|NCI/PDQ® Patients: Sleep Disorders (PDQ®)|
|National Cancer Institute|
| Last Modified: August 24, 2012
Sleep is an important part of physical and mental health. While we sleep, the brain and body do a number of important jobs that help us stay in good health and function at our best.
There are two main phases of sleep and both are needed in order to get "a good night's sleep." The two main phases of sleep are rapid eye movement (REM) and non-rapid eye movement (NREM):
The phases of sleep repeat during the night in a cycle of a non-REM phase followed by a REM phase. Each cycle lasts about 90 minutes and is repeated 4 to 6 times during 7 to 8 hours of sleep.
Normal sleep patterns differ from person to person. The amount of sleep you need to feel rested may be less or more than others need. If sleep is interrupted or does not last long enough, the phases of sleep are not completed and the brain cannot finish all the tasks that help restore the body and mind. There are five major types of sleep disorders that affect normal sleep.
Sleep disorders keep you from having a good night's sleep. This may make it hard for you to stay alert and involved in activities during the day. Sleep disorders can cause problems for cancer patients. You may not be able to remember treatment instructions and may have trouble making decisions. Being well-rested can improve energy and help you cope better with side effects of cancer and treatment.
This summary is about sleep disorders in adults who have cancer, with a section on somnolence syndrome in children.
While sleep disorders affect a small number of healthy people, as many as half of patients with cancer have problems sleeping. The sleep disorders most likely to affect patients with cancer are insomnia and an abnormal sleep-wake cycle.
For patients with tumors, the tumor may cause the following problems that make it hard to sleep:
Long-term use of certain drugs may cause insomnia. Stopping or decreasing the use of certain drugs can also affect normal sleep. Other side effects of drugs and treatments that may affect the sleep-wake cycle include the following:
Getting sleep during a hospital stay may also be affected by anxiety and the patient's age.
Stress, anxiety, and depression are common reactions to learning you have cancer, receiving treatments, and being in the hospital. These are common causes of insomnia. (See the PDQ® summary on Depression for more information.)
An assessment is done to find problems that may be causing the sleep disorder and how it affects your life. Patients with mild sleep disorders may be irritable and unable to concentrate. Patients with moderate sleep disorders can be depressed and anxious. These sleep disorders may make it hard for you to stay alert and involved in activities during the day. You may not be able to remember treatment instructions and may have trouble making decisions. Being well-rested can improve energy and help you cope better with side effects of cancer and treatment.
You and your family can tell your doctor about your sleep history and patterns of sleep.
A polysomnogram is a group of recordings taken during sleep that show:
This information helps the doctor find the cause of your sleeping problems.
Sleep disorders that are caused by side effects of the cancer or cancer treatment may be helped by relieving the symptoms of those side effects. It's important to talk about your sleep problems with your family and the health care team so education and support can be given. Supportive care may improve your quality of life and ability to sleep.
Cognitive behavioral therapy (CBT) helps reduce anxiety about getting enough sleep. You learn to change negative thoughts and beliefs about sleep into positive thoughts and images, in order to fall asleep more easily. CBT helps replace the anxiety of I need to sleep with the idea of just relax. You learn how to change sleep habits that keep you from sleeping well. CBT may include the following:
Good sleep habits help you fall asleep more easily and stay asleep. Habits and routines that may help improve sleep include the following:
A comfortable bed and bedroom
Regular bowel and bladder habits
Diet and exercise
The following diet and exercise habits may improve sleep:
Treatment without drugs does not always work. Sometimes cognitive behavioral therapies are not available or they do not help. Also, some sleep disorders are caused by conditions that need to be treated with drugs, such as hot flashes, pain, anxiety, depression, or mood disorders. The drug used will depend on your type of sleep problem (such as trouble falling asleep or trouble staying asleep) and other medicines you're taking. All of your other medicines and health conditions will affect which sleeping medicines are safe and will work well for you.
Some drugs that help you sleep should not be stopped suddenly. Suddenly stopping them may cause nervousness, seizures, and a change in the REM phase of sleep that increases dreaming, including nightmares. This change in REM sleep may be dangerous for patients with peptic ulcers or heart conditions.
In patients with pain that disturbs their sleep, treatment to relieve the pain will be used before sleep medicines are used. Pain drugs, other drugs being taken, and any other health conditions may affect which sleeping medicines are prescribed.
It's normal for older people to have some insomnia. Changes related to age can cause lighter sleep, waking up more often during the night, and sleeping less total time. If an older patient with cancer is having trouble sleeping, the doctor will look for the specific causes, such as:
Medicine may be used if non-drug treatments don't work. The doctor will look at all the patient's medicines and health conditions before choosing a sleeping medicine. For some patients, doctors will suggest a sleep disorder clinic for treatment.
Somnolence syndrome (SS) is a side effect of radiation therapy to the head and is often seen in children treated for acute lymphocytic leukemia. Children with SS seems to be sleepy all the time. They are less alert when awake, irritable, and have low energy and little appetite. There is sometimes a low-grade fever. The risk of SS increases when the total dose of radiation is given in fewer parts (fractions) and over a short period of time. The syndrome usually appears 4 to 6 weeks after radiation therapy ends. Up to half of children treated with radiation to the head may have SS..
Patients who have surgery on the jaw may develop sleep apnea, which is a sleep disorder that causes the person to stop breathing for 10 seconds or more during sleep. Plastic surgery to rebuild the jaw may help prevent sleep apnea.
Check NCI's list of cancer clinical trials for U.S. supportive and palliative care trials about sleep disorders that are now accepting participants. The list of trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
This summary was completely reformatted and some content was added.
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