The mechanisms and causes of insomnia in palliative care

Dr. Ana-Maria Tebeică
Medical Center Gral, Ploieşti, România, Oncologie medicală


The prevalence of insomnia among patients with cancer is higher than in general population (up to 50% versus 4-22%); its prevalence among patients with advanced cancer has been estimated between 45% and 95%. Nevertheless, insomnia has received little attention from the oncology community compared with other symptoms such as pain.

Other factors which could influence insomnia in cancer population are age, performance status, dyspnoea, incontinence, fever, sweating, nausea, vomiting, itch, pain, drug or tobacco abstinence, nycturia, cough and restless-legs, female gender and non-white race, excessive consumption of coffee and/or alcohol, chronic kidney disease, cytokines, metabolic disorders, cortisol awaking response, environmental factors for example interruptions by the nurse, noise coming from another patient, sleep during the day.

As long as we don’t have a gold-standard definition for normal sleep, so does insomnia becomes hard to define or to evaluate.

In one study by Davidson et al, 89% of the patients reported that sleep deprivation is affecting their clinical status, 76% declared that it’s affecting their coping mechanisms with stress, for 72% it affected their emotional status and for 64% their ability to focus.

Keywords: insomnia, sleep disturbances, oncology, palliative care, symptom

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