Table 4. Nonpharmacologic Nursing Interventions to Promote Sleep.

Category	Intervention	Rationale
Sleep Hygiene Measures	Limit caffeine (coffee, tea, soft drinks, and chocolate), cigarettes, stimulants, and alcohol	These are stimulants that promote wakefulness
	If medically able, increase activity in the afternoon or early evening (not close to bedtime)	Promotes daytime arousal, reduces daytime napping, and reduces depression
	Increase exposure to bright light and/or sunlight during the day and early evening hours	Helps maintain circadian rhythm, which are established by patterns of light and dark
	Avoid napping, if possible, or limit to one nap of less than 30 minutes	Weakens the homeostatic drive to sleep.
	Check the effect of medications on sleep	See Table 3
	Maintain comfortable temperature, darkness, and good ventilation in bedroom	A comfortable sleep environment promotes sleep
	Minimize light and noise exposure as much as possible	Light and noise disrupt sleep
	Eat a light snack if hungry	Hunger can keep a person awake
	Avoid heavy meals at bedtime	This reduces nighttime awakenings caused by GERD
	Limit liquids in the evening	This reduces nighttime awakenings caused by nocturia
	Keep a regular schedule Rest and retire at the same time everyday Eat and exercise on a regular schedule	Maintaining temporal patterns of rest and activity enhances synchrony with circadian rhythm
	Practice stress-management techniques Discuss worries and stressful events enough time before bedtime Practice progressive muscle relaxation or other techniques to promote relaxation	Reducing stress and promoting relaxation at bedtime will augment a person's readiness for sleep
Environment	Use a noise machine to provide “white noise”	Has been shown to promote sleep maintenance in some populations
Massage	Provide slow-stroke back massage during bedtime routine	Has been shown to promote sleep in nursing home residents with dementia
Delirium	Assess for signs of delirium; to prevent delirium, frequently reorient the person by keeping clocks and calendars in living and sleeping areas, maintain a regular schedule, and keep day and night associated with environmental light and dark	These measures reduce anxiety and help maintain circadian rhythms

Sources: (Smith, 2002; Cole & Richards, 2007; Ancoli-Israel & Ayalon, 2009; Floyd, 1999; Harris, 2009)