Addressing sleep problems in cancer patients
If you’ve had trouble sleeping during or after cancer treatment, you’re not alone. Up to half of cancer patients don’t sleep well at some point, according to the National Cancer Institute.
Trouble sleeping, also referred to as “sleep disturbance,” includes insomnia, restless legs syndrome (RLS) and fragmented sleep. Insomnia is the most common, with up to 80 percent of cancer patients having difficulty falling and/or staying asleep. Cancer patients are twice as likely to experience insomnia as people without cancer.
Why sleep matters
A good night’s sleep not only feels good, it has significant benefits for cancer patients. Dr. Laurence Altshuler says “patients need as much vitality and energy as possible to fight their cancer. Sleep allows the body to relax and recoup.” Dr. Altshuler is the head physician of the Sleep Lab at Cancer Treatment Centers of America® (CTCA) in Tulsa.
“Without sleep, the body becomes even more stressed, which can interfere with its ability to fight cancer,” Dr. Altshuler says. “In fact, lack of sleep can depress the immune system, as well as hamper recovery from major illness or injury.”
Researchers are studying how your sleep quality might influence how well your body fights cancer. Trouble sleeping, especially when it’s chronic, alters the balance of cortisol and melatonin. These two hormones may influence the behavior of cancer cells. Here’s how each hormone works:
Cortisol helps regulate immune system activity, including the release of natural killer cells that help the body battle cancer.
- Cortisol levels typically peak at dawn, after hours of sleep, and decline throughout the day.
- Reseach suggests that women who work the night shift have higher rates of breast cancer than women who sleep normal hours. These night shift workers are more likely to have a "shifted cortisol rhythm," in which their cortisol levels peak in the afternoon.
- Cortisol levels are supposed to be low during night sleep before they rise rapidly in the morning to provide energy for the day.
Melatonin is produced by the brain during sleep and may have antioxidant properties that help prevent damage to cells that can lead to cancer.
- Adequate sleep maintains melatonin levels, while a lack of sleep results in the body producing too little melatonin. It's recommended that adults get 7-8 hours of sleep every night.
- Melatonin is important for women because it decreases estrogen production from the ovaries. Women with high levels of estrogen may have an increased risk of breast cancer.
Dr. Altshuler notes that lack of sleep also can worsen other medical conditions patients may have, including heart disease, hypertension, diabetes, respiratory disorders, anxiety and depression. Those conditions can have a negative impact on your body’s ability to fight cancer and on the effectiveness of your treatment.
Why cancer patients have sleep problems
Emotional distress is usually the main reason cancer patients don’t sleep well. Think of the toll that a cancer diagnosis alone can take, and it’s no wonder that cancer patients suffer from sleepless nights. Uncertainty and fears about the future, along with confronting the big decisions about your treatment, create stress that can hamper sleep.
Veronica Stevens, Naturopathic Oncology Provider at CTCA in Philadelphia, says emotional distress disrupts sleep for about 70 percent of the cancer patients she treats. Emotional distress includes worry, anxiety, depression, and overall stress caused related to family issues and financial concerns.
The side effects of the cancer itself or treatment, including certain medications, also may contribute to sleep problems. One in four of Stevens’ patients experience sleep disturbance because of side effects. Another 5 percent don’t sleep well because of pain.
Cheryl Merkel, who was diagnosed with stage IV breast cancer in 2010, didn’t sleep well before she transferred to our hospital outside of Chicago. A poor diet and a stress level that was “through the roof” were to blame, Merkel says.
“I was a mess,” says Merkel, a mother of three. “I slept better once I made nutritional changes and curbed my activities and workload. Then worry took over. So, I slept better but not like I did before.” As long as Merkel keeps her stress in check and eats a healthy diet, she says she can get a good night’s sleep.
Diagnosing sleep disorders
Clinicians diagnose some sleep disorders, such as insomnia, by asking specific questions to obtain a patient history. Others, such as sleep apnea and narcolepsy, require a formal sleep study. Sleep studies measure the quality of your sleep and your body’s response to sleep problems. Sleep Diagnostics Labs at CTCA hospitals in Tulsa, Philadelphia and near Phoenix offer overnight sleep studies to pinpoint a patient's specific sleep problem.
Sleep apnea occurs when you stop breathing for at least 10 seconds on a regular basis during sleep. Sleep apnea is more common among cancer patients. Studies have found:
- Almost 30 percent of patients reporting cancer-related fatigue were diagnosed with sleep apnea.
- Up to 80 percent of head and neck cancer patients suffer from sleep apnea.
Sleep studies also can detect problems during either of the two stages of sleep: rapid eye movement (REM) and non-rapid eye movement (NREM). Sleep typically begins with NREM sleep, then transitions to a short period of REM sleep before switching back to NREM sleep. This cycle occurs four to five times during the night.
NREM sleep consists of four stages, with stages 3 and 4 being deep sleep. The body strengthens the immune system during deep sleep, when it also repairs and regenerates tissues, while building bones and muscle.
Therapies to sleep better
If you have chronic sleep problems, a good night’s sleep can seem out of reach. There are several therapies, though, to help improve your sleep. In many cases, cancer patients can benefit from working with a psychologist or sleep specialist. It’s best to consult your clinician before starting any specific therapy.
Light and stimulant therapy: Using special lamps, specifically dosed and timed light exposure helps regulate circadian rhythms and establish a regular sleep-wake cycle.
Cognitive behavioral therapy: Research shows that cognitive behavioral therapy has helped 70-80 percent of all patients, not just cancer patients, and reduces by half the need for cancer patients to take sleep medications. Some methods include:
- Relaxation techniques, such as deep breathing, guided imagery and progressive muscle relaxation
- Stimulus control, which involves limiting time awake in bed and viewing the bed only as a place for sleep
- Sleep hygiene, such as avoiding heavy meals and television before bed and going to bed at the same time every night
Mindfulness-based stress reduction: This therapy focuses on reducing stress and improving psychological well-being. Mindfulness is defined as nonjudgmental awareness of the present moment and is used to better deal with stressful situations.
Sleep restriction procedures: Setting a strict bedtime and wake-up time reduces sleep to a fixed window of time. Sleep time is adjusted to account for waking up in the middle of the night, with the ultimate goal of sleeping through the night. This therapy may create daytime sleepiness at first, which helps reset the body's internal clock.
Naturopathic therapies: Some remedies may help improve sleep quality. Consult with a naturopathic oncology provider before beginning supplements.
- Oral magnesium supplementation may improve symptoms of fatigue in persons with low magnesium levels.
- A ginseng supplement may help enhance mental activity as well as physical endurance.
- Coenzyme Q10 is a vital nutrient involved in cellular energy production throughout the body.
- Cordyceps, a traditional Chinese medicinal mushroom, may help fight fatigue and boost energy levels.
View our infographic about the link between sleep and cancer to learn more.