Cancer Related Sleep Disorders

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, depression, pain, fever, cough, breathing problems, itching, fatigue, seizures, headaches, night sweats, hot flashes, diarrhea, constipation, nausea, and the inability to control bodily functions. 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 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.