An adult reports difficulty falling asleep and returning to sleep at least 4 nights each week for 4 months, with daytime fatigue. The assessment identifies no urgent medical cause. Complete the rest-and-sleep plan.
Drop-down Cloze
Choose your responses, then check the answer.
Explanation
Cognitive behavioral therapy for insomnia is the recommended first-line treatment for chronic insomnia. It combines behavioral and cognitive strategies, including stimulus control and a consistent schedule. The bed is reserved for sleep and intimacy, and the client leaves the bed for a quiet activity when unable to sleep, returning when sleepy. Sleep-hygiene tips can support treatment but should not be the only therapy for chronic insomnia, and routine reliance on over-the-counter sedating products can create adverse effects without treating the maintaining pattern.
Correct Answer Arrange CBT-I, use a consistent wake time and stimulus-control plan, and avoid using sleep hygiene or sedating products as the sole long-term treatment.
Why It Fits CBT-I directly addresses the behaviors and beliefs that maintain chronic insomnia and has stronger evidence than sleep-hygiene education alone.
Clinical Picture The scenario is chronic rather than one transient poor night, so a structured multicomponent treatment is appropriate.
Memory Link Train the clock and the bed: consistent wake time, bed for sleep, structured CBT-I.
NCLEX Rule For chronic insomnia, sleep hygiene supports treatment but does not replace CBT-I.
Why the Alternatives Fail Staying in bed awake for hours strengthens the bed-wake association. Sleeping in after a poor night disrupts the schedule. Indefinite self-treatment with sedating products may add harm and delay assessment.
Source
12025 VA DoD Chronic Insomnia and OSA Guideline
22025 VA DoD Full Insomnia Guideline
32026 NCLEX-RN Test Plan
The nurse collaborates with the clinician on evidence-based behavioral treatment and screens for factors that could require a different pathway, including sleep apnea, substance use, medication effects, and mood symptoms.
CBT-I — Cognitive behavioral therapy for insomnia, a multicomponent treatment targeting sleep-related thoughts and behaviors.
Stimulus Control — A strategy that strengthens the association between bed and sleep by limiting wakeful activities in bed.
Sleep Efficiency — The proportion of time in bed that is actually spent asleep.