Sleep Disorders (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 for more information).
• Diarrhea, constipation, nausea, or incontinence.

Long-term use of certain drugs commonly used during cancer treatment may cause insomnia. Stopping or decreasing the use of certain drugs may also cause insomnia.

Some drugs that help patients sleep (such as hypnotics and sedatives) should not be stopped suddenly without the advice of a doctor. Suddenly stopping these medicines may cause nervousness, seizures, and a change in REM sleep that increases dreaming, including nightmares. This change in REM sleep may be dangerous for patients with peptic ulcers or heart conditions.

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

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.

It is important for the patient to talk about sleep problems with family and the health care team so education and support can be offered. Some treatments help the patient change thoughts and behaviors to decrease anxiety and relax mentally, so sleep can happen more easily:

• Relaxation exercises.
• Self-hypnosis at bedtime.
• Cognitive-behavior therapy, in which the patient learns to change the goal from "I need to sleep" to "just relax." This may help the patient relax enough to fall asleep.

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