Insomnia is a subjective complaint by the patient of sleep disturbance despite adequate opportunity to sleep. There may be difficulty in initiating or maintaining sleep, interrupted sleep, or poor-quality sleep.
Disturbances in sleep are seen in up to 50% of patients with advanced cancer and chronic respiratory disease, while it is reported in 77% of patients undergoing hemodialysis for end-stage renal failure.
Some factors that contribute to insomnia are depression, anxiety, pain, respiratory distress, and medications.
For palliative care patients, it may not be feasible to treat the underlying primary disease but it may be possible to control the factors contributing to sleep disturbances
Some suggestions for sleep hygiene
for palliative care patients are: minimize nighttime sleep disturbance due to medication, noise, etc.; be as active as possible during the day; maintain adequate pain relief and use of sleep medication, if required.
Sateia MJ, Byock IR. Sleep in Palliative Care. Hanks G, Cherny NI, Christakis NA, Fallon M, Kaasa S, Portenoy RK (Ed).Oxford Textbook of Palliative Medicine. Oxford University Press, 4th ed. 2010, pp.1059-1083.