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Sleep Disorders (PDQ®)

Overview

Sleep disturbances occur in about 10% to 15% of the general population [1] and are often associated with situational stress, illness, aging, and drug treatment.[2] It is estimated that one-third to one-half of people with cancer experience sleep disturbance.[3,4] Physical illness, pain, hospitalization, drugs and other treatments for cancer, and the psychological impact of a malignant disease may disrupt the sleeping patterns of persons with cancer.[5] Poor sleep adversely affects daytime mood and performance. In the general population, persistent insomnia has been associated with a higher risk of developing clinical anxiety or depression.[6] Sleep disturbances and, ultimately, sleep-wake cycle reversals can be early signs of a developing delirium. (Refer to the PDQ summary on Delirium for more information.) Adequate sleep may increase the cancer patient's pain tolerance.

Sleep consists of two phases: rapid eye movement (REM) sleep and non-REM (NREM) sleep.[7] REM sleep, also known as dream sleep, is the active or paradoxic phase of sleep in which the brain is active. NREM sleep is the quiet or restful phase of sleep. NREM, also referred to as slow wave sleep, is divided into four stages of progressively deepening sleep based on electroencephalogram findings.

The stages of sleep occur in a repeated pattern or cycle of NREM followed by REM, with each cycle lasting approximately 90 minutes. The sleep cycle is repeated four to six times during a 7- to 8-hour sleep period.[7] The sleep-wake cycle is dictated by an inherent biological clock or circadian rhythm. Disruptions in individual sleep patterns can disrupt the circadian rhythm and impair the sleep cycle.[8]

Five major categories of sleep disorders have been defined by the Sleep Disorders Classification Committee of the American Academy of Sleep Medicine:[9]

  1. Disorders of initiating and maintaining sleep (insomnias).
  2. Sleep-related breathing disorders (sleep apnea).
  3. Disorders of excessive somnolence (hypersomnias).
  4. Disorders of the sleep-wake cycle (circadian rhythm sleep disorders).
  5. Dysfunctions associated with sleep, sleep stages, or partial arousals (parasomnias).

In this summary, unless otherwise stated, evidence and practice issues as they relate to adults are discussed. The evidence and application to practice related to children may differ significantly from information related to adults. When specific information about the care of children is available, it is summarized under its own heading.

References

  1. National Sleep Foundation: Insomnia and Sleep. Arlington, Va: National Sleep Foundation, 2013. Available online. Last accessed April 23, 2014.
  2. Sateia MJ, Pigeon WR: Identification and management of insomnia. Med Clin North Am 88 (3): 567-96, vii, 2004. [PUBMED Abstract]
  3. Palesh OG, Roscoe JA, Mustian KM, et al.: Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol 28 (2): 292-8, 2010. [PUBMED Abstract]
  4. Savard J, Morin CM: Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19 (3): 895-908, 2001. [PUBMED Abstract]
  5. Berger AM: Update on the state of the science: sleep-wake disturbances in adult patients with cancer. Oncol Nurs Forum 36 (4): E165-77, 2009. [PUBMED Abstract]
  6. Ohayon MM, Caulet M, Lemoine P: Comorbidity of mental and insomnia disorders in the general population. Compr Psychiatry 39 (4): 185-97, 1998 Jul-Aug. [PUBMED Abstract]
  7. Hirshkowitz M: Normal human sleep: an overview. Med Clin North Am 88 (3): 551-65, vii, 2004. [PUBMED Abstract]
  8. Hrushesky WJ, Grutsch J, Wood P, et al.: Circadian clock manipulation for cancer prevention and control and the relief of cancer symptoms. Integr Cancer Ther 8 (4): 387-97, 2009. [PUBMED Abstract]
  9. American Academy of Sleep Medicine: The International Classification of Sleep Disorders: Diagnostic & Coding Manual. 2nd ed. Westchester, Ill: American Academy of Sleep Medicine, 2005.
  • Updated: April 23, 2014