Cancer and trouble with sleep

Mary was diagnosed with breast cancer a few months ago. She is currently going through treatment with chemotherapy. Her major complaint is fatigue; excessive fatigue and tiredness that is disabling which forces her to stay home and not go out much. She doesn’t sleep as well as she used to. She doesn’t necessarily feel depressed but her energy level has been low. Her doctor told her that she has a good chance for cure and she is looking forward to healing. But she doesn’t like the fact that she is not sleeping as good as she used to and that her ability to function has been limited because of the tiredness.

Sleep problems are common in people with cancer. A large 2002 study published in the May issue of Social Science and Medicine interviewed patients with different cancers and asked them about their sleep problems: 44% had excessive fatigue, 41% leg restlessness, 31% insomnia, and 28% excessive sleepiness.

Pain, the psychological and emotional stress, depression, anxiety, anemia, weight loss and the effect of chemotherapy, surgery or radiation are all possible causes for the sleep problems and daytime fatigue and sleepiness.

Suggestions on improving sleep-related problems in cancer patients

  • Make sure you discuss your sleep problems with your doctors. Sleep problems are often overlooked. You might need to see a sleep specialist if your sleep problem is complex and affecting your quality of life.
  • Sleeping pills might be needed in few individuals, however, they should not be the only mean of treatment. Good sleep habits are important. There are many newer and safe sleeping pills that can be considered.
  • The National Institute of Health (NIH) State-of-the-Science Conference on insomnia in 2005 stated that cognitive-behavioral therapy (CBT) is a very effective treatment for chronic insomnia in adults. CBT improved the sleep quality, reduced night awakenings and improved overall life quality.
    • CBT is a type of talk therapy that works on the idea that if we change the way we think (negative thoughts to positive ones), then we can change the way we feel (sad or anxious to happy or optimistic).
  •  A 2005 study by Ancoli-Israel which was published in the Supportive Care in Cancer found that increased fatigue was significantly correlated with decreased light exposure among patients with breast cancer.
    • One way to increase alertness and resynchronize daily rhythm is to have outdoor exposure and get some sunshine. Light therapy though the use of a box have been used for Seasonal Affective Disorder (SAD), shift work and insomnia. It has not been studied in cancer patients. This is an alternative treatment that you can try but you need to talk to your doctor to make sure it is not contraindicated for the cancer treatment. You can purchase it on-line
  • Exercise is another way to promote daytime alertness and reduce fatigue.
  • If fatigue continues to be a problem despite sleeping well, you might benefit from a wake promoting medications such as provigil. Again you would need to talk to your doctor about the pros and cons.