ES15.03 Managing Sleep Difficulties and Cancer

Abstract

This paper discusses evidence-based interventions for managing sleep difficulties in people with cancer. Insomnia is a common sleep problem in people with cancer. Insomnia refers to the difficulty of falling asleep, staying asleep and early morning awakenings. It causes distress or impairment in important areas of functioning, such as relationships and employment. It is estimated that between 30-60% of cancer survivors experience significant sleep disturbances that can persist for up to five years post treatment. Aside from greatly impacting on quality of life, poor sleep is associated with anxiety, depression, concentration and memory difficulties, higher rates of pain, increased use of sedatives and poorer work performance [1-3]. People with lung cancer are at an increased risk of experiencing sleep difficulties because of their generally older age, compromised respiratory function, increased disease burden and the impact of treatments [4]. Sleep difficulties also have economic and social impacts on the broader community, due to increased health system costs, productivity losses and wellbeing costs [5]. Cognitive Behaviour Therapy (CBT) is considered to be the first-line treatment for insomnia [6]. CBT targets dysfunctional attitudes, beliefs and habits that interfere with sleep. CBT for insomnia commences with a comprehensive assessment about the nature and duration of sleep complaints, the impact on daytime functioning, compensatory behaviours, the person's beliefs about sleep and any other biopsychosocial factors that might be impacting on sleep. Common screening tools used to assess the impact of sleep difficulties include the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Insomnia Rating Scale (PIRS). These tools are self-reporting and easy to administer. CBT for insomnia is a multi-component intervention and includes psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, cognitive strategies and relapse prevention strategies. It is usually delivered between four to eight session modules. CBT is effective in improving sleep disturbance, fatigue, pain and quality of life. The effects of CBT are durable, with benefits lasting up to three years post-treatment [7, 8]. CBT is suitable for most adults with insomnia, however, it works best with people who are motivated and have the cognitive capacity to learn and adopt CBT strategies. CBT can be effectively provided in group settings, individually, via telephone, video or online methods. Over three quarters of patients achieve remission or significant reduction of sleep disturbance after CBT treatment [9]. CBT has been found to be more effective than mindfulness, massage, exercise and acupuncture intervention. CBT has been found to be as effective as pharmacological intervention in the short-term and more beneficial than medication in the longer term. CBT is also more cost-effective than pharmacological or non-treatment of sleep difficulties [10]. Despite the benefits of CBT, access for people with cancer is limited due to lack specialist availability, cost and awareness of the benefit of CBT. To improve access to evidence-based interventions for people with cancer, stepped-care approaches (where face-to-face CBT is reserved for the most complex cases while less burdensome and less costly self-managed interventions are available for less complex cases) could help translate evidence into clinical practice. Sleep difficulties are highly prevalent in people with cancer, however, access to evidenced-based interventions are limited. Embedding evidence based-screening and CBT into routine care is essential to improving quality of life and care for people with cancer. 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