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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.

This summary is about sleep disorders in adults with cancer.

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 five major categories of sleep disorders that interfere with normal sleep patterns include:

  • The inability to fall asleep and stay asleep (insomnia).

  • Sleep-related breathing disorders (sleep apnea).

  • Excessive sleepiness (hypersomnia).

  • Disorders of the sleep-wake cycle (circadian rhythm disorders).

  • Disorders associated with sleep stages, or partial waking (parasomnia).

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 diagnosesleep 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.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp� online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

  • NCI Public Inquiries Office

  • Suite 3036A

  • 6116 Executive Boulevard, MSC8322

  • Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI 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 or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).

Changes to This Summary (11/04/2011)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site?s Contact Form. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).