Sleep Research at UB SON

It is estimated that anywhere from 50 to 80 percent of persons diagnosed with lung cancer experience severe insomnia that may persist for an average of eight years after the initial diagnosis. Sleeplessness in lung cancer patients is related to a blend of pre existing habits and conditions, as well as treatments specific to lung cancer, including a history of smoking, pre-existing chronic obstructive pulmonary disease (COPD), and the effects of lung cancer surgery and the postoperative radiotherapy that may follow. These treatments and conditions can result in anxiety, pain, cough and impaired breathing making it difficult to fall asleep and stay asleep.

To date, little research exists on strategies to reduce insomnia in lung cancer patients. Grace Dean, PhD, RN, associate professor at UBSON who has studied fatigue in patients with cancer beginning in the late 1980s, is hoping to find ways to help patients solve this problem — and not always with sleeping medication.

Dr. Dean is the primary investigator on a $485,000 National Institutes of Health (NIH) grant to study cognitive behavior therapy (CBT) techniques for lung cancer survivors who suffer from sleeplessness related to their diagnosis. The study, “Translating Cognitive Behavior Therapy-Insomnia (CBT-I) for Lung Cancer into Practice: A randomized controlled trial (RCT),” will run through August 2015.

“The importance of sleep to health and well-being cannot be underestimated. Sleep is an absolute basic human necessity, like eating, drinking and breathing, but is often overlooked and not assessed unless the lack of it is determined to be severe,” she says. “Chronic sleep deficiency leads to increased risks for heart disease, kidney disease, hypertension, obesity, diabetes and depression.” Preliminary work by Dean and her co-investigators suggests that lung cancer patients with chronic insomnia may benefit from CBT-I to improve sleep. CBT-I includes sleep hygiene, sleep restriction, stimulus control, cognitive therapy and relaxation techniques. Although all these techniques are essential to CBT-I, Dr. Dean says the two most important are sleep restriction and stimulus control. She points out that CBT-I results in clinically significant improvements in insomnia symptoms without the negative effects commonly reported with some hypnotic (sleeping) medications, such as slowed respirations in patients already dealing with oxygen deficiency.

Why nurses? Dr. Dean says nurses are uniquely positioned to deliver CBT-I because they have access to patients and, as members of the “most trusted” profession according to Gallup polls, patients are positively influenced by them. “For some individuals, having a nurse deliver the therapy is less stigmatizing than seeing a psychologist or psychiatrist, no matter the reason,” states Dr. Dean. Her co-investigators are Suzanne Dickerson, DNS, RN, and Carla Jungquist, PhD, RN, both from UBSON; Lynn
Steinbrenner, MD, VA Medical Center of WNY; Joseph Lucke, PhD, UB Research Institute on Addictions; Nadine Fisher, EdD, UB Department of Rehabilitation Science; and Samjot Dhillon, MD; Hongbin Chen, MD; and Elizabeth Dexter, MD, RPCI.

- SARA R. SALDI