From the Guidelines
Treatment for sleep disturbances in patients with esophageal adenocarcinoma should prioritize non-pharmacological approaches, particularly cognitive behavioral therapy for insomnia (CBT-I), due to its efficacy and safety as a first-line treatment option. According to a systematic review of evidence for best practices in assessment and management for clinical practice 1, CBT-I has been shown to be effective in improving sleep disturbance in cancer patients. This approach addresses the multifactorial and treatable causes of insomnia, which is crucial in managing sleep disturbances in patients with esophageal adenocarcinoma.
Some key considerations for managing sleep disturbances in these patients include:
- Screening for sleep disturbance using key questions or measures sensitive and specific to case identification, such as the Insomnia Severity Index 1
- Focused assessment using valid and reliable measures for sleep disturbance, including sleep diaries and medical evaluation 1
- Addressing comorbid symptoms such as pain or depression that may be contributing to sleep disturbances 1
- Promoting sleep hygiene practices, such as a consistent sleep schedule and comfortable environment 1
- Considering exercise therapies, such as walking or yoga, to improve sleep quality, although further research is needed to establish their efficacy for insomnia syndrome 1
While pharmacologic agents, such as low-dose benzodiazepines or non-benzodiazepine hypnotics, may be considered for short-term use, their efficacy and safety in adults with cancer are not established, and CBT-I is recommended as a first-line treatment option 1. Melatonin may also be considered as a safer alternative to regulate sleep cycles, but its efficacy in cancer patients requires further research. Ultimately, treatment should be individualized based on the specific causes of sleep disturbance and regularly reassessed to adjust interventions as the patient's condition changes throughout their cancer journey.
From the Research
Treatment Options for Sleep Disturbances in Esophageal Adenocarcinoma Patients
- Sleep disturbances are a common issue in patients with esophageal adenocarcinoma, particularly after esophagectomy 2, 3.
- The use of mirtazapine has been shown to be effective in treating sleep disorders, as well as other cancer-related symptoms such as depression, anxiety, and neuropathic pain 4.
- Severe reflux after esophagectomy is associated with an increased risk of sleep disturbances and poor sleep quality, which can negatively impact health-related quality of life (HRQL) 3.
- Alleviating reflux after esophageal cancer surgery is important to reduce the risk of sleep disturbances and improve HRQL 3.
- Early detection and treatment of esophageal adenocarcinoma are crucial to improve patient outcomes, and effective screening strategies are needed to diagnose the disease at an early stage 5, 6.
Management of Sleep Disturbances
- The management of sleep disturbances in esophageal adenocarcinoma patients may involve the use of medications such as mirtazapine, as well as non-pharmacological interventions to alleviate reflux and improve sleep quality 4, 3.
- A multidisciplinary approach to care, including input from oncologists, surgeons, and supportive care specialists, is essential to address the complex needs of patients with esophageal adenocarcinoma 6.
- Further research is needed to fully understand the relationship between sleep disturbances, reflux, and HRQL in esophageal adenocarcinoma patients, and to develop effective strategies to manage these issues 2, 3.