Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-27T13:26:40.606Z Has data issue: false hasContentIssue false
  • English
  • Français

A qualitative examination of the factors related to the development and maintenance of insomnia in cancer survivors

Published online by Cambridge University Press:  16 May 2018

Sheila N. Garland ,
Frances K. Barg ,
Brigid Cakouros ,
Philip Gehrman Open the ORCID record for Philip Gehrman [Opens in a new window] ,
Katherine N. DuHamel  and
Jun J. Mao
Sheila N. Garland*
Affiliation:
Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
Frances K. Barg
Affiliation:
Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Brigid Cakouros
Affiliation:
Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Philip Gehrman
Affiliation:
Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Katherine N. DuHamel
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
Jun J. Mao
Affiliation:
The Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
*
Author for correspondence: Sheila N. Garland, Departments of Psychology and Oncology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John's, Newfoundland, A1B 3X9, Canada. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Insomnia is underrecognized and inadequately managed, with close to 60% of cancer survivors experiencing insomnia at some point in the treatment trajectory. The objective of this study was to further understand predisposing, precipitating, and perpetuating factors in the development and maintenance of insomnia in cancer survivors.

Method

A heterogeneous sample of 63 patients who had completed active treatment was recruited. Participants were required to have a score >7 on the Insomnia Severity Index and meet the diagnostic criteria for insomnia disorder. Open-ended, semistructured interviews were conducted to elicit participants’ experiences with sleep problems. An a priori set of codes and a set of codes that emerged from the data were used to analyze the data.

Result

The mean age of the sample was 60.5 years, with 30% identifying as non-white and 59% reporting their sex as female. The cancer types represented were heterogeneous with the two most common being breast (30%) and prostate (21%). Participants described an inherited risk for insomnia, anxious temperament, and insufficient ability to relax as predisposing factors. Respondents were split as to whether they classified their cancer diagnosis as the precipitating factor for their insomnia. Participants reported several behaviors that are known to perpetuate problems with sleep including napping, using back-lit electronics before bed, and poor sleep hygiene. One of the most prominent themes identified was the use of sleeping medications. Participants reported that they were reluctant to take medication but felt that it was the only option to treat their insomnia and that it was encouraged by their doctors.

Significance of results

Insomnia is a prevalent, but highly treatable, disorder in cancer survivors. Patients and provider education is needed to change individual and organizational behaviors that contribute to the development and maintenance of insomnia and increase access to evidence-based nonpharmacological interventions.

Keywords

Insomnia disordercancerqualitative researchcognitive-behavioral therapy
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 2 , April 2019 , pp. 221 - 226
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5), 5th ed. Washington, DC: APA.Google Scholar
Berger, AM, Kuhn, BR, Farr, LA, et al. (2009) Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psycho-Oncology 18(6), 634–646.Google Scholar
Berger, AM, Matthews, EE, Kenkel, AM (2017) Management of sleep-wake disturbances comorbid with cancer. Oncology (Williston Park) 31(8):610–617.Google Scholar
Costantini, C, Ale-Ali, A, Helsten, T (2011) Sleep aid prescribing practices during neoadjuvant or adjuvant chemotherapy for breast cancer. Journal of Palliative Medicine 14(5), 563–566.Google Scholar
Curry, LA, Nembhard, IM, Bradley, EH (2009) Qualitative and mixed methods provide unique contributions to outcomes research. Circulation 119(10), 1442–1452.Google Scholar
Davidson, JR, Feldman-Stewart, D, Brennenstuhl, S, et al. (2007) How to provide insomnia interventions to people with cancer: Insights from patients. Psycho-Oncology 16(11), 1028–1038.Google Scholar
Drake, CL, Roth, T (2006) Predisposition in the evolution of insomnia: Evidence, potential mechanisms, and future directions. Sleep Medicine Clinics 1, 333–349.Google Scholar
Garland, SN, Gehrman, P, Barg, FK, et al. (2016) Choosing options for insomnia in cancer effectively (CHOICE): Design of a patient centered comparative effectiveness trial of acupuncture and cognitive behavior therapy for insomnia. Contemporary Clinical Trials 47, 349–355.Google Scholar
Garland, SN, Johnson, JA, Savard, J, et al. (2014). Sleeping well with cancer: A systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatric Disease and Treatment 10, 1113–1124.Google Scholar
Greenlee, H, Balneaves, LG, Carlson, LE, et al. ,. Society for Integrative Oncology. (2014) Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. Journal of the National Cancer Institute Monographs 2014(50), 346–358.Google Scholar
Irwin, MR (2013) Depression and insomnia in cancer: Prevalence, risk factors, and effects on cancer outcomes. Current Psychiatry Reports 15(11), 404.Google Scholar
Kyle, SD, Espie, CA, Morgan, K (2010) “…Not just a minor thing, it is something major, which stops you from functioning daily”: Quality of life and daytime functioning in insomnia. Behavioral Sleep Medicine 8(3), 123–140.Google Scholar
Lis, CG, Gupta, D, Grutsch, JF (2008) The relationship between insomnia and patient satisfaction with quality of life in cancer. Supportive Care in Cancer 16(3), 261–266.Google Scholar
Perlis, M, Shaw, PJ, Can, G, et al. (2011) Models of insomnia. In Principles and practice of sleep medicine, 5th ed. Kryger, MH, Roth, T, Dement, WC (eds.), pp. 850–865). St. Louis, MO: Elsevier.Google Scholar
Pilkington, S (2013) Causes and consequences of sleep deprivation in hospitalised patients. Nursing Standard (Royal College of Nursing (Great Britain) 27(49), 35–42.Google Scholar
Riemann, D, Perlis, ML (2009) The treatments of chronic insomnia: A review of benzodiazepine receptor agonists and psychological and behavioral therapies. Sleep Medicine Reviews 13(3), 205–214.Google Scholar
Ruel, S, Savard, J, Ivers, H (2015) Insomnia and self-reported infections in cancer patients: An 18-month longitudinal study. Health Psychology 34(10), 983–991.Google Scholar
Savard, J, Ivers, H, Villa, J, et al. (2011) Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. Journal of Clinical Oncology 29(26), 3580–3586.Google Scholar
Spielman, AJ, Caruso, LS, Glovinsky, PB (1987) A behavioral perspective on insomnia treatment. The Psychiatric Clinics of North America 10(4), 541–553.Google Scholar
Stepanski, EJ, Walker, MS, Schwartzberg, LS, et al. (2009) The relation of trouble sleeping, depressed mood, pain, and fatigue in patients with cancer. Journal of Clinical Sleep Medicine 5(2), 132–136.Google Scholar