Effectiveness Not Established

Aromatherapy

for Sleep-Wake Disturbances

Aromatherapy is the use of fragrant essential oils distilled from plants to alter mood or improve health. Aromatherapy was studied in patients with cancer in the management of lymphedema and depression.

Research Evidence Summaries

Blackburn, L., Achor, S., Allen, B., Bauchmire, N., Dunnington, D., Klisovic, R. B., . . . Chipps, E. (2017). The effect of aromatherapy on insomnia and other common symptoms among patients with acute leukemia. Oncology Nursing Forum, 44, E185–E193.

Study Purpose

To determine if aromatherapy by diffusion of essential oils improves insomnia in hospitalized patients with newly diagnosed acute leukemia undergoing induction chemotherapy.

Intervention Characteristics/Basic Study Process

Patients served as their own controls and were randomized to receive aromatherapy over 3 weeks in the following fashion. 1 week placebo or aromatherapy, followed by a 1 week washout period, and a third week of placebo or aromatherapy. Patients were allowed to choose their preferred essential oil for the aromatherapy, lavender, chamomile, or peppermint.  Rose water served as the placebo control.  The aromatherapy diffuser was placed in the same location in all hospital rooms. 8 blinded drops of placebo or essential oil were placed in a diffuser each evening at 9 pm and ran until drops were gone (approx. 8 hours). Sleep quality and disturbance were measured at baseline and after each week of the intervention (placebo or aromatherapy), a general symptom assessment was completed daily during the intervention weeks, and the evaluation of aromatherapy was completed at the end of each week of the intervention.

Sample Characteristics

  • N = 50    
  • AGE: 19-72 yrs
  • MALES: 56%  
  • FEMALES: 44%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: Newly diagnosed patients with acute leukemia
  • OTHER KEY SAMPLE CHARACTERISTICS: initiating 4 weeks of induction chemotherapy

Setting

  • SITE: Single site   
  • SETTING TYPE: Inpatient    
  • LOCATION: Midwestern university medical center

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

Randomized control trial.  Trial was a crossover over trial with a washout period in which patients served as own control.

Measurement Instruments/Methods

Pittsburgh Sleep Quality Index (PSQI), Edmonton Symptom Assessment Scale-Revised (ESASr), Final evaluation of aromatherapy (FEA)

Results

Sleep quality as measured by mean scores on the PSQI improved with aromatherapy (p=0.0001) with specific improvements in sleep duration (p=0.03),  sleep quality (p=0.05), and sleep disturbance (p=0.04).  General symptom scores as measured by the EASSr , all subscales, improved with aromatherapy treatment (p=0.0006)

Conclusions

Aromatherapy for hospitalized patients with acute leukemia undergoing induction chemotherapy improves sleep disturbances and other symptoms.

Limitations

  • Small sample (< 100)
  • Findings not generalizable
  • Other limitations/explanation:  Participants were allowed to choose their own oil, may have biased results?  Were nurses really blinded to the assignment?  FEA form used for evaluation of aromatherapy is an investigator developed tool that has no reliability or validity data.

Nursing Implications

Aromatherapy appears to be an effective intervention for improving sleep wake disturbances and other symptoms in hospitalized patients with acute leukemia.  Nurses may want to explore ways to use aromatherapy for patients in their institutions as well as educate patients and families about the potential positive benefits of aromatherapy as a non-pharmacological method to treat sleep wake disturbances as well as a variety of other symptoms.

Print

Özkaraman, A., Dugum, O., Ozen Yilmaz, H., & Usta Yesilbalkan, O. (2018). Aromatherapy: The effect of lavender on anxiety and sleep quality in patients treated with chemotherapy. Clinical Journal of Oncology Nursing, 22, 203–210.

Study Purpose

To determine the effects of lavender oil aromatherapy on anxiety and sleep quality in patients undergoing paclitaxel-based chemotherapy.

Intervention Characteristics/Basic Study Process

Patients were randomized to lavender essential oil (Lavandula hybrid), tea tree oil, or control. During the first chemotherapy infusion, three drops of lavender essential oil or tea tree oil were put onto a piece of cotton that was placed on each patient’s neck and shoulders, about 10 inches below the nose. No aromatherapy was administered to the control group. Patients randomized to lavender and tea tree oils continued to smell the oil for five minutes every night for one month. Lavender and tea tree oil were purchased from a herbal product firm with quality certifications. Tea tree oil does not have a sedative or relaxing effect; therefore, it was used as a placebo. Patients were evaluated at baseline, after the first chemotherapy infusion, and after one month of chemotherapy infusions.

Sample Characteristics

  • N = 70    
  • MEAN AGE: 58.22 years
  • MALES: 16%  
  • FEMALES: 84%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: Mixed cancers; 66% breast cancer, 16% lung cancer, 18% other cancers
  • OTHER KEY SAMPLE CHARACTERISTICS: All chemotherapy regimens included weekly paclitaxel

Setting

  • SITE: It appears that the data was collected at a single site, but this is not clearly stated.      
  • SETTING TYPE: Outpatient
  • LOCATION: Private hospital in Turkey

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active anti-tumor treatment
  • APPLICATIONS: Not available

Study Design

Randomized control trial with three arms (lavender oil, tea tree oil, control)

Measurement Instruments/Methods

Pittsburgh Sleep Quality Index (PSQI), State-Trait Anxiety Inventory (STAI), measured before and after chemotherapy treatment

Results

A significant improvement in sleep quality as measured by mean score of PSQI before and after chemotherapy in the lavender group (time, p = 0.001), with group differences between lavender and the other groups based on assessments (group*time, p = 0.001). Trait anxiety values before and after chemotherapy were significantly decreased in the lavender group (p = 0.0003); however, there was no difference state anxiety by time or group.

Conclusions

Lavender oil inhalation at bedtime for outpatients with mixed cancer treated with paclitaxel-based chemotherapy may be useful for improving sleep quality and trait anxiety.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Findings not generalizable
  • Other limitations/explanation: Small study arms (n = 30, 20, and 20), non-blinded participants because most people are familiar with lavender scent, lack of data analysis details–difficult to understand results.

Nursing Implications

Lavender oil inhaled at bedtime appears to be an acceptable and helpful intervention for adults treated with paclitaxel-based chemotherapy for mixed cancer types with poor sleep quality and medium levels of state and trait anxiety. Additional research in larger samples is warranted before recommending for practice in general oncology populations.

Print