How to Get a Good Night's Sleep

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Eric Zhou, PhD, clinical fellow at Dana-Farber Cancer Institute and research fellow at Harvard Medical School, provides tips on how cancer survivors can fight insomnia and get a good night's sleep. …

Eric Zhou, PhD, clinical fellow at Dana-Farber Cancer Institute and research fellow at Harvard Medical School, provides tips on how cancer survivors can fight insomnia and get a good night's sleep. This presentation was originally given on Feb. 5, 2014 for Dana-Farber's Blum Family Resource Center. | http://www.dana-farber.org

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  • 1. The Development of Insomnia Eric Zhou, Ph.D. Clinical Fellow, Dana-Farber Cancer Institute Research Fellow, Harvard Medical School
  • 2. How Much Sleep Do You Need? There is a “short sleep phenotype” in less than 3% of the population where approximately 6 hours of sleep per night is sufficient. Most (the unlucky 97% of us) healthy adults need approximately 7-9 hours per night to function at their best. National Sleep Foundation; He et al. (2009) - Science
  • 3. Problems with Sleep: A Cancer Context Potential impact of hospital stay on sleep: 1. 2. 3. 4. 5. Pain / illness. Noise. Light. Medication side effects. Patient care activities (e.g., vital signs, being given medication, diagnostic testing). Weinhouse & Schwab (2006) – Sleep
  • 4. Medications that Affect Sleep ADHD?  Mixed amphetamines (e.g., Adderall) High blood pressure?  Beta-blockers Asthma?  Albuterol Allergies?  Pseudoephedrine (e.g., Benadryl, Sudafed) Depression?  Anti-depressants(e.g., Prozac)
  • 5. Diagnostic Criteria: Insomnia >1 month Difficulty maintaining sleep OR Difficulty initiating sleep OR >30 minutes, 3x/week AND Causes significant distress or impairment in functioning Nonrestorative sleep
  • 6. How Common are Insomnia Symptoms?
  • 7. How Long Have You Had Problems With Sleep?
  • 8. Insomnia: What It Is Not  Sleep apnea  Advanced/Delayed sleep phase syndrome  Narcolepsy  Night terrors  Periodic limb movement disorder  Restless legs syndrome  Sleepwalking  Nocturia
  • 9. Insomnia: 3 P’s of Development Pre-disposing factors: • • • • • Female Older age Hyper-arousability Familial history of insomnia Psychiatric disorder
  • 10. Insomnia: 3 P’s of Development Precipitating factors: • • • • • Cancer diagnosis Hospitalization Chemotherapy Radiation therapy Surgery • • • • • Hormone therapy Medications Menopause Pain Life events (e.g., having children, divorce/separation)
  • 11. Insomnia: 3 P’s of Development Perpetuating factors: • • • • Excessive time in bed Irregular sleep wake schedule Daytime napping Sleep interfering activities in bedroom • • • Unrealistic sleep expectations Inaccurate appraisal of sleep difficulties and fatigue Misconception about cause of insomnia
  • 12. Health Consequences of Poor Sleep “Short sleep duration is associated with lower natural killer cell activity.”
  • 13. Health Consequences of Poor Sleep “Cross-sectional studies from around the world show a consistent increased risk of obesity amongst short sleepers.”
  • 14. Health Consequences of Poor Sleep “Chronic restriction of sleep to 6 hours or less per night produced cognitive performance deficits equivalent to 2 nights of total sleep deprivation.”
  • 15. Health Consequences of Poor Sleep “Non-depressed subjects with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties.”
  • 16. Health Consequences of Poor Sleep There are significant “associations between sleep disturbance … and substance use disorders.”
  • 17. Treatment: Medication Medications “are effective treatments in the management of chronic insomnia, although they pose a risk of harm.” Adverse events: • Headache, drowsiness, dizziness, nausea, decreased cognitive function. • Medication tolerance, dependence, and abuse. • Rebound insomnia. Buscemi et al. (2007) – Journal of General Internal Medicine
  • 18. Treatment: Cognitive-Behavioral
  • 19. Does It Work?
  • 20. Cognitive-Behavioral Treatment for Insomnia
  • 21. Cognitive-Behavioral Treatment for Insomnia JAMA “Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did relaxation therapy.”
  • 22. Cognitive-Behavioral Treatment for Insomnia Archives of Internal Medicine “These findings suggest that [patients] with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia.”
  • 23. Cognitive-Behavioral Treatment for Insomnia American Journal of Psychiatry “Practitioners should strongly consider referring patients for behavior therapy.”
  • 24. Questions? “I love sleep. My life has the tendency to fall apart when I’m awake.” - Ernest Hemingway If you believe you may be suffering from insomnia, please discuss this issue with your medical providers. More information on cancer survivorship and cognitive-behavioral treatment for insomnia can be found on the Dana-Farber Cancer Institute Survivorship Program website or by contacting the program at DFCI_AdultSurvivors@dfci.harvard.edu or 617-632-4523.