![]() ![]() These may include fatigue and depression, tumor pathology, advanced stage of cancer, cancer-related treatments, adjunct medications, environmental factors, psychosocial disturbances, and comorbid medical conditions. Multiple factors may contribute to the development and maintenance of insomnia in oncologic patients. Perpetuating factors, especially behavioral, cognitive, and environmental factors, intervene in the perpetuation of insomnia. Precipitating factors include physiological, environmental, or psychological stressors interacting with predisposing factors to produce acute symptoms. Predisposing factors include genetic, physiological, or psychological diatheses that confer differential susceptibility to individuals in response to stress. The most heuristic model of insomnia is the diathesis-stress model proposed, commonly known as the “3-P” model, describing Predisposing, Precipitating, and Perpetuating factors relevant to the development and maintenance of insomnia. Although details of current models are beyond the scope of this paper, concepts are critical for insomnia evaluation in cancer. The evolving models of chronic insomnia according to neurobiological, neurophysiological, cognitive, behavioral, or other perspectives made the evaluation of insomnia progressively more complex. Frequency, severity, and pattern of insomnia can vary in cancer, with insomnia affecting more than 50% of patients with lung and breast cancer, almost 40% of patients with other forms of cancer, and at the first cycle of chemotherapy or during the peri-operative period. It is the most frequent sleep disturbance interesting almost one third of the general population. Insomnia is defined as difficulty initiating or maintaining sleep, early-morning awakening, or non-restorative sleep associated with daytime consequences such as fatigue, irritability, and lack of concentration. ![]() ![]() Insomnia can be episodic, lasting for a period within 1 month or between 1 month-3-months, or persistent, lasting longer than 3 months transient-episodic forms tend, in the majority of the cases, to chronicity. Insomnia disorder is now considered a 24-hour sleep-wake disorder characterized by nocturnal and diurnal symptoms. A revision of theoretical aspects of insomnia, cancer-related fatigue, and depression in cancer has been performed, and clinical and therapeutic implications have been discussed under the form of a narrative review.Ĭhronic insomnia, also currently referred to as “insomnia disorder”, now has similar diagnostic criteria in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (APA 2013) and in other sleep manuals. With the aim of discussing this hypothesis, we conducted a theoretical overview on the association among insomnia, fatigue, and depression in cancer. By treating insomnia, we may be able to interrupt their vicious cycle. Since depression and cancer-related fatigue can also negatively affect sleep quality and duration in cancer, we may hypothesize a self-reinforcing feedback loop among these factors. Although insomnia is common throughout the cancer trajectory, it continues to be under-diagnosed and under-treated in clinical practice the burden of insomnia in patients with cancer still needs to be addressed. Consequences of insomnia in cancer patients include mood symptoms, psychological distress, daytime fatigue, increased pain, increased chances of cancer recurrence, medication misuse and abuse, impaired cognitive functioning, and quality of life. Even if sleep of disorders can occur singly or in combination and include different disturbances, insomnia symptoms are the most frequent in the oncologic population affecting from 30 to 50% of the patients. The frequency of sleep disturbances in oncologic patients is more than 2 times higher than in the general population and might affect from 25 to 75% of newly diagnosed patients, those undergoing active cancer treatment or those who completed cancer treatment. Disturbed sleep is frequent in patients with cancer, and it is rated the second most disturbing symptom in this population. Sleep serves important regulatory functions influencing mood, emotion regulation, impulse behavior, and stress adjustments, while sleep problems are recognized as major risk factors for mental and physical problems, including cancer. ![]()
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