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Sleep Disturbances

Introduction

  • sleep is a state of decreased responsiveness to external stimuli from which an individual may be aroused
  • sleep may be classified as either REM (rapid eye movement) or non-REM. REM is the active phase of sleep, nonREM is the quiet, restful phase of sleep
  • sleep is regulated by circadian rhythms as well as external cues such as time of day, light and dark, psychosocial stress
  • insomnia is the most common sleep disorder, affecting 1/3 of all adults
    • initial insomnia, difficulty falling asleep, is common among young adults
    • intermittent insomnia is the inability to stay asleep
    • terminal insomnia is characterized by early morning awakening
  • sleep disturbance is a frequent problem among cancer patients
  • the causes of sleep disturbances among cancer patients include:
    • physical illness increases sleep requirements and disrupts usual sleep/wake patterns
    • associated anxiety and depression
    • side effects of disease and treatment, such as pain, nausea, immobility, steroids

Assessment

  • elicits information from several sources, including the patient's subjective report of sleep difficulties and objective observations of sleep problems from care givers
  • assess the number of hours slept, frequency of sleep periods, timing of sleep periods, the patient's usual sleep habits
  • evaluate patterns of insomnia, IE. difficulty falling asleep, awakening during the night, early awakenings
  • evaluate activity level and exercise habits, presleep routine
  • review medications and treatments for their impact on sleep

Intervention

  • help patient establish a quiet, relaxing period before sleep
  • establish regular sleep and wake times
  • include exercise as part of daily routine, as appropriate
  • explore potential causes of anxiety, fear, depression
  • avoid caffeine, especially late in the day
  • incorporate relaxation techniques and distraction techniques
  • short term or intermittent use of medications may be indicated
  • long term use of medications can destroy natural sleep patterns, produce tolerance, physical and psychological dependence
  • commonly used medications include:
    • benzodiazepine - promote more natural sleep, safe for short term use
    • antidepressants - sedative effects may be useful
    • antihistamines - may also relieve other symptoms

References

Kaempfer, SH and Johnson, BL (1994) "Sleep" in Gross, J., Johnson, BL (eds) Handbook of Oncology Nursing, 2nd ed, Boston: Jones and Bartlett.

Nail, LM (1997) "Fatigue" in Groenwald, SL, Frogge, MH, Goodman, M., Yarbro, CH. Cancer Nursing: Principles and Practice, 4th ed, Boston: Jones and Bartlett.






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