The EPECO TM Education in Palliative and Endoflife

The EPEC-O TM Education in Palliative and End-of-life Care - Oncology Project The EPEC-O Curriculum is produced by the EPECTM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.

E P E C O EPEC – Oncology Education in Palliative and End-of-life Care – Oncology Module 3 l Symptoms – Insomnia

Insomnia. . . l Definition: inadequate or poor quality sleep Difficulty falling asleep Difficulty maintaining sleep Early morning awakening Non-refreshing sleep

. . . Insomnia Epidemiology l Impact: tiredness or fatigue, anergia, poor concentration, or irritability l Up to 63 % of cancer patients l Restful sleep can often be restored

Key points 1. Pathophysiology 2. Assessment 3. Management

Pathophysiology l Multiple possible cause l Prior sleep disorder l Uncontrolled symptoms Pain, pruritus Depression, anxiety l Medications

Assessment l Determine course and pattern Lifelong pattern or recent? Difficulty falling asleep? Early awakening? Spouse observations? l Other unrelieved symptoms?

Management. . . l Regular sleep schedule, avoid staying in bed l Avoid caffeine, assess alcohol intake l Cognitive / physical stimulation l Avoid overstimulation l Control pain during the night l Relaxation, imagery

. . . Management l Antihistamines l Benzodiazepines l Neuroleptics l Sedating antidepressant (trazodone) l Careful titration l Attention to adverse effects

E P E C O Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience