There are many reasons for this:
- Change in routine and environment
- Chemotherapy regimens (such as when they are on intravenous hyper-hydration)
- Nursing or medical observations through the night
- Environmental noise
- Anxiety
- Steroids (advised to take second dose by mid-afternoon as Dexamethasone may cause sleep disturbances, mood swings, anxiety or irritability)
- Pain
Most children and young people will adapt and develop good sleeping patterns. Although these factors are mainly unavoidable, thought can be given as to how best manage an individual’s care when they are having difficulty sleeping.
It is common for healthy young people to sleep until late morning and it is helpful to allow the young person with cancer that normality and adjust the hospital routine where possible and safe. It is also well recognised that young people tend to turn night into day whilst in hospital for extended times, especially if they are in isolation. Again, as long as it is not interfering with the team’s ability to deliver the care they require, this does not have to be a concern. Often acknowledging that this is the norm and reassuring them that once they get home they will get in to a more normal routine can help with acceptance of the present patterns.
Reviewing tips on good sleep behaviours with the family can help, encouraging them to limit the time the child or young person spends in bed during the day. If they nap, encourage one good quality nap in the middle of the day. Try to make an association of bed with sleep (acknowledging this is difficult in the hospital setting) but maintaining or introducing a regular bedtime routine - a wash, pyjamas, quiet time, dimmed lights and a story can all help.