late in the day makes falling asleep easier. |
| Teach relaxation. | Relaxation techniques lower muscle tension and anxiety, which helps the mind and body settle for sleep. |
| Give sleep medicine only as ordered. | Sleep medicines can cause drowsiness, falls and slowed breathing, so they are given only as prescribed and after other measures. |
**Expected outcomes**
- Within 3 nights: sleeps at least 6 hours and reports feeling rested.
- Patient names two sleep-promoting steps.
**Linking the data to the diagnosis**
The patient sleeps only about 3 hours per night and says they cannot sleep with the noise and are exhausted. The nurse saw yawning, irritability, and frequent lights and alarms on the ward. Poor sleep that leaves the person unrefreshed fits this diagnosis, and it has already occurred, so it is an actual diagnosis. It overlaps with noise or light disturbing rest, but here the main problem is the poor sleep and its effect on the patient. The plan aims for at least 6 hours of sleep within 3 nights, a rested feeling, and the patient naming two sleep-promoting steps.
CarePath diagnosis
Unable to sleep well related to ward noise and light, as evidenced by sleeping only 3 hours a night, yawning, and irritability.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Group care to allow rest. | Doing care tasks together leaves longer undisturbed periods, which allows the patient to cycle through deeper, more restful sleep. |
| 2. Reduce noise and light. | Less noise and light make it easier to fall asleep and prevent sudden waking, since the body treats sound and brightness as signals to stay alert. |
| 3. Avoid caffeine late in the day. | Caffeine is a stimulant that can stay active for hours, so avoiding it late in the day makes falling asleep easier. |
| 4. Teach relaxation. | Relaxation techniques lower muscle tension and anxiety, which helps the mind and body settle for sleep. |
| 5. Give sleep medicine only as ordered. | Sleep medicines can cause drowsiness, falls and slowed breathing, so they are given only as prescribed and after other measures. |
Expected outcomes
- Within 3 nights: sleeps at least 6 hours and reports feeling rested.
- Patient names two sleep-promoting steps.
Linking the data to the diagnosis
The patient sleeps only about 3 hours per night and says they cannot sleep with the noise and are exhausted. The nurse saw yawning, irritability, and frequent lights and alarms on the ward. Poor sleep that leaves the person unrefreshed fits this diagnosis, and it has already occurred, so it is an actual diagnosis. It overlaps with noise or light disturbing rest, but here the main problem is the poor sleep and its effect on the patient. The plan aims for at least 6 hours of sleep within 3 nights, a rested feeling, and the patient naming two sleep-promoting steps.