Eleven months after being treated for breast cancer, a client reports difficulty sleeping and ...

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Survivors' feelings of distress range along a continuum from sadness to disabling depression (Vachon, 2006). The long-term presence of fatigue and sleep disturbances, for example, is often associated with anxiety and depression in many cancer survivors (Barton-Burke, 2006).
Sleep disorders and fatigue would not necessarily be expected at this point in the remission stage.
Post-traumatic stress disorder (PTSD) is a psychiatric disorder characterized by an acute emo-tional response to a traumatic event or situation. Cancer survivors experience symptoms of PTSD (e.g., grief, nightmares, panic attacks, or fear) at a rate of 4 to 19, as a result of their diagno-sis, treatment, or a past traumatic episode.
While chemotherapy drugs can produce side effects, sleep disorders are not a typical complaint.