How Head and Neck Cancer Can Impact Sleep

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We already know cancer can have a negative impact on sleep — but head and neck cancer seems to be particularly damaging when it comes to sleep health. For example, one study found that three-quarters of patients with head and neck cancer also had obstructive sleep apnea (OSA). Here’s what you need to know.


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The seriousness of OSA in head and neck cancer

This high prevalence of OSA is particularly concerning since the same study found that two-thirds of individuals with the sleep disorder experienced a prolonged intensive care unit stay, required mechanical ventilation, or suffered from cardiopulmonary problems compared with just one-quarter of non-OSA patients.


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Increasing air flow during sleep

In an email interview with HealthCentral, Houtan Chaboki, M.D., owner and president of Potomac Plastic Surgery, reported that cancers in the nasal area can lead to a narrowing of the nasal passage. This can reduce airflow and lead to issues such as snoring and sleep apnea. Dr. Chaboki suggested that, in addition to surgery, external nasal strips, internal nasal cones, and dental appliances can help to open the airways during sleep.


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CPAP therapy for OSA

Dr. Chaboki pointed out that CPAP is a good option for head and neck cancer patients with OSA. The American Cancer Society agrees — their current guidelines for head and neck cancer care recommend that primary care clinicians should manage sleep disturbance similar to patients in the general population (this typically involves an overnight sleep study and CPAP therapy if appropriate).


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Change your sleeping position

Dr. Chaboki suggested that sleeping with the head of the bed elevated by 15 degrees or more can help to improve sleep disrupted by breathing problems. The American Cancer Society also suggests sleeping in a propped‐up position to reduce snoring and mouth‐breathing. The organization also recommends the use of cool‐mist humidifiers since they can aid sleep by keeping the airway moist.


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The role of dry mouth

Rajiv Datta, M.D., medical director of the Gertrude & Louis Feil Cancer Center at South Nassau Communities Hospital, spoke with HealthCentral by email about head and neck cancer and sleep. He explained that those who undergo treatment for head and neck cancer often experience xerostomia (dry mouth) — and this can lead to sleep difficulties. Chewing on gum, limiting caffeine, avoiding alcohol, and regularly sipping water can help alleviate dry mouth.


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Depression, smoking, and alcohol

Dr. Datta pointed out that depression, smoking, and alcohol problems are common in head and neck cancer patients — and all of these factors are associated with reduced sleep. Indeed, one study found that dry mouth and depression were significant predictors of poor sleep one year after a diagnosis of head and neck cancer — and that reducing dry mouth, quitting smoking, and cutting back on alcohol can improve sleep and quality of life.


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Addressing gastroesophageal reflux disease (GERD)

Those with head and neck cancer can develop gastroesophageal reflux disease (GERD), and this can also disrupt sleep. The American Cancer Society recommends proton-pump inhibitors (PPIs) or antacids, sleeping with a wedge pillow or three‐inch blocks under the head of the bed, avoiding tobacco and alcohol, and not eating or drinking fluids for three hours before bedtime as methods to relieve GERD symptoms.


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Dealing with fatigue

Cancer-related fatigue is common and should be taken seriously since it has been found to reduce head and neck cancer survival rates. The American Cancer Society recommends investigating and treating identifiable causes of fatigue such as anemia, thyroid dysfunction, mood disorders, and pain. If no identifiable cause exists, engaging in regular physical activity can improve symptoms and overall health.


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The role of pain and the benefits of relaxation

As many as 70 percent of head and neck cancer patients report pain — a higher prevalence of pain compared to other cancer sites. A study published in 2018 suggested that cognitive behavioral therapy-based relaxation techniques may help manage pain and improve sleep. Another study published in 2016 found that mindfulness‐based stress reduction reduced distress and increased quality of life for head and neck cancer patients who were undergoing radiotherapy.


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The importance of a healthy diet

Lastly, it's important to know that inflammation has long been linked to sleep problems — and a 2018 study concluded that circulating levels of interleukin-6 (an inflammatory messenger) was a strong predictor of the occurrence of secondary primary cancer in head and neck cancer patients. A separate study suggested that a healthy diet with high intakes of vegetables, fruit, fish, poultry, and whole grains can reduce inflammation and reduce symptoms such as dysphagia (difficulty swallowing) and difficulty chewing.