Introduction
Overview
Risk Factors
Diagnosis
Treatment
Get More Information From NCI
Changes to This Summary (09/09/2008)
Questions or Comments About This Summary
About PDQ

Introduction

This patient summary on sleep disorders is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Sleep disorders may be caused by tumor growth, cancer therapy, or other factors. This brief summary describes sleep disorders, their causes and treatment.

Overview

Sleep disorders occur in some people with cancer and may be caused by physical illness, pain, treatment drugs, being in the hospital, and emotional stress. Sleep has two phases: rapid eye movement (REM) and non-REM (NREM). REM sleep, also known as "dream sleep," is the phase of sleep in which the brain is active. NREM is the quiet or restful phase of sleep. The stages of sleep occur in a repeated pattern of NREM followed by REM. Each sleep cycle lasts about 90 minutes and is repeated 4 to 6 times during a 7- to 8-hour sleep period. The four major categories of sleep disorders that interfere with normal sleep patterns include:

• The inability to fall asleep and stay asleep (insomnia).
• Disorders of the sleep-wake cycle.
• Disorders associated with sleep stages, or partial waking (parasomnia).
• Excessive sleepiness.

Risk Factors

The sleep disorders most likely to affect patients with cancer are insomnias and disorders of the sleep-wake cycle. Effects of tumor growth and cancer treatment that may cause sleep disturbances include:

• Anxiety or depression.
• Pain or itching.
• Fever, cough, or trouble breathing.
• Fatigue.
• Seizures.
• Headaches.
• Night sweats or hot flashes. (See the PDQ summary on Fever, Sweats, and Hot Flashes ¹ for more information).
• Diarrhea, constipation, nausea, or incontinence.

For more information on managing symptoms and side effects, see PDQ Cancer Information Summaries: Supportive and Palliative Care ².

Patients may have sleep interruptions due to treatment schedules, hospital routines, and roommates. Other factors affecting sleep during a hospital stay include noise, temperature, pain, anxiety, and the patient's age. Chronic sleep disturbances can cause irritability, inability to concentrate, depression, and anxiety. While in the hospital, sleep disorders may make it hard for the patient to continue with cancer therapy.

Diagnosis

To diagnose sleep disorders in cancer patients, the doctor will get the patient's complete medical history and give a physical examination. The doctor may get information about the patient's sleep history and patterns of sleep from the patient, from observations, and from the patient's family and friends. A polysomnogram, an instrument that measures brain waves, eye movements, muscle tone, heart rate, and breathing during sleep, may also be used to diagnose sleep disorders in patients with cancer.

Treatment

Sleep disorders that are related to cancer may be treated by eliminating the cancer and side effects of cancer treatment. To promote rest and treat sleep disorders the following may be considered:

• Create an environment that decreases sleep interruptions by:
  • Lowering noise.
  • Dimming or turning off lights.
  • Adjusting room temperature.
  • Keeping bedding, chairs, and pillows clean, dry, and wrinkle-free.
  • Using bedcovers for warmth.
  • Placing pillows in a supportive position.
  • Encouraging the patient to dress in loose, soft clothing.
• Encourage regular bowel and bladder habits to minimize sleep interruptions, such as
  • No drinking before bedtime.
  • Emptying the bowel and bladder before going to bed.
  • Increasing consumption of fluids and fiber during the day.
  • Taking medication for incontinence before bedtime.

Rest in patients with cancer may also be promoted by:

• Eating a high- protein snack 2 hours before bedtime.
• Avoiding heavy, spicy, or sugary foods 4 to 6 hours before bedtime.
• Avoiding drinking alcohol or smoking 4 to 6 hours before bedtime.
• Avoiding drinks with caffeine.
• Exercising (which should be completed at least 2 hours before bedtime).
• Keeping regular sleeping hours.

Drugs may also be used to help patients with cancer manage their sleep disorders.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® ³ online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

NCI Public Inquiries Office

Suite 3036A

6116 Executive Boulevard, MSC8322

Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site ⁴ provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ⁵. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (09/09/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form ⁶. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ⁴. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁷. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

The organ that stores urine.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called the intestine.

A substance found in the leaves and beans of the coffee tree, in tea, yerba mate, guarana berries, and in small amounts in cocoa. It can also be made in the laboratory, and is added to some soft drinks, foods, and medicines. Caffeine increases brain activity, alertness, attention, and energy. It may also increase blood pressure, heart rate, breathing rate, and the loss of water from the body in urine.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A disease or condition that persists or progresses over a long period of time.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.

A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Frequent and watery bowel movements.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

An increase in body temperature above normal (98.6 degrees F), usually caused by disease.

In food, fiber is the part of fruits, vegetables, legumes, and whole grains that cannot be digested. The fiber in food may help prevent cancer. In the body, fiber refers to tissue made of long threadlike cells, such as muscle fiber or nerve fiber.

Liquid.

A sudden, temporary onset of body warmth, flushing, and sweating (often associated with menopause).

Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence).

Difficulty in going to sleep or getting enough sleep.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.

An abnormal disruption of sleep, such as sleep walking, sleep talking, nightmares, bedwetting, sleep apnea (problems with breathing that cause loud snoring), or nighttime seizures.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

An exam of the body to check for general signs of disease.

A group of recordings taken during sleep that shows brain wave changes, eye movements, breathing rate, blood pressure, heart rate, and the electrical activity of the heart and other muscles. A polysomnogram may be used to help diagnose sleep disorders.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

One of the five stages of sleep. During rapid eye movement sleep, the eyes move rapidly while closed and dreams occur. Rapid eye movement sleep is the lightest stage of sleep, during which a person may wake easily. During several hours of normal sleep, a person will go through several sleep cycles that include rapid eye movement sleep and the 4 stages of non-rapid eye movement (light to deep sleep). Also called REM sleep.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

Convulsion; a sudden, involuntary movement of the muscles.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A disturbance of normal sleep patterns. There are a number of sleep disorders that range from trouble falling asleep, to nightmares, sleepwalking, and sleep apnea (problems with breathing that cause loud snoring). Poor sleep may also be caused by diseases such as heart disease, lung disease, or nerve disorders.

One of 5 parts or stages of the sleep cycle based on the type of brain activity that occurs during the stage. During stages 1 to 4, a person will feel drowsy, fall asleep, and move into a deep, dreamless sleep. Stage 5 is called rapid eye movement (REM) sleep, and it is during this stage that dreams occur. During several hours of normal sleep, a person will go through several sleep cycles that include REM sleep and the 4 stages of non-REM sleep (light to deep sleep).

The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, comfort care, and symptom management.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.