Assessment is the initial step in management strategies. Assessment data should include documentation of predisposing factors, sleep patterns, emotional status, exercise and activity levels, diet, symptoms, medications, and caregiver routines. The sections below outline recommendations for a sleep history and physical examination. Data can be retrieved from multiple sources: the patient's subjective report of sleep difficulty, objective observations of behavioral and physiologic manifestations of sleep disturbances, and reports from the patient's significant others regarding the patient's quality of sleep. Use of the Insomnia Severity Index is suggested to screen for insomnia in clinical settings.[3,4]
The diagnosis of insomnia is primarily based on a careful, detailed medical and psychiatric history. The American Academy of Sleep Medicine has produced guidelines for the use of polysomnography as an objective tool in evaluating insomnia. The routine polysomnogram includes the monitoring of electroencephalography, electro-oculography, electromyography, effort of breathing and air flow, oxygen saturation, electrocardiography, and body position. Polysomnography is the major diagnostic tool in sleep disorders and is indicated in the evaluation of suspected sleep-related breathing disorders and periodic limb movement disorder, and when the cause of insomnia is uncertain or when behavioral or pharmacologic therapy is unsuccessful.[Level of evidence: IV]
Family caregivers may be spouses, partners, children, relatives, or friends who help the patient with activities of daily living and health care needs at home.
Many cancer patients today receive part of their care at home. Hospital stays are shorter than they used to be, and there are now more treatments that don't need an overnight hospital stay or can be given outside of the hospital. People with cancer are living longer and many patients want to be cared for at home as much as possible. This...
Sleep disturbance has been shown to change throughout the cancer trajectory, which supports the need to assess sleep throughout the patient's cancer experience. One descriptive study [Level of evidence: II] involving 398 women with breast cancer used the General Sleep Disturbance Scale (GSDS) to identify three different sleep trajectories when self-reported sleep was evaluated beginning before surgery and continuing for 6 months. One group (55% of the sample) had a high level of sleep disturbance throughout the study, defined as scores on the GSDS of around 58 to 60 at all data points. A second group (40% of the sample) was considered to have a low level of sleep disturbance throughout, defined as scores on the GSDS in the low 30s at each data point. The final group (5% of the sample) started out high with scores around 62, but their scores decreased to below 30 over the first 4 months and remained there through month 6. Characteristics of women in the group who were identified as having a more severe sleep disorder were significantly younger, had more comorbidities, had a lower performance status, and experienced hot flashes.