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Article

Sleep–Wake Disturbances: Common Side Effect

Suzanne M. Mahon
Ellen Carr
CJON 2021, 25(6), 33 DOI: 10.1188/21.CJON.S2.33

Sleep–wake disturbances are defined as ongoing issues with sleep or daytime sleepiness (e.g., circadian rhythm disorder, hypersomnia, insomnia, narcolepsy, sleep apnea). Sleep–wake disturbances are estimated to occur in 35%–75% of patients with cancer.

For sleep–wake disturbances, standards of care are based on established evidence-based practice.

Definition

•  Sleep–wake disturbances are defined as ongoing issues with sleep or daytime sleepiness (e.g., circadian rhythm disorder, hypersomnia, insomnia, narcolepsy, sleep apnea).

Incidence

•  Sleep–wake disturbances are estimated to occur in 35%–75% of patients with cancer.

Assessment Tools and Recommended Intervals

•  Screening should include health history and physical examination. Further evaluation can include assessment for distress, hot flashes, pain, and fatigue, as well as laboratory evaluation. Patients can also complete a sleep diary.

Prevention Measures

•  Recommend the following principles of good sleep hygiene:

•  Be consistent. Go to bed at the same time each night and get up at the same time each morning, including weekends.

•  Make sure the bedroom is quiet, dark, relaxing, and at a comfortable temperature.

•  Remove electronic devices, such as televisions, computers, and smartphones, from the bedroom.

•  Avoid large meals, caffeine, and alcohol before bedtime.

•  Get exercise. Being physically active during the day can help an individual fall asleep more easily at night.

Evidence-Based Interventions and Management

•  Discuss sleep medications and adjustments of medications.

•  Consider cognitive behavioral therapy.

•  Suggest exercise.

•  Refer to sleep experts.

Agents and Interventions to Avoid

•  Quick fixes, such as over-the-counter agents

•  Strategies based on incorrect targets, such as not treating pain, anxiety, or depression

Evidence-Based Resources for Providers

•  NCCN Clinical Practice Guidelines in Oncology: Survivorship (v.3.2021) (www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf)

•  Oncology Nursing Society Putting Evidence Into Practice: Sleep–wake disturbances (www.ons.org/pep/sleep-wake-disturbances)

Evidence-Based Resources for Patients and Family

•  NCCN Guidelines for Patients: Survivorship Care for Cancer-Related Late and Long-Term Effects (www.nccn.org/patients/guidelines/content/PDF/survivorship-crl-patient.pdf)

About the Author(s)

Suzanne M. Mahon, DNS, RN, AOCN®, AGN-BC, FAAN, is a professor in the Department of Internal Medicine in the Division of Hematology/Oncology and in the Trudy Busch Valentine School of Nursing at Saint Louis University in Missouri and Ellen Carr, PhD, RN, AOCN®, is the editor of the Clinical Journal of Oncology Nursing at the Oncology Nursing Society in Pittsburgh, PA. The authors take full responsibility for this content. The article has been reviewed by independent peer reviewers to ensure that it is objective and free from bias. Mahon can be reached at suzanne.mahon@health.slu.edu, with copy to CJONEditor@ons.org. (Submitted June 2021. Accepted August 26, 2021.)

 

References 

National Comprehensive Cancer Network. (2020). NCCN guidelines for patients: Survivorship care for cancer-related late and long-term effects. https://www.nccn.org/patients/guidelines/content/PDF/survivorship-crl-pa...

Oncology Nursing Society. (2019). Putting Evidence Into Practice: Sleep–wake disturbances. https://www.ons.org/pep/sleep-wake-disturbances

Sheikh-Wu, S., Downs, C., & Anglade, D. (2020). Interventions for managing a symptom cluster of pain, fatigue, and sleep disturbances during cancer survivorship: A systematic review. Oncology Nursing Forum, 47(4), E107–E119 https://doi.org/10.1188/20.ONF.E107-E119