Managing sleep disturbance in palliative care

When managing sleep disturbance in palliative care, consider the benefits and burdens of each intervention and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Consider the capability of the patient (physically and mentally) to engage in treatment.

A cornerstone of management is to address factors affecting sleep—see Assessing sleep disturbance in palliative care. This includes encouraging good sleep practices (see Good sleep practices for adults in the Psychotropic guidelines). Optimising sleep setting and addressing patient needs and comfort (eg thirst, urinary frequency, posture, ambient temperature, bedding) can become more important as life-limiting illnesses progress; patients often require more sleep. Ensure patients can readily call for assistance when required.

If insomnia is causing distress and daytime symptoms, see the Psychotropic guidelines for managementHugel, 2004Takemura, 2020. Nonpharmacological interventions are first-line therapy; other interventions may need to be considered to maintain patient comfort and alleviate carer fatigue.

Management of other common sleep disorders is discussed in other guidelines; see:

• Advanced sleep–wake phase disorder
• Delayed sleep–wake phase disorder
• Central sleep apnoea in adults
• Obstructive sleep apnoea in adults
• Parasomnias
• Restless legs syndrome and periodic limb movements of sleep/wakefulness.