Sleep disorders

Sleep disturbances represent frequent distressing symptoms in the palliative care setting. The more common disorders include insomnia, excessive daytime sleepiness, and circadian rhythm sleep disorders. The most prevalent sleep disorder, insomnia, includes difficulty initiating and/or maintaining sleep, waking up too early, and non-restorative or poor quality sleep. Primary sleep disturbances are thought to be a disorder of hyperarousal, while a hypothalamic-pituitary-adrenal axis dysfunction has also been confirmed. Secondary sleep disorders have been associated with a large number of potential causes, both physical and psychological. Sleep disturbances in palliative care can be due to either the advanced disease and/or its treatment. Chronic medication use, neurological or psychiatric disorders, as well as environmental factors, can also present contributing factors. This chapter discusses the diagnosis and treatment of sleep disturbances, both pharmacological and non-pharmacological, including cognitive behavioural therapy, the cornerstone of non-pharmacological interventions.