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Sleep-Wake Disturbances

Sleep-Wake Disturbances. Objectives. The learner will be able to: Name the parameters for effective assessment of sleep habits. Discuss evidence-based interventions likely to be effective for sleep-wake disturbances. Problem/Importance of Sleep. Active behavioral state

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Sleep-Wake Disturbances

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  1. Sleep-Wake Disturbances

  2. Objectives The learner will be able to: • Name the parameters for effective assessment of sleep habits. • Discuss evidence-based interventions likely to be effective for sleep-wake disturbances.

  3. Problem/Importance of Sleep • Active behavioral state • Regulation of metabolism • Hormone production • Immune function • Memory consolidation and learning • Restorative

  4. Sleep-Wake Disturbances Alterations in nighttime sleep that result in impaired daytime function (sleepiness) need to be distinguished from primary sleep disorders that are medical diagnoses.

  5. Incidence of Sleep-Wake Disturbances in Persons With Cancer • Occur in up to 75% of cancer patients • Contributing factors • Demographic factors • Lifestyle and environmental factors • Disease-related factors • Treatment-related factors • Associated with other symptoms • Pain • Fatigue • Depression

  6. Nine Parameters for Sleep Assessment • Total sleep time • Sleep latency • Number of awakenings • Wake after sleep onset • Daytime napping • Daytime sleepiness • Quality of perceived sleep • Circadian rhythm • Sleep efficiency

  7. Clinical Assessment of Sleep • All patients should be screened for sleep-wake disturbances. • Examples of clinical screening tools • Clinical Sleep Assessment for Adults • ‘BEARS’ • B = bedtime problems • E = excessive daytime sleepiness • A = awakenings • R = regularity of sleep • S = sleep-disordered breathing

  8. Evidence-Based Interventions • Likely to be effective • Cognitive behavioral therapy • Stimulus control, sleep restriction, and sleep hygiene • Weigh benefits and harmful effects • Pharmacologic agents • Effectiveness is not established • Complementary therapies • Education • Exercise

  9. References American Academy of Sleep Medicine. (2005). International classification of sleep disorders: Diagnostic and coding manual (2nd ed.). Westchester, IL: Author. Berger, A.M., Parker, K.P., Young-McCaughan, S., Mallory, G.A., Barsevick, A.M., & Hall, M. (2005). Sleep/wake disturbances in people with cancer and their caregivers: State of the science. Oncology Nursing Forum, 32(6), E98-E126. doi: 10.1188/05.ONF.E98-E126 Carskadon, M.A., & Dement, W.C. (2005). Normal human sleep: An overview. In M.H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine (4th ed., pp. 60-619). Philadelphia: Elsevier Saunders. Erickson, J.M., & Berger, A.M. (2010). Sleep-wake disturbances. In C.G. Brown (Ed.), A guide to oncology symptom management (pp. 473-495). Pittsburgh: Oncology Nursing Society. Lee, K., Cho, M., Miaskowski, C., & Dodd, M. (2004). Impaired sleep and rhythms in persons with cancer. Sleep Medicine, 8, 199-212. doi: 10.1016/j.smrv.2003.10.001 Lee, K.A., & Ward, T.M. (2005). Critical components of a sleep assessment for clinical practice settings. Issues in Mental Health Nursing, 26(7), 739-750. Owen, J.A., & Dalzell, V. (2005). Use of the ‘BEARS’ sleep screening tool in a pediatric residents’ continuity clinic: A pilot study. Sleep Medicine, 6(1), 63-69. Page, M.S., Berger, A.M., & Johnson, L.B. (2006). Putting evidence into practice: Evidence-based interventions for sleep-wake disturbances. Clinical Journal of Oncology Nursing, 10(6), 753-767. doi: 10.1188/06.CJON.753-767

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