Sleep disturbance (insomnia and poor-quality sleep) is common in people with advanced illness. It often has a significant impact on the person’s quality of life.
Sleep disturbance is particularly common in people with COPD, heart disease, end-stage renal disease, end-stage liver disease, cancer, and dementia.
Sleep disturbance may be a combination of difficulty falling asleep, fragmented sleep, early morning waking or the feeling that sleep is not refreshing. It also includes symptoms of functional daytime impairment such as fatigue, sleepiness, cognitive impairment, and disturbances in mood.
Nurses have an important role in recognising, assessing, and managing symptoms related to sleep disturbance. They can also help patients and families with sensitive and culturally appropriate education and support.
Sleep habits can be varied and personal. People used to sleeping communally (lots of people in the room) are likely to find it difficult to sleep or rest if they are on their own. Some people are used to a long siesta after lunch. Others will have the habit of staying up until late at night. It can help if you talk with the person and their family (if appropriate) to understand what is normal for them.
Insomnia is likely to be underreported by patients and is often not routinely screened for.
Poorly controlled symptoms of pain, dyspnoea, fatigue, anxiety, or depression significantly impact sleep quality in people with advanced disease. Similarly, insomnia can increase the intensity of these symptoms and further complicate their management.
Family and/or carers may also experience sleep disturbance, and this can affect their ability to care.
Sleep disturbance is a common complaint during bereavement and you can include questions about this as part of following up the bereaved.
Assessment for sleep disturbances includes the exploration of predisposing factors including:
Medications which may contribute to insomnia include beta or calcium channel blockers, antidepressants, steroids, herbal or over-the-counter medication, and stimulants (tobacco, caffeine, alcohol, or illicit drugs).
It may help to ask the doctor, nurse practitioner, or pharmacist to review the person’s medicines.
The Symptom Assessment Scale (SAS) or Edmonton Symptom Assessment System (ESAS) can be used to screen for sleep disturbances and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbance.
Care of sleep
disturbances initially includes treatment of:
Nurses can assist
the person with ways to promote healthy sleep patterns including:
As a nurse you can advocate for appropriate referrals
such as to a psychologist or counsellor to help manage emotional stressors, a
psychologist for behaviour therapies, or a doctor or pharmacist for a
Pharmacological management usually includes
benzodiazepines as well as Zolpidem, and Zopiclone. Pharmacological management should
not be first-line treatment for sleep disturbance, and, if used, should
complement non-pharmacological treatment.
This information was drawn from the following resources:
Watch the Agency for Clinical Innovation video, Anxiety and sleep disturbances
Go to Sleep problems in palliative care on the Marie Curie website
Access more Sleeping Disturbance resources
Page created 09 October 2023