Nurses need to teach patients about steps they can take to improve the quality and quantity of their sleep. Those with insomnia need to develop a regular sleep routine. This includes going to bed the same time every day and waking up at the same time.
Maintaining a consistent routine before bed will help set the mood for sleep. Ideally incorporating some sort of relaxation before bed will improve sleep. This may include activities such are meditation, stress management, taking a hot shower or prayer.
Practicing healthy habits will improve sleep. Incorporating an exercise program will improve insomnia. The exercise should be carried out earlier in the day. Vigorous exercise before bed is associated with difficulty falling asleep.
Activities practiced before bed can have an impact on sleep. Blue light, which is emitted by electronics, may interfere with sleep. There is evidence that blue light suppresses the secretion of melatonin (a hormone made by the pineal gland that helps regulate sleep and wake cycles), thereby interfering with sleep. Nurses should encourage patients to not look at bright screens of electronic devices two to three hours before bed. If you must look at electronic devices at night, consider blue-light blocking glasses or install an app that filters blue wavelengths.
Stress management is another important technique to improve sleep. Those who manage stress are better able to quiet their mind at night. One technique that can be tried is to tell patients to set a worry time during the day. This involves spending 10-15 minutes at a specific time every day to worry about things. This way when the patient’s mind tries to worry at night, they can remind themselves that they are to worry at a specific time tomorrow.
Setting up an adequate sleep environment is helpful to assure adequate sleep. Make sure that the room is dark. Investing in adequate shades and curtains and turning off any lights will help individuals get to sleep. The use of a sleep mask may be needed to get adequate darkness. The bed should be used for only sleep and sex. Do not use the bed for reading, watching TV, or other activities. The room should be quiet. Earplugs or white noise machines may help with sleep. The bed should be comfortable. A good mattress and pillows can aid in sleep. Those with back pain can sometimes benefit from a pillow under the knees. A comfortable sleep environment includes a comfortable temperature.
Do not nap. Naps during the day disturb the sleep-wake cycle and may make insomnia worse.
Exercise, eating, using caffeine, drinking large quantities of liquid and alcohol should not occur before bed. Exercise increase the sympathetic nervous system and makes it more difficult to sleep if done to close to bed. Eating before bed, especially a big meal, increases the risk of gastroesophageal reflux. Drinking, especially a lot of fluid, increases the risk of getting up in the middle of the night to use the bathroom. Caffeine is a stimulant and reduces the ability to sleep. Alcohol, while sedating, actually reduces the quality of sleep and results in early morning awakening.
Encourage patients to be careful what they do when they wake up in the middle of the night. Ideally, they should not open their eyes when they wake up in the middle of the night. If they do open their eyes, do not look at the clock. The more one does when they wake up, the more work the mind has to do and the more this drives the patient awake.
Placing a nightlight in the bathroom can be used to reduce the need to turn on the bright overhead lights when awakening in the middle of the night. Bright light exposure in the middle of the night drives the patient out of a state of sleep.
Spend a little time outside every day. Bright light during the day is associated with improved nighttime sleep.
Many cases of insomnia can be managed with the above interventions. This may take a lot of work and patients often would rather take medication than have to take on all the tasks necessary to improve quality of sleep.
When the patient returns to the office to discuss what else can be done, the first step a nurse must take is to review and coach the patient again about non-pharmacological interventions. There are many interventions that can be implemented and they take repetitive encouragement.