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Fighting Insomnia and Battling Lethargy: The Yin and Yang of Palliative Care

  • Palliative Medicine (A Jatoi, Section Editor)
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Abstract

There is an interdependent relationship between insomnia and fatigue in the medical literature, but both remain distinct entities. Insomnia entails problematic sleep initiation, maintenance, or restoration with an accompanying decrease in perceived daytime function. Lethargy is a symptom that has a wide differential diagnosis that heavily overlaps with cancer-related fatigue; however, insomnia may contribute to worsened fatigue and lethargy in cancer patients. Insomnia is a major risk factor for mood disturbances such as depression, which may also contribute to lethargy in this at-risk population. The pathophysiology of fatigue and insomnia is discussed in this review, including their differential diagnoses as well as the emerging understanding of the roles of neurotransmitters, branched-chain amino acids, and inflammatory cytokines. Treatment approaches for insomnia and fatigue are also discussed and reviewed, including the role of hypnotics, psychotropics, hormonal agents, and alternative therapies.

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Harold Goforth declares that he has no conflict of interest.

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  1. Cleveland Clinic Lerner School of Medicine Case Western Reserve University, Cleveland, USA

    Mellar P. Davis

  2. Clinical Fellowship Program, Cleveland, USA

    Mellar P. Davis

  3. Palliative Medicine and Supportive Oncology Services, Taussig Cancer Institute, Cleveland, USA

    Mellar P. Davis & Harold Goforth

  4. Cleveland Clinic, 9500 Euclid Avenue, R35, Cleveland, OH, 44195, USA

    Mellar P. Davis

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Davis, M.P., Goforth, H. Fighting Insomnia and Battling Lethargy: The Yin and Yang of Palliative Care. Curr Oncol Rep 16, 377 (2014). https://doi.org/10.1007/s11912-014-0377-1

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