Sleep Disturbance in Cancer Patients
Cancer patients are at great risk for developing insomnia and disorders of the
sleep-wake cycle. Insomnia is the most common sleep disturbance in this
population and is most often secondary to physical and/or psychological factors
related to cancer and/or cancer treatment.[1] Anxiety and depression, common
psychological responses to the diagnosis of cancer, cancer treatment, and
hospitalization, are highly correlated with insomnia.[2-6]
Sleep disturbances may be exacerbated by paraneoplastic syndromes associated
with steroid production and by symptoms associated with tumor invasion, such as
draining lesions, gastrointestinal (GI) and genitourinary (GU) alterations,
pain, fever, cough, dyspnea, pruritus, and fatigue. Medications—including
vitamins, corticosteroids, neuroleptics for nausea and
vomiting, and sympathomimetics for the treatment of dyspnea—as well as other
treatment factors can negatively impact sleep patterns.
Side effects of treatment that may affect the sleep-wake cycle include the following:[7]
- Pain.
- Anxiety.
- Night sweats/hot flashes (refer to the PDQ summary on Fever, Sweats, and Hot Flashes 1 for more information).
- GI disturbances (e.g., incontinence, diarrhea, constipation, or nausea).
- GU disturbances (e.g., incontinence, retention, or GU irritation).
- Respiratory disturbances.
Medications commonly used in the treatment of cancer can cause insomnia.
Sustained use of central nervous system (CNS) stimulants (e.g., amphetamines,
caffeine, and diet pills, including some dietary supplements that promote weight
loss and appetite suppression), sedatives and hypnotics (e.g., glutethimide,
benzodiazepines, pentobarbital, chloral hydrate, secobarbital sodium,
and amobarbital sodium), cancer chemotherapeutic agents (especially
antimetabolites), anticonvulsants (e.g., phenytoin), adrenocorticotropin, oral
contraceptives, monoamine oxidase inhibitors, methyldopa, propranolol,
atenolol, alcohol, and thyroid preparations can cause insomnia. In addition,
withdrawal from CNS depressants (e.g., barbiturates, opioids,
glutethimide, chloral hydrate, methaqualone, ethchlorvynol, alcohol, and
over-the-counter and prescription antihistamine sedatives), benzodiazepines,
major tranquilizers, tricyclic and monamine oxidase inhibitor antidepressants,
and illicit drugs (e.g., marijuana, cocaine, phencyclidine, and opioids) may cause
insomnia. The most commonly prescribed hypnotics can interfere with rapid eye movement (REM) sleep,
resulting in increased irritability, apathy, and diminished mental alertness.
Abrupt withdrawal of hypnotics and sedatives may lead to many symptoms,
including nervousness, jitteriness, seizures, and REM rebound.
REM rebound has been defined as a “marked increase in REM sleep with increased frequency and
intensity of dreaming, including nightmares.”[8] The increased physiologic
arousal that occurs during REM rebound may be dangerous for patients with
peptic ulcers or a history of cardiovascular problems.
The sleep of hospitalized patients is likely to be frequently interrupted by treatment schedules, hospital routines, and roommates, which singularly
or collectively alter the sleep-wake cycle. Other factors influencing
sleep-wake cycles in the hospital setting include patient age, comfort, pain, and anxiety; and environmental noise and temperature.[9]
Consequences of sleep disturbances can influence outcomes of therapeutic and
supportive care measures. The patient with mild to moderate sleep disturbances
may experience irritability and inability to concentrate, which may in turn
affect the patient's compliance with treatment protocols, ability to make
decisions, and relationships with significant others. Depression and anxiety
can also be caused by sleep disturbances. Supportive care measures are
directed toward promoting quality of life and adequate rest.
References
-
Savard J, Simard S, Hervouet S, et al.: Insomnia in men treated with radical prostatectomy for prostate cancer. Psychooncology 14 (2): 147-56, 2005.
[PUBMED Abstract]
-
Coursey RD: Personality measures and evoked responses in chronic insomniacs. J Abnorm Psychol 84 (3): 239-49, 1975.
[PUBMED Abstract]
-
Freemon FR: Sleep Research: A Critical Review. Springfield, Ill: Thomas Publishing, 1972.
-
Johns MW, Bruce DW, Masterton JP: Psychological correlates of sleep habits reported by healthy young adults. Br J Med Psychol 47 (2): 181-7, 1974.
[PUBMED Abstract]
-
Engstrom CA, Strohl RA, Rose L, et al.: Sleep alterations in cancer patients. Cancer Nurs 22 (2): 143-8, 1999.
[PUBMED Abstract]
-
Berger AM, Farr L: The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncol Nurs Forum 26 (10): 1663-71, 1999 Nov-Dec.
[PUBMED Abstract]
-
Page M: Sleep pattern disturbance. In: McNally JC, Stair JC, Somerville ET, eds.: Guidelines for Cancer Nursing Practice. Orlando, Fla: Grune and Stratton, Inc., 1985, pp 89-95.
-
Berlin RM: Management of insomnia in hospitalized patients. Ann Intern Med 100 (3): 398-404, 1984.
[PUBMED Abstract]
-
Webster RA, Thompson DR: Sleep in hospital. J Adv Nurs 11 (4): 447-57, 1986.
[PUBMED Abstract]
|