Books


Sleep Disturbances

Introduction

  • sleep is a state of decreased responsiveness to external stimuli from which an individual may be aroused
  • sleep may be classified as either REM (rapid eye movement) or non-REM. REM is the active phase of sleep, nonREM is the quiet, restful phase of sleep
  • sleep is regulated by circadian rhythms as well as external cues such as time of day, light and dark, psychosocial stress
  • insomnia is the most common sleep disorder, affecting 1/3 of all adults
    • initial insomnia, difficulty falling asleep, is common among young adults
    • intermittent insomnia is the inability to stay asleep
    • terminal insomnia is characterized by early morning awakening
  • sleep disturbance is a frequent problem among cancer patients
  • the causes of sleep disturbances among cancer patients include:
    • physical illness increases sleep requirements and disrupts usual sleep/wake patterns
    • associated anxiety and depression
    • side effects of disease and treatment, such as pain, nausea, immobility, steroids

Assessment

  • elicits information from several sources, including the patient's subjective report of sleep difficulties and objective observations of sleep problems from care givers
  • assess the number of hours slept, frequency of sleep periods, timing of sleep periods, the patient's usual sleep habits
  • evaluate patterns of insomnia, IE. difficulty falling asleep, awakening during the night, early awakenings
  • evaluate activity level and exercise habits, presleep routine
  • review medications and treatments for their impact on sleep

Intervention

  • help patient establish a quiet, relaxing period before sleep
  • establish regular sleep and wake times
  • include exercise as part of daily routine, as appropriate
  • explore potential causes of anxiety, fear, depression
  • avoid caffeine, especially late in the day
  • incorporate relaxation techniques and distraction techniques
  • short term or intermittent use of medications may be indicated
  • long term use of medications can destroy natural sleep patterns, produce tolerance, physical and psychological dependence
  • commonly used medications include:
    • benzodiazepine - promote more natural sleep, safe for short term use
    • antidepressants - sedative effects may be useful
    • antihistamines - may also relieve other symptoms

References

Kaempfer, SH and Johnson, BL (1994) "Sleep" in Gross, J., Johnson, BL (eds) Handbook of Oncology Nursing, 2nd ed, Boston: Jones and Bartlett.

Nail, LM (1997) "Fatigue" in Groenwald, SL, Frogge, MH, Goodman, M., Yarbro, CH. Cancer Nursing: Principles and Practice, 4th ed, Boston: Jones and Bartlett.





News
Early Palliative Care in Lung CA Focuses on Coping, Symptoms

Jan 31, 2013 - Early palliative care clinic visits, integrated with standard oncologic care for patients with metastatic lung cancer, emphasize symptom management, coping, and psychosocial aspects of illness, according to research published online Jan. 28 in JAMA Internal Medicine.



I Wish You Knew

Pain management in cancer care - are patients getting what they need?

View More



Blogs and Web Chats

OncoLink Blogs give our readers a chance to react to and comment on key cancer news topics and provides a forum for OncoLink Experts and readers to share opinions and learn from each other.




OncoLink OncoPilot

Facing a new cancer diagnosis or changing the course of your current treatment? Let our cancer nurses help you through!

Learn More