# 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.

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> language: en  
> subject: Rest and Sleep  
> category: BCC

## Question

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.

The plan should prioritize ::선택::referral or access to cognitive behavioral therapy for insomniasleep-hygiene handouts as the only treatmentindefinite nightly over-the-counter sedating medicationremaining in bed until sleep occurs regardless of time awake, include ::선택::a different wake time after each poor nightusing the bed for work and televisiona consistent wake time and leaving the bed for a quiet activity when unable to sleeplong daytime naps to compensate for every short night, and avoid ::선택::screening for sleep-apnea symptomsreviewing medication and substance effectsmonitoring daytime functionusing sleep hygiene or sedating products as the sole long-term strategy.

## 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.

## In-depth explanation

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

## Clinical scenario

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.

## Key concepts

- **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.

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