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Why sleep matters?

Sleep disturbances affect between 30% to 75% of newly diagnosed or recently treated cancer patients [1], a rate that has been reported as double as that of the general population [2]. Surveys have suggested that sleep complaints in from cancer patients consisted of difficulty falling asleep and difficulty staying asleep, with frequent and prolonged nighttime awakenings. Patients reported these complaints both before treatment and during treatment [3].

Sleep disturbances have been shown to decrease quality of life, decrease work productivity, increase utilization of health care resources, decrease mental health, and serve as a predictor of other complications in cancer patients [4, 5, 6].

Why sleep matters for cancer patients

Studies have shown that bad sleep habits may influence the risk of cancer recurrence. During sleep, our brain produces the hormone called melatonin. Melatonin is a very potent stimulant for our immune system and has oncostatic properties, which means it may help reduce the risk of cancer progression. Even more, trouble sleeping, especially when it is chronic, alters the balance of cortisol and melatonin. These two hormones may influence the behavior of cancer cells [7].

“Patients need as much vitality and energy as possible to fight their cancer. Sleep allows the body to relax and recoup. Without sleep, the body becomes even more stressed, which can interfere with its ability to fight cancer” says Dr. Altshuler, head physician of the Sleep Lab at Cancer Treatment Centers of America® (CTCA) in Tulsa [8].

Also, when patients get enough rest they are less likely to be depressed, and there are some evidences that depression may be associated with an increased risk of recurrence. A study submitted at the 2013 Annual Meeting of the American Society of Clinical Oncology reported that depressed women with breast cancer had a 50 percent greater chance of recurrence than women with breast cancer who were not depressed.

Which are the primary reasons why cancer experience sleep disturbance?

Emotional distress is usually the main reason cancer patients don’t sleep well. Uncertainty and fears about the future, which includes worry, anxiety, depression, and overall stress caused related to family issues and financial concerns, creates stress that can hamper sleep.

The side effects of the cancer itself or treatment, radiation and chemotherapy are both known to produce sleep disturbances, including certain medications, also may contribute to sleep problems. So does pain, a symptom often observed in cancer patients. Regarding the onset of sleep disturbances, studies have shown that it might already be present before the start of a treatment.

Diagnosing sleep disorders

Sleep disturbances are common among patients with cancer for many reasons. Sleep problems can be present at any stage during treatment for cancer and in some patients sleep disturbance may be the presenting symptoms that lead to the diagnosis of some types of cancer. Poor sleep impairs quality of life in people with cancer, but most do not specifically complain of sleep problems unless they are explicitly asked. Insomnia and fatigue are most common sleep disorders in this cohort, although primary sleep disorders, including obstructive sleep apnea and restless legs syndrome, which are common in the general population, have not been carefully studied in the oncology setting despite significant impairment to their quality of life [9].

If sleep is interrupted or does not last long enough, the phases of sleep are not completed and the brain cannot finish all the tasks that help restore the body and mind. Sleep problems are significant among patients with cancer prior to undergoing radiotherapy, and were found to be associated with progression of cancer, prior treatments and other psychosomatic symptoms (e.g. anxiety). Sleep problems within this context must be explored to provide adequate guidelines to palliate their effects on quality of life [10].

Dealing with sleep disorders

If you have chronic sleep problems, a good night’s sleep can seem out of reach. Sleep problems that go on for a long time may increase the risk of anxiety or depression. 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. Cognitive behavioural therapy, such as relaxation techniques, have shown promising results, next to mindfulness or setting up a strict bedtime and wake-up time.  Please consult your clinician or medical specialist before starting any specific therapy.

Monitor your sleep, together with other quality of life indicators

On Esperity you can monitor your sleep by simply indicating what your subjective scoring is for your quality of sleep (on a scale from 0 to 5). You can also couple your Fitbit to capture the amount of sleep and link it to your lifestyle score.  Furthermore, you can also manage your consultations and medication, and exchange experience with other Esperity members.

 

*REFERENCES:

  1. Ancoli-Israel S, Moore P, Jones V. The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care (Engl) 2001;10:245–255.
  2. Berger AM, Parker KP, Young-McCaughan S, et al. Sleep wake disturbances in people with cancer and their caregivers: state of the science.Oncol Nurs Forum.2005;32:E98–E126. A comprehensive review.[PubMed]
  3. Cimprich B. Pretreatment symptom distress in women newly diagnosed with breast cancer.Cancer Nurs.1999;22:185–194.[PubMed]
  4. Cancer Nurs. 2015 Jan-Feb;38(1):60-70. doi: 10.1097/NCC.0000000000000128.
  5. Akman, T., Yavuzsen, T., Sevgen, Z., Ellidokuz, H. and Yilmaz, A. U. (2015), Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index. European Journal of Cancer Care. doi: 10.1111/ecc.12296
  6. Rumble ME, Keefe FJ, Edinger JD, Affleck G, Marcom PK, Shaw HS. Contribution of Cancer Symptoms, Dysfunctional Sleep Related Thoughts, and Sleep Inhibitory Behaviors to the Insomnia Process in Breast Cancer Survivors: A Daily Process Analysis. Sleep. 2010;33(11):1501-1509.
  7. De Bella et al (2013), Melatonin Anticancer Effects: Review, Int J Mol Sci. 2013 Feb; 14(2): 2410–2430.
  8. http://www.cancercenter.com/community/newsletter/article/addressing-sleep-problems-in-cancer-patients/
  9. J Community Support Oncol.2015 Apr;13(4):148-55. doi: 10.12788/jcso.0126. / http://www.ncbi.nlm.nih.gov/pubmed/25978413
  10. Eur J Oncol Nurs.2015 Mar 14. pii: S1462-3889(15)00021-6. doi: 10.1016/j.ejon.2014.12.008. / http://www.ncbi.nlm.nih.gov/pubmed/25782721

Additional references