Box 2.

Sleep hygiene measures. Adapted from Howell D, Oliver TK, Keller-Olaman S et al. A pan-Canadian practice guideline: Prevention, screening, assessment and treatment of sleep disturbances in adults with cancer. Toronto: Canadian Partnership Against Cancer (Cancer Journey Advisory Group) and the Canadian Association of Psychosocial Oncology, 2012.

Ensure sleep expectations are realistic
Normal sleep duration is 6–10 hours per night; normal sleep pattern includes 1–2 awakenings per night.
Wake up at the same time each day (irrespective of sleep duration)
Ensure exposure to natural/artificial light after awakening
Establish a ‘clear your head time’ in early evening
Set aside 30–45 minutes to consider concerns/problems.
Establish a ‘buffer zone’ before going to bed
Set aside 90 minutes to engage in sedentary/relaxing activities; lights should be dimmed, stimulants should be avoided.
Use your bedroom only for sleep (and sexual intercourse)
Bed-bound patients require as much cognitive/physical stimulation as possible during daytime.
Go to bed only when sleepy
Get up if still awake after 20–30 minutes (and go back to bed only when sleepy)
Repeat the establishment of a ‘buffer zone’.
Restrict napping
Avoid multiple naps, and naps in the evening.
A short nap in the afternoon ‘may’ be helpful, ie less than 1 hour, before 3–4pm.
Additional strategies
Minimise ambient light and noise; consider using eye masks and earplugs.
  • Adapted from Howell D, Oliver TK, Keller-Olaman S et al. A pan-Canadian practice guideline: Prevention, screening, assessment and treatment of sleep disturbances in adults with cancer. Toronto: Canadian Partnership Against Cancer (Cancer Journey Advisory Group) and the Canadian Association of Psychosocial Oncology, 2012.