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

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.