So any medical diagnosis is off limits. The pt was observed sucking their thumb, so that could be impaired skin integrity r/t... Readiness for enhanced sleep could be the suggestion to cut back on hours, sleep with earplugs, use room darkening curtains. Or should the suggestions be physically related: stop caffeine intake 6-8 hours before bedtime, no stimulation or exercise prior to sleep. I get the at risk now. Thanks for all the help.