Sleep

Key points

  • It is estimated that one-third to one-half of people with cancer or end-stage disease experience sleep disturbance and that this impacts on their quality of life and coping ability.
  • Sleep disturbance should be assessed in relation to previous sleep problems - chronic insomnia is common in the general population.
  • Physical symptoms, pain, hospitalisation, drugs and cancer treatments, and the psychological impact of a disease may all affect sleep.
  • Sedative hypnotic medications have a significant potential for harm in the medium to long term (tolerance, withdrawal, increased risk of falls, drug interactions and delirium) and their ongoing use should be minimised. Non-pharmacological approaches must be considered. 

Assessment

  • Review sleep hygiene – where and when the patient sleeps, the physical environment, and cues for sleeping.
  • Identify and manage all potentially reversible causes of sleep disturbance as clinically appropriate
    • Uncontrolled pain or other symptoms
    • Steroids
    • Depression leading to sleep fragmentation - ask about rumination, early morning wakening
    • Bladder or bowel discomfort
    • Anxiety / fears
    • obstructive sleep apnoea, restless legs, cramps.
  • Sleep – wake cycle disturbances can be early symptoms of delirium, and of hepatic encephalopathy, and 'sundowning' is common in patients with dementia.
  • Identify the impacts of sleep disturbance
    • Functional
    • Psychosocial
    • Safety – eg, managing with medications, driving, etc
    • Interpersonal – others who are affected eg, caregiver.
  • Provide appropriate support – eg, home nursing for medication management, respite and support for caregiver.

Approach to management

  • Helpful strategies for managing tiredness include energy conservation, optimisation of physical activity around the most valued priorities, psychosocial interventions, and management of comorbidities (eg, pain, insomnia, depression).
  • Non-pharmacological approaches include relaxation, education about sleep hygiene, cognitive restructuring to reduce anxiety about sleep problems, and attention to any environmental factors that distrupt sleep patterns.
  • Multicomponent approaches are more effective than single therapy.

Prescribing guidance - Sleep

Sleep Disorders
Physician Data Query (PDQ)

See also Hot Flashes and Night Sweats, Depression, and Anxiety Disorders

From: National Cancer Institute (US)


Evidence summary - Sleeping Problems

Sleeping Problems
Summarises the palliative care literature

From: CareSearch

Last updated 16 February 2017