Between 67 and 90 percent of women with breast cancer have sleep issues, according to a 2016 study in the journal Supportive Care in Cancer — double that of the general population. In fact, sleeplessness in breast cancer patients is so common that studies focusing on the relationship between cancer and insomnia are most often done using people with breast cancer.
This isn’t surprising. Emotionally ravaged by what may still be a new and frightening shift in her interior landscape — the specter of cancer — a woman with breast cancer may stay up late chasing down leads on the internet about her particular diagnosis, then fall into restless sleep only to awaken early, the challenges of the new day colliding with worries from the night before.
Painkillers and chemotherapy also upset the body’s delicate chemical balance, and sleep becomes even more of a problem. Insomnia — the inability to fall asleep — may keep a woman with cancer awake deep into the night. Or, she may fall asleep only to awaken an hour or so later, then toss and turn the remainder of the night.
Many breast cancer survivors deal with a wide range of sleep issues; and for women with metastatic breast cancer (MBC), the issues can be even more intense.
What triggers sleep problems with metastatic breast cancer?
A small study out of Stanford University’s Department of Psychiatry found that about 63 percent of women with MBC experienced one or more sleep issues: falling asleep, staying asleep, fatigue upon waking, or insufficient hours of sleep per night. These women were more likely to have trouble sleeping if they also experienced the following:
- Lack of social support
- Metastasis to the bone
In addition, chemotherapy and opioid use for treatment of pain, both common in women with MBC, can contribute to sleep issues, according to a study in Current Treatment Options in Neurology.
Treatment options for sleep issues
Are you an MBC survivor with insomnia? You may choose to add sleep meds to your daily drug regimen (with the advice of your oncologist, of course), but there’s evidence that cognitive behavioral therapy (CBT) may be more effective and efficient than drug treatment.
Behavioral therapy can include things like changing your daytime activities, and/or your evening schedule, to better prepare you for sleep.
Cognitive therapy involves talking yourself out of the fact that bedtime automatically means insomnia. A negative attitude, developed after many nights of sleep challenges, can be turned positive — with some education and work.
In addition, complementary therapies such as relaxation techniques, Reiki, meditation, yoga, and exercise all promote a better night of sleep.
CBT isn’t something you can undertake on your own; you’ll need a referral from your oncologist to a professional. If your health care center has an area specializing in sleep problems, ask to be referred there. It may take several months to rework your habits, but you’ll likely find some relief over time.
Sleep hygiene basics
In addition, “sleep hygiene” — best practices around sound sleep — is key to falling asleep and staying asleep, whether you’re dealing with MBC or not. Some basic tenets taught at sleep clinics include the following:
Your bed is for sleep and sex — and nothing else. Spend no more than 15 minutes awake in bed, before assuming sleep is being elusive and getting up. Sit in a chair, do laundry — just make sure you’re getting out of bed.
Make sure your bedroom is dark and quiet.
Avoid alcohol whenever possible.
Eliminate caffeine in the late afternoon and evening
Don’t nap during the day if at all possible.
Exercise is good, but don’t exercise within two hours of going to bed.
Living with MBC can make trying to get a good night’s sleep feel like a nightmare. Luckily, these strategies may be able to help. If you’re struggling with sleeplessness, your doctor can also help you come up with a plan to tackle the problem.
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PJ Hamel is senior digital content editor and food writer at King Arthur Flour, and a James Beard award-winning author. A 16-year breast cancer survivor, her passion is helping women through this devastating disease. She manages a large and active online survivor support network based at her local hospital and shares her wisdom and experience with the greater community via HealthCentral.com.