Why Sleep Disturbances Linger Long after the Cancer Is Gone (and What to Do about It)by Martin Reed Patient Advocate
Insomnia is prevalent among those living with cancer. But even when the cancer is gone, sleep issues often remain.
While breast cancer patients appear to be the most likely to report insomnia compared to those with other forms of cancer, it doesn't really matter the type of cancer you beat or how old you are; sleep disorders tend to be associated with all types of cancer and affect all types of cancer survivors.
An exploratory study published in Pediatric Blood & Cancer (2015) found that out of 62 cancer survivors aged between 8 and 18 years of age, 19 percent were at risk of sleep disordered breathing. In fact, childhood cancer survivors were found to be more than three times as likely to be at risk of sleep disordered breathing as other children.
Another study published in Gynecologic Oncology found that 55 percent of adult gynecologic cancer survivors reported sleep disturbances, and it has been found that around 42-69 percent of women with breast cancer experience symptoms of insomnia.
Why does cancer cause sleep problems?
The study published in Gynecologic Oncology found that those who received chemoradiation were 4.5 times more likely to experience sleep disturbances compared to other patients. So the cancer treatment itself could have a negative impact on sleep.
Cancer (and its treatment) can be painful, of course, and the presence of pain has been found to be associated with excessive daytime sleepiness and short sleep durations. However, the source or location of the pain seems to matter. The study found that acute pain had more of an impact on sleep compared to chronic pain. Acute pain includes acute muscle, bone and joint pain. Chronic pain refers to chronic conditions such as osteoarthritis, RA, and fibromyalgia.
Younger patients have been found to experience more symptoms of insomnia than those higher in age, perhaps due to higher levels of anticipatory anxiety associated with the diagnosis.
Previous studies have suggested a link between obesity and sleep disturbances. However, after adjusting for age, race, presence of pain, education level, and menopausal status, this association has been found to be no longer statistically significant.
How cancer survivors can improve their sleep
Melatonin supplements may help, particularly for breast cancer survivors. A clinical trial found that postmenopausal breast cancer survivors who took 3mg of melatonin at 9 PM every night for four months reported improvements in their sleep quality. In fact, nearly one in five of those who took melatonin who were poor sleepers at the start of the study were no longer poor sleepers four months later.
You don't necessarily need to pop pills, though.
A 2013 study published in the Journal of Cancer Survivorship found that mind-body bridging (designed to improve awareness and coping methods) and mindfulness meditation (based on mindfulness-based stress-reduction, which includes meditation and yoga) can improve sleep in posttreatment cancer survivors.
Both mind-body bridging and mindfulness meditation were found to reduce sleep disturbance symptoms better than sleep hygiene education alone. Although sleep hygiene education was effective during the study, when the sessions ended, the effectiveness of sleep hygiene training alone proved inferior compared to mind-body bridging and mindfulness meditation.
Survivors of nasopharyngeal cancer often experience issues with their heads, necks, and shoulders, all of which can impact sleep. One study found that a six-month program of Tai Chi Qigong training improved neck mobility, maintained jaw and shoulder joint mobility, and reduced sleep problems.
Cognitive behavioral therapy can be particularly effective for cancer patients and survivors, too.
Untreated sleep disturbances in cancer patients have been found to negatively affect immune response and overall survival. It's important, therefore, not to ignore sleep issues when undergoing cancer treatment, or when enjoying life as a cancer survivor.
Chen, Wendy, Anita Giobbie-Hurder, Kathryn Gantman, Jennifer Savoie, Rochelle Scheib, Leroy Parker, and Eva Schernhammer. "A randomized, placebo-controlled trial of melatonin on breast cancer survivors: impact on sleep, mood, and hot flashes." Breast Cancer Research and Treatment 145.2 (2014): 381-388. Accessed May 31, 2016.
Fong, Shirley, Shamay Ng, H. Lee, Marco Pang, W. Luk, Joanne Chung, Janet Wong, and Rich Masters. "The Effects of a 6-Month Tai Chi Qigong Training Program on Temporomandibular, Cervical, and Shoulder Joint Mobility and Sleep Problems in Nasopharyngeal Cancer Survivors." Integrative Cancer Therapies 14.1 (2015): 16-25. Accessed May 31, 2016.
Kathy, Ruble, George Anna, Lisa Gallicchio, and Charlene Gamaldo. "Sleep disordered breathing risk in childhood cancer survivors: An exploratory study." Pediatric Blood & Cancer 62.4 (2015): 693-697. Accessed May 31, 2016.
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Nakamura, Yoshio, David L. Lipschitz, Renee Kuhn, Anita Y. Kinney, and Gary W. Donaldson. "Investigating efficacy of two brief mind–body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial." Journal of Cancer Survivorship 7.2 (2013): 165-182. Accessed May 31, 2016.
Tung, C., S. Westin, C. Sun, R. Lacour, L. Meyer, M. Schlumbrecht, and D. Bodurka. "Sleep disturbances: A critical issue among gynecologic cancer survivors." Gynecologic Oncology 130.1 (2013). Accessed May 31, 2016.