For cancer patients, sleep provides respite from physical and psychological distress, [1
] restores a sense well-being [2
] and maintains cognitive function [4
]. Insomnia has a negative impact on quality of life [5
], ability to engage in work or recreational activities, and is associated with neuro-endocrine abnormalities [6
The prevalence of sleep disturbance in cancer patients ranges from 24% to 95% [8
]. Insomnia affects about 70% of hospice patients, with frequent waking being the most common problem reported [15
]. Hypersomnolence, excessive daytime sleepiness, is also common in cancer patients and frequently associated with opioids.
Patients with insomnia frequently develop tolerance to hypnotics and their use may result in fragmented sleep and dependence [16
]. Undesirable side effects of hypnotics include day-time sedation, delirium, fatigue, and respiratory depression. A recent study reported that hypnotic use was associated with a greater than threefold increased risk for death even when patients were prescribed less than 18 pills per year [17
]. In cancer patients, 23% of the populations were utilizing hypnotics and their use was associated with older age, increased stress and anxiety, greater use of opioids, and history or current chemotherapy treatment [18
One promising non-pharmacologic treatment for insomnia is bright light therapy (BLT). BLT has been studied in institutionalized elderly patients [19
] and adolescents with delayed sleep phase disorder. [24
] In breast cancer patients receiving chemotherapy, stage I-III, BLT was shown to prevent an increase in total fatigue scores [25
Advanced cancer patients often have altered sleep patterns resulting in disruptions in their circadian rhythm [26
] which may be restored with BLT. The primary objective of our study was to compare BLT with dim red light on global sleep quality in advanced cancer patients. We hypothesized that BLT was more effective than dim red light in improving sleep disturbances.