Sleep Disorders in Cancer Patients

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 of 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); and excessive sleepiness.

Risk Factors for Sleep Disorders

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 of Sleep Disorders

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 of Sleep Disorders

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 sleep hygiene tips 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, and 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, and 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), and keeping regular sleeping hours. Drugs may also be used to help patients with cancer manage their sleep disorders.
  (Editor's Note: More sleep hygiene information is available here. You should also see a sleep specialist to fully diagnose and treat any sleep disorder. For information about sleep and sleep disorders check out our Sleep Information section.)

To Learn More

For more information, U.S. residents may call the Cancer Information Service 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.

The National Cancer Institute 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 from the NCI Publications Locator Service at www.cancer.gov/publications or by telephone from the Cancer Information Service toll free at 1-800-4-CANCER.

There are many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.

A list of organizations and websites that offer information and services for cancer patients and their families is available on CancerNet at http://cancernet.nci.nih.gov/cancerlinks.html.

For more information from the National Cancer Institute, visit the CancerNet website at http://cancernet.nci.nih.gov or write to this address:

National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Please note that TalkAboutSleep.com offers a great deal of information about sleep and sleep disorders. We also recommend that any patient with a diagnosed or undiagnosed sleep problem be seen by a qualified sleep specialist, preferably one board certified in sleep medicine. For directories of sleep centers and sleep physicians, see our Directories section.

The material in this article was adapted and reprinted from the CancerNet website managed by the National Cancer Institute and was updated in June of 2001.