1. The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation. Education in Palliative and End-of-life Care - Oncology The Project EPEC-O TM

2. EPECEPECOOEPECEPECOOO EPECEPECOOEPECEPECOOO Module 3l Symptoms – Insomnia Module 3l Symptoms – Insomnia EPEC – Oncology Education in Palliative and End-of-life Care – Oncology

3. Insomnia... l Definition: inadequate or poor quality sleep Difficulty falling asleep Difficulty maintaining sleep Early morning awakening Non-refreshing sleep l Definition: inadequate or poor quality sleep Difficulty falling asleep Difficulty maintaining sleep Early morning awakening Non-refreshing sleep

4. ... Insomnia Epidemiology l Impact: tiredness or fatigue, anergia, poor concentration, or irritability l Up to 63 % of cancer patients l Restful sleep can often be restored Epidemiology l Impact: tiredness or fatigue, anergia, poor concentration, or irritability l Up to 63 % of cancer patients l Restful sleep can often be restored

5. Key points 1.Pathophysiology 2.Assessment 3.Management 1.Pathophysiology 2.Assessment 3.Management

6. Pathophysiology l Multiple possible cause l Prior sleep disorder l Uncontrolled symptoms Pain, pruritus Depression, anxiety l Medications l Multiple possible cause l Prior sleep disorder l Uncontrolled symptoms Pain, pruritus Depression, anxiety l Medications

7. Assessment l Determine course and pattern Lifelong pattern or recent? Difficulty falling asleep? Early awakening? Spouse observations? l Other unrelieved symptoms? l Determine course and pattern Lifelong pattern or recent? Difficulty falling asleep? Early awakening? Spouse observations? l Other unrelieved symptoms?

8. Management... l Regular sleep schedule, avoid staying in bed l Avoid caffeine, assess alcohol intake l Cognitive / physical stimulation l Avoid overstimulation l Control pain during the night l Relaxation, imagery l Regular sleep schedule, avoid staying in bed l Avoid caffeine, assess alcohol intake l Cognitive / physical stimulation l Avoid overstimulation l Control pain during the night l Relaxation, imagery

9. ... Management l Antihistamines l Benzodiazepines l Neuroleptics l Sedating antidepressant (trazodone) l Careful titration l Attention to adverse effects l Antihistamines l Benzodiazepines l Neuroleptics l Sedating antidepressant (trazodone) l Careful titration l Attention to adverse effects

10. EPECEPECOOEPECEPECOOO EPECEPECOOEPECEPECOOO Summary Use comprehensive assessment and pathophysiology-based therapy to treat the cause and improve the cancer experience