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OBJECTIVES-To determine whether fragmented sleep in nursing home patients would improve with increased exposure to bright light. DESIGN-Randomized controlled trial. SETTING-Two San Diego-area nursing homes.PARTICIPANTS-Seventy-seven (58 women, 19 men) nursing home residents participated. Mean age ± standard deviation was 85.7 ± 7.3 (range 60-100) and mean Mini-Mental State Examination was 12.8 ± 8.8 (range 0-30).

Goals-Previous investigations have shown that women undergoing chemotherapy for breast cancer experience both disturbed sleep and fatigue. However, most of the previous research examined women either during or after chemotherapy. This study examined sleep, fatigue, and circadian rhythms in women with breast cancer before the start of chemotherapy.Patients and methods-Eighty five women with Stages I-IIIA breast cancer who were scheduled to begin adjuvant or neo-adjuvant anthracycline-based chemotherapy participated. Each had sleep/ wake activity recorded with actigraphy for 72 consecutive hours and filled out questionnaires on sleep, fatigue, depression, and functional outcome.Main results-On average, the women slept for about 6 h a night and napped for over an hour during the day. Sleep was reported to be disturbed and fatigue levels were high. Circadian rhythms were robust, but women who were more phase-delayed reported more daily dysfunction (p<0.01). Conclusions-The data from the current study suggest that the women with breast cancer likely experience both disturbed sleep and fatigue before the beginning of chemotherapy. Although their circadian rhythms are robust, breast cancer patients with more delayed rhythms experience more daily dysfunction secondary to fatigue. These data suggest that strategies to improve disturbed sleep and to phase-advance circadian rhythms prior to initiation of chemotherapy may be beneficial in improving daily function in breast cancer patients.

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