Sleep in palliative care

Sleep disorders have been recognized for centuries as a frequent complication of medical illness. The last several decades have produced an explosive growth in our knowledge and understanding of sleep physiology and pathophysiology. Unfortunately, the practical application of this knowledge has been slow in reaching the majority of health-care providers, including those in palliative medicine. However, examination of the literature on this subject does suggest a growing recognition on the part of clinicians that attention to patients’ sleep is a necessary and an important aspect of care in this population. Problems related to sleep are among the most commonly reported complaints of patients with advanced illness who are hospitalized or who reside in hospice settings. A good night’s sleep can provide a seriously ill person valuable respite from the physical discomforts, worries, and sorrows of the day, and may allow the person to meet the next day with enhanced energy and motivation. Therefore, it is important that palliative care clinicians routinely ask their patients how they are sleeping at night, and whether they are bothered by daytime sleepiness or other sleep–wake-related disturbances. In this chapter, we review basic aspects of sleep and sleep disorders, particularly as they apply to palliative care, and discuss strategies for the evaluation and treatment of these conditions.