A 43-year-old healthy woman, Maria Lupe, is being seen for her annual women’s health visit. She tells you

A 43-year-old healthy woman, Maria Lupe, is being seen for her annual women’s health visit. She tells you she lies awake in bed for hours before falling asleep at night. Sometimes she falls asleep without problems but will wake up and then have trouble going back to sleep. After feeling as though she had been awake nearly all night, Maria wakes in the morning feeling exhausted. She tells you she feels tired all the time and can’t seem to get things done during her time off because of her fatigue. Maria admits to feeling irritable with her coworkers and children. Because of her lack of rest, she doesn’t have the desire to do things socially anymore.


Theoretical Knowledge: The NANDA-I definition and defining characteristics of Insomnia differ slightly from the medical diagnosis of insomnia.

What is insomnia, as defined medically (e.g., by the National Sleep Foundation)?
What other health conditions might a medical diagnosis of insomnia be confused with?
What factors either lead to or aggravate insomnia, as described medically?

Critical Thinking (Contextual Awareness):

Obviously Maria has trouble sleeping. Based on the data you have, do you consider her difficulty sleeping significant enough to require consultation with her primary healthcare provider? Explain your thinking.

Nursing Process (Assessments):

When conducting a sleep history for Maria, what questions would you ask her in order to (i) describe more fully her sleeping problem and (ii) identify the cause of her sleeping problem?
What would you suggest Maria do to help you gain more information about her sleeping problem?

Nursing Process (Nursing Diagnosis):

Based on the data in the Patient Situation, would you use a nursing diagnosis of Sleep Deprivation or Insomnia for Maria? Explain your thinking. Use a nursing diagnosis handbook, as needed, to compare the defining characteristics of the two diagnoses.

Nursing Process (Interventions):

How might you help your patient manage her Insomnia other than using prescription medication? What might you suggest?


Have you ever had trouble falling or staying asleep? How did you feel at the time and in the morning? Describe your experience.
How might you provide better emotional care and support to your patient after recalling your own episodes of sleeping difficulty?

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