The Development of Insomnia

Eric Zhou, Ph.D.
Clinical Fellow, Dana-Farber Cancer Institute
Research Fellow, Harvard Medic...
How Much Sleep Do You Need?

There is a “short sleep phenotype” in less than 3% of the population where
approximately 6 ho...
Problems with Sleep: A Cancer Context

Potential impact of hospital stay on sleep:
1.
2.
3.
4.
5.

Pain / illness.
Noise.
...
Medications that Affect Sleep
ADHD?


Mixed amphetamines (e.g., Adderall)

High blood pressure?


Beta-blockers

Asthma?...
Diagnostic Criteria: Insomnia
>1 month
Difficulty
maintaining
sleep

OR

Difficulty
initiating
sleep

OR

>30 minutes, 3x/...
How Common are Insomnia Symptoms?
How Long Have You Had Problems With Sleep?
Insomnia: What It Is Not
 Sleep apnea
 Advanced/Delayed sleep phase
syndrome
 Narcolepsy
 Night terrors
 Periodic lim...
Insomnia: 3 P’s of Development

Pre-disposing factors:
•
•
•
•
•

Female
Older age
Hyper-arousability
Familial history of ...
Insomnia: 3 P’s of Development

Precipitating factors:
•
•
•
•
•

Cancer diagnosis
Hospitalization
Chemotherapy
Radiation ...
Insomnia: 3 P’s of Development

Perpetuating factors:
•
•
•
•

Excessive time in bed
Irregular sleep wake schedule
Daytime...
Health Consequences of Poor Sleep
“Short sleep duration is associated with lower natural
killer cell activity.”
Health Consequences of Poor Sleep
“Cross-sectional studies from around the world
show a consistent increased risk of obesi...
Health Consequences of Poor Sleep

“Chronic restriction of sleep to 6 hours or less per night
produced cognitive performan...
Health Consequences of Poor Sleep

“Non-depressed subjects with insomnia have a twofold
risk to develop depression, compar...
Health Consequences of Poor Sleep

There are significant “associations between sleep
disturbance … and substance use disor...
Treatment: Medication

Medications “are effective treatments in the management of chronic
insomnia, although they pose a r...
Treatment: Cognitive-Behavioral
Does It Work?
Cognitive-Behavioral Treatment for Insomnia
Cognitive-Behavioral Treatment for Insomnia

JAMA
“Cognitive behavioral therapy
produced larger improvements across
the ma...
Cognitive-Behavioral Treatment for Insomnia

Archives of Internal Medicine
“These findings suggest that
[patients] with sl...
Cognitive-Behavioral Treatment for Insomnia

American Journal of Psychiatry
“Practitioners should strongly
consider referr...
Questions?
“I love sleep. My life has the tendency to
fall apart when I’m awake.”
- Ernest Hemingway

If you believe you m...
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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. 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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Transcript of "How to Get a Good Night's Sleep"

  1. 1. The Development of Insomnia Eric Zhou, Ph.D. Clinical Fellow, Dana-Farber Cancer Institute Research Fellow, Harvard Medical School
  2. 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. 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. 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. 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. 6. How Common are Insomnia Symptoms?
  7. 7. How Long Have You Had Problems With Sleep?
  8. 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. 9. Insomnia: 3 P’s of Development Pre-disposing factors: • • • • • Female Older age Hyper-arousability Familial history of insomnia Psychiatric disorder
  10. 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. 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. 12. Health Consequences of Poor Sleep “Short sleep duration is associated with lower natural killer cell activity.”
  13. 13. Health Consequences of Poor Sleep “Cross-sectional studies from around the world show a consistent increased risk of obesity amongst short sleepers.”
  14. 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. 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. 16. Health Consequences of Poor Sleep There are significant “associations between sleep disturbance … and substance use disorders.”
  17. 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. 18. Treatment: Cognitive-Behavioral
  19. 19. Does It Work?
  20. 20. Cognitive-Behavioral Treatment for Insomnia
  21. 21. Cognitive-Behavioral Treatment for Insomnia JAMA “Cognitive behavioral therapy produced larger improvements across the majority of outcome measures than did relaxation therapy.”
  22. 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. 23. Cognitive-Behavioral Treatment for Insomnia American Journal of Psychiatry “Practitioners should strongly consider referring patients for behavior therapy.”
  24. 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.

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