Skip to content

Cancer Health Center

Font Size

Sleep Disorders (PDQ®): Supportive care - Health Professional Information [NCI] - Special Considerations

The Patient With Pain

Since enhanced pain control improves sleep, appropriate analgesics or nonpharmacologic pain management should be administered before introducing sleep medications. Tricyclic antidepressants can be particularly useful for the treatment of insomnia in patients with neuropathic pain and depression. Patients on high-dose opioids for pain may be at increased risk for the development of delirium and organic mental disorders. Such patients may benefit from the use of low-dose neuroleptics as sleep agents (e.g., haloperidol 0.5–1.0 mg).

Recommended Related to Cancer

Treatment Option Overview

There are different types of treatment for patients with gastrointestinal stromal tumors. Different types of treatments are available for patients with gastrointestinal stromal tumors (GISTs). Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment...

Read the Treatment Option Overview article > >

The Older Patient

Older patients frequently have insomnia due to age-related changes in sleep. The sleep cycle in this population is characterized by lighter sleep, more frequent awakenings, and less total sleep time. Anxiety, depression, loss of social support, and a diagnosis of cancer are contributory factors in sleep disturbances in older patients.[1]

Sleep problems in older adults are so common that nearly half of all hypnotic prescriptions written are for persons older than 65 years. Although normal aging affects sleep, the clinician should evaluate the many factors that cause insomnia, such as medical illness, psychiatric illness, dementia, alcohol and/or polypharmacy, restless legs syndrome, periodic leg movements, and sleep apnea syndrome. Nonpharmacologic treatment of sleep disorders is the preferred initial management, with the use of medication when indicated and referral to a sleep disorder center when specialized care is necessary.[2]

Providing a regular schedule of meals, discouraging daytime naps, and encouraging physical activity may improve sleep. Hypnotic prescriptions for older patients must be adjusted for variations in metabolism, increased fat stores, and increased sensitivity. Dosages should be reduced by 30% to 50%. Problems associated with drug accumulation (especially flurazepam) must be weighed against the risks of more severe withdrawal or rebound effects associated with short-acting benzodiazepines. An alternate drug for older patients is chloral hydrate.[1]

Somnolence Syndrome in Children

Cranial irradiation and intrathecal methotrexate are used to prevent the development of central nervous system leukemia in children with acute lymphocytic leukemia. Somnolence syndrome (SS) is a complication of cranial irradiation occurring in 30% to 50% of patients who receive more than 18 Gy at daily dose fractions of 1.5 Gy to 2 Gy. The syndrome may appear 4 to 6 weeks posttherapy. SS is characterized by mild drowsiness to moderate lethargy and, occasionally, low-grade fever. The pathophysiology is unknown, but electroencephalogram and cerebral spinal fluid abnormalities are detectable in affected children. Although supportive care measures cannot prevent the occurrence of SS, acknowledgment of the existence of this problem may prevent or minimize anxieties for children and parents when symptoms of SS appear.

    1|2
    Next Article:

    Today on WebMD

    Colorectal cancer cells
    A common one in both men and women.
    Lung cancer xray
    See it in pictures, plus read the facts.
     
    sauteed cherry tomatoes
    Fight cancer one plate at a time.
    Ovarian cancer illustration
    Do you know the symptoms?
     
    Jennifer Goodman Linn self-portrait
    Blog
    what is your cancer risk
    HEALTH CHECK
     
    colorectal cancer treatment advances
    Video
    breast cancer overview slideshow
    SLIDESHOW
     
    prostate cancer overview
    SLIDESHOW
    lung cancer overview slideshow
    SLIDESHOW
     
    ovarian cancer overview slideshow
    SLIDESHOW
    Actor Michael Douglas
    Article