As the patient learns to cope with the stresses of illness, hospitalization, and treatment, sleep may improve. To date, it has not been widely used or studied in cancer patients. Benzodiazepines have been widely used in the management of sleep disturbances. Used as an adjunct to other treatment for short periods of time, these agents are safe and effective in producing natural sleep because they are less disruptive of REM sleep than are other hypnotic agents. Benzodiazepines have an anti-anxiety effect in low doses and a hypnotic effect in high doses.
Benzodiazepines differ from each other in duration of action and pharmacokinetics.
Liver disease has less effect on the metabolism of lorazepam, oxazepam, and temazepam than on the metabolism of other benzodiazepines. In general, non-benzodiazepines are reserved for patients who cannot tolerate benzodiazepines. Antihistamines have become popular drugs for the management of sleep disturbances among cancer patients. The anticholinergic properties of antihistamines relieve nausea and vomiting as well as insomnia. These agents must be used with caution since daytime sedation and delirium can occur, especially in the elderly.