title: Long-term and short-term effects of insomnia in cancer and effective interventions.
abstract: Sleep disorders and insomnia are more prevalent in patients with cancer than in the normal population. Sleep disorders consist of delayed sleep latency, waking episodes after sleep onset, unrefreshing sleep, reduced quality of sleep, and reduced sleep efficiency. Sleep disorders cluster with pain, fatigue, depression, anxiety, and vasomotor symptoms, depending on stage of disease, treatment, and comorbidities. Premorbid sleep problems and shift work have been associated with a higher prevalence of cancer; in fact, shift work has been labeled a carcinogen. Treatment for insomnia includes cognitive behavioral therapy with sleep hygiene, bright-light therapy, exercise, yoga, melatonin, and hypnotic medications. Unfortunately, there are few randomized trials in cancer-related sleep disorders such that most recommendations particularly for hypnotics are based on treatment for primary insomnia. In this article, insomnia is reviewed as a predisposing factor to cancer, prior to and during treatment, in cancer survivorship and in advanced cancer. Recommendations for treatment are based on low-quality evidence but are also reviewed.
authors.affiliation: From the *Cleveland Clinic Lerner School of Medicine, Case Western Reserve University; and †Palliative Medicine and Supportive Oncology Services, Division of Solid Tumor, Taussig Cancer Institute, and ‡Neurological Institute, Department of Psychiatry and Psychology, The Cleveland Clinic, Cleveland, OH.
authors.forename: Mellar P
authors.initials: MP
authors.lastname: Davis
authors.forename: Harold W
authors.initials: HW
authors.lastname: Goforth
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006272:Health Facility Environment; D006801:Humans; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000209:etiology / Q000473:pathology; D011788:Quality of Life; D012306:Risk; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D017741:Survivors; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents