Overview of insomnia in palliative care
- Jeremy M Hirst, MD, PhD, FAPM, FAPA
Jeremy M Hirst, MD, PhD, FAPM, FAPA
- Professor of Psychiatry and Behavioral Neurosciences
- Associate Director, Palliative Care Psychiatry
- University of UC San Diego Health
- Director of Psychiatry & Psychosocial Services; Patient & Family Support Services
- University of California San Diego, Moores Cancer Center
- Scott A Irwin, MD, PhD
Scott A Irwin, MD, PhD
- Associate Professor of Psychiatry
- Director, Supportive Care Services
- Samuel Oschin Comprehensive Cancer Institute
- Cedars-Sinai Medical Center
- Section Editors
- Susan D Block, MD
Susan D Block, MD
- Editor-in-Chief — Palliative Care
- Section Editor — Psychosocial Issues
- Professor of Psychiatry
- Harvard Medical School
- Ruth Benca, MD, PhD
Ruth Benca, MD, PhD
- Section Editor — Insomnia
- Professor and Chair, Department of Psychiatry and Human Behavior
- University of California, Irvine
Insomnia is a condition of impaired sleep, with difficulties in initiating or maintaining sleep, and/or experiencing sleep as nonrestorative and unrefreshing, despite having the appropriate opportunity for sleep to occur . It is a very common medical complaint in primary care patients, and the same is true for patients in palliative care, which is illustrated by studies that report that the prevalence of insomnia is over 60 percent [2-5]. Insomnia is associated with multiple consequences that have a negative impact on quality of life and the ability to perform normal functions. In addition, insomnia is a strong predictor of the development of psychiatric disorders. (See "Overview of insomnia in adults", section on 'Consequences'.)
In the context of palliative care, insomnia often coexists with other symptoms, such as pain, depression, and anxiety, and the presence of one often exacerbates the other, contributing to a decrease in quality of life [5,6]. Patients receiving palliative care may vary in terms of their functional status and where they are in their personal trajectory in a chronic illness. As a result, the approach and treatment to insomnia in these patients should be individualized. An overview and the general treatment approach to insomnia, as well as an overview of palliative care and the assessment of patients in palliative care, are discussed separately.
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- Associated factors
- TREATMENT APPROACH
- General principles
- - Symptom management
- - Addressing the environment
- - Lifestyle modifications
- - Promote physical comfort
- - Encourage healthy sleep-wake cycles
- - Minimize disruptions
- Behavioral therapy
- - Atypical antidepressants
- - Benzodiazepine receptor agonists
- - Sedating antidepressants
- - Selective melatonin receptor agonists
- - Benzodiazepines
- - Over-the-counter agents
- - Other agents
- Special populations
- - Older adult patients
- - Dementia
- IMPACT TO CAREGIVERS
- SUMMARY AND RECOMMENDATIONS