Patients with cancer also have an elevated likelihood of EDS. Studies indicate prevalence rates of 54-68% for "feeling drowsy" and 21-40% for being "overly sleepy" in this population [72,73]. Causes of EDS in this population may be related to an increased risk of primary sleep disorders due to age alone (the average age at onset of cancer is 55 years) or a complex combination of etiologies. These include insufficient sleep due to insomnia, depression, or pain; disruption or erratic hormone secretion due to the malignancy or chemotherapy, with subsequent sleep disruption or shortened sleep periods; effects of cytokines and inflammatory mediators induced by cancer cells, biotherapy, or radiotherapy; and side-effects from chemotherapy or other adjunctive medications [74].

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