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Treatment of Sleep Disorders

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Psychopharmacology in Oncology and Palliative Care

Abstract

Sleep disturbances have a negative impact over mood, cognition, performance, and well-being. Quality of sleep and sleep physiology can be studied using several methods. There are also many different classifications for sleep disorders (eg: in the DSM-5, the diagnosis of primary insomnia has been renamed insomnia disorder, in order to avoid the differentiation of primary and secondary insomnia). The impact and nature of sleep problems in the cancer population are presently a hot research topic. The most prevalent sleep problems in the Oncology setting are Insomnia (the most common sleep complaint), Hypersomnolence Disorder (HD), and Restless Legs Syndrome. Breathing-related sleep Disorder (Obstructive Sleep Apnea) is common in head and neck cancer patients. Parasomnias and Narcolepsy are occasionally referred to. In this work, the term insomnia will refer to sleep problems (difficulty falling or staying asleep, poor sleep quality, and/or short sleep duration) and insomnia syndrome (the cluster of several and severe sleep), with or without full criteria for insomnia disorder. Despite broad discrepancies in the literature, the most consistent studies have figured a general prevalence of insomnia among cancer patients between 25.9 and 57.9.

Insomnia is frequently secondary to multiple and synergistic factors: etiological factors may be directly related to the tumor’s biology or symptoms, oncologic treatments, or lifestyle changes. The path between pain and sleep in cancer patients is bidirectional, as sleep loss also leads to increased pain. Insomnia, depression, and fatigue are often present as a symptom cluster that should be treated overall.

Chemotherapy deregulates immune function, enhances inflammatory response, and interferes with circadian rhythms; when chronic, these effects are predictors of acute and long-term poor quality of sleep either in cancer patients or survivors. Other treatments like synthetic glucocorticoids may disrupt diurnal cortisol rhythms and alter the circadian component of sleep. Considering the medical burden of cancer patients, one should minimize pharmacotherapy only focused on poor sleep and try to scope the health problems altogether. Recent studies highlight the importance of non-pharmacologic approaches like sleep hygiene measures and behavioral interventions. The newer hypnotics are safe, have few side effects, and may help within other cancer symptoms (pain, pruritus, nausea, anorexia, hot flashes, fatigue, and memory decline).

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Correspondence to Lúcia Monteiro .

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Monteiro, L., Ribeiro, A., Xavier, S. (2014). Treatment of Sleep Disorders. In: Grassi, L., Riba, M. (eds) Psychopharmacology in Oncology and Palliative Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40134-3_14

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