Sleep-Wake Disturbances

Objectives

The learner will be able to:1.Name the parameters for effective assessment of sleep habits.2.Discuss evidence-based interventions likely to be effective for sleep-wake disturbances.

Problem/Importance of Sleep• Active behavioral state– Regulation of metabolism– Hormone production– Immune function– Memory consolidation and learning

• Restorative

Sleep-Wake Disturbances

Alterations in nighttime sleep that result in impaired daytime function (sleepiness) need to be distinguished from primary sleep disorders that are medical diagnoses.

Incidence of Sleep-Wake Disturbances in Persons With Cancer

• Occur in up to 75% of cancer patients• Contributing factors– Demographic factors– Lifestyle and environmental factors– Disease-related factors– Treatment-related factors

• Associated with other symptoms– Pain– Fatigue– Depression

Nine Parameters for Sleep Assessment• Total sleep time• Sleep latency• Number of awakenings• Wake after sleep onset• Daytime napping• Daytime sleepiness• Quality of perceived sleep• Circadian rhythm• Sleep efficiency

Clinical Assessment of Sleep• All patients should be screened for sleep-wake

disturbances.• Examples of clinical screening tools– Clinical Sleep Assessment for Adults– ‘BEARS’

• B = bedtime problems• E = excessive daytime sleepiness• A = awakenings• R = regularity of sleep• S = sleep-disordered breathing

Evidence-Based Interventions• Likely to be effective– Cognitive behavioral therapy

• Stimulus control, sleep restriction, and sleep hygiene

• Weigh benefits and harmful effects– Pharmacologic agents

• Effectiveness is not established– Complementary therapies– Education– Exercise

References

American Academy of Sleep Medicine. (2005). International classification of sleep disorders: Diagnostic and coding manual (2nd ed.). Westchester, IL: Author.

Berger, A.M., Parker, K.P., Young-McCaughan, S., Mallory, G.A., Barsevick, A.M., & Hall, M. (2005). Sleep/wake disturbances in people with cancer and their caregivers: State of the science. Oncology Nursing Forum, 32(6), E98-E126. doi: 10.1188/05.ONF.E98-E126

Carskadon, M.A., & Dement, W.C. (2005). Normal human sleep: An overview. In M.H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine (4th ed., pp. 60-619). Philadelphia: Elsevier Saunders.

Erickson, J.M., & Berger, A.M. (2010). Sleep-wake disturbances. In C.G. Brown (Ed.), A guide to oncology symptom management (pp. 473-495). Pittsburgh: Oncology Nursing Society.

Lee, K., Cho, M., Miaskowski, C., & Dodd, M. (2004). Impaired sleep and rhythms in persons with cancer. Sleep Medicine, 8, 199-212. doi: 10.1016/j.smrv.2003.10.001

Lee, K.A., & Ward, T.M. (2005). Critical components of a sleep assessment for clinical practice settings. Issues in Mental Health Nursing, 26(7), 739-750.

Owen, J.A., & Dalzell, V. (2005). Use of the ‘BEARS’ sleep screening tool in a pediatric residents’ continuity clinic: A pilot study. Sleep Medicine, 6(1), 63-69.

Page, M.S., Berger, A.M., & Johnson, L.B. (2006). Putting evidence into practice: Evidence-based interventions for sleep-wake disturbances. Clinical Journal of Oncology Nursing, 10(6), 753-767. doi: 10.1188/06.CJON.753-767