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Published byDomenic Jordan Modified over 9 years ago
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The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation. Education in Palliative and End-of-life Care - Oncology The Project EPEC-O TM
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EPECEPECOOEPECEPECOOO EPECEPECOOEPECEPECOOO Module 3l Symptoms – Insomnia Module 3l Symptoms – Insomnia EPEC – Oncology Education in Palliative and End-of-life Care – Oncology
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Insomnia... l Definition: inadequate or poor quality sleep Difficulty falling asleep Difficulty maintaining sleep Early morning awakening Non-refreshing sleep l Definition: inadequate or poor quality sleep Difficulty falling asleep Difficulty maintaining sleep Early morning awakening Non-refreshing sleep
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... 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 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
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Key points 1.Pathophysiology 2.Assessment 3.Management 1.Pathophysiology 2.Assessment 3.Management
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Pathophysiology l Multiple possible cause l Prior sleep disorder l Uncontrolled symptoms Pain, pruritus Depression, anxiety l Medications l Multiple possible cause l Prior sleep disorder l Uncontrolled symptoms Pain, pruritus Depression, anxiety l Medications
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Assessment l Determine course and pattern Lifelong pattern or recent? Difficulty falling asleep? Early awakening? Spouse observations? l Other unrelieved symptoms? l Determine course and pattern Lifelong pattern or recent? Difficulty falling asleep? Early awakening? Spouse observations? l Other unrelieved symptoms?
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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 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
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... Management l Antihistamines l Benzodiazepines l Neuroleptics l Sedating antidepressant (trazodone) l Careful titration l Attention to adverse effects l Antihistamines l Benzodiazepines l Neuroleptics l Sedating antidepressant (trazodone) l Careful titration l Attention to adverse effects
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EPECEPECOOEPECEPECOOO EPECEPECOOEPECEPECOOO Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience
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