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Cancer's Toll on Sleep

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  • Cancer's Toll on Sleep

    Cancer's Toll on Sleep

    Many people have trouble cutting off racing thoughts so they can drift off into sleep?or find that they can't stay asleep though the night. So it's probably not a surprise to learn that up to 50 percent of people with cancer report sleep problems. And it's not just stress that is keeping them awake. Medication, treatment side effects and pain can also interfere with someone with cancer's ability to get a decent night's sleep.
    Few people with cancer share their sleep problems with their doctors. But Jos?e Savard, PhD, a professor of psychology at Universit? Laval, Qu?bec says they should speak up because help is available. Below, Dr. Savard and Sonia Ancoli-Israel, PhD, a professor of psychiatry at the University of California, San Diego, talks about the impact of cancer on sleep.

    How common are sleep problems in people with cancer?
    JOS?E SAVARD, PhD: Around 30 to 50 percent of cancer patients report sleep difficulties. It is difficult with the limited medical literature we have to comment on the cancer types that are more likely to cause sleep difficulties.

    SONIA ANCOLI-ISRAEL, PhD: The research that's been done on sleep and cancer has been primarily in breast cancer, lung cancer or colon cancer. These surveys have shown that patients with breast and lung cancer complain of sleep problems more than other types of cancers, but most cancers haven't been studied yet.

    What type of sleep difficulties do cancer patients experience?
    JOS?E SAVARD, PhD: Generally, cancer patients report mixed types of sleep difficulties. So they have difficulties both initiating sleep and maintaining sleep overnight.

    Why do sleep problems occur in people with cancer?
    SONIA ANCOLI-ISRAEL, PhD: We don't really know exactly what's disturbing sleep in cancer patients. The little that we know about sleep and cancer suggests that anything that causes pain and discomfort is going to disrupt sleep. So whether it be the patient with lung cancer who is coughing or the patient with colon cancer who is having GI problems and diarrhea, the discomfort they are experiencing is also going to disrupt sleep at night.

    But the major factors are probably the depression, the stress and the physiological changes that are going on in the body as a result of the cancer and the treatment of cancer.

    JOS?E SAVARD, PhD: Cancer patients may worry about a lot of things. First, they may worry about the consequences of the diagnosis, their treatments and the side effects. And when the treatments are over, then they tend to worry about the future: "Am I going to have this cancer again?"
    How do cancer therapies affect sleep?
    JOS?E SAVARD, PhD: Sleep difficulties are associated with each type of cancer treatment but for different reasons. For example, radiation therapy can lead to fatigue and people who are fatigued tend to spend too much time in their bed, so they tend to develop bad sleep habits that may lead to insomnia.

    Hormone therapy is another common cancer treatment. It can cause hot flashes during the night, which may interfere with sleep. Chemotherapy can cause premature menopause or aggravate menopausal symptoms, and that too can cause hot flashes that may interfere significantly with sleep. Chemotherapy can also cause nausea, and some anti-nausea medications, which are used to treat nausea, can also disturb sleep.

    Some types of cancer and cancer treatment can cause intestinal problems such as diarrhea and urinary problems. So people are awakened because they feel pain, discomfort or because they have to urinate during the night. Also, surgery for prostate cancer, and abdominal radiation can cause urinary incontinence and intestinal problems.

    What are the consequences of insomnia?
    JOS?E SAVARD, PhD: Insomnia in cancer patients clearly affects quality of life, including cognitive functioning, mood and energy levels.

    SONIA ANCOLI-ISRAEL, PhD: Not sleeping well at night is going to make everything harder during the day. So when patients have to go through their treatment during the day, it might be harder for them to tolerate some of the side effects if they're sleep deprived. It would also be hard for them to deal with relationships because it makes them even more irritable then they might ordinarily be from the chemotherapy or other treatment.

    To what degree does insomnia become a long-term problem for cancer patients?
    JOS?E SAVARD, PhD: Our data suggests that most of the cancer patients with insomnia will develop chronic insomnia, which is having sleep difficulties for more than six months. So it is very important to offer them an appropriate intervention early on.
    Can insomnia affect recurrence?
    JOS?E SAVARD, PhD: A common misconception that cancer patients with insomnia entertain is that insomnia will increase their probability of having a cancer recurrence. So far, we have no evidence it is at all implicated in the cancer progression.
    Are people with cancer seeking help for their insomnia?
    JOS?E SAVARD, PhD: We know that cancer patients are underreporting their sleep difficulties to their physicians. There may be several reasons. One of them is probably the short duration of the meetings that they have with their physicians. Also both physicians and patients may think is a minor problem, a short-term problem that will fade out with time.

    What treatment is appropriate?
    SONIA ANCOLI-ISRAEL, PhD: Emotional support in general is very important for a person with cancer. If they don't have a partner or friends that can give them that support, then they should seek out a support groups. The more emotional and psychological support they have, the better they will be able to deal with their cancer, and the better they're able to deal with the cancer, the more likely it is they will sleep well at night.

    Then, of course, there are a variety of sleep aids that people can use to help them sleep better at night. It's very important however to talk to your physician before you start any medications whether it's a prescription or over-the-counter medication. You need to be sure that these aren't going to interact negatively with your chemotherapy and your other treatments. Not that there have been any studies suggesting that there would, but it's always important to check with your doctor.

    What are some strategies for sleeping better?
    SONIA ANCOLI-ISRAEL, PhD: We know very little about the best ways to treat sleep in cancer patients in particular. Nevertheless, the lessons we've learned really apply to everybody so one of the first things that cancer patients need to do is learn what we call " good sleep hygiene." Just like you brush your teeth and wash your face every night before you go to bed, there are certain rules that one needs to live by to improve their sleep.

    JOS?E SAVARD, PhD: Behavioral strategies include very simple rules that people need to follow, such as go to bed only when you feel sleepy, don't spend too much time in bed not sleeping, don't stay in bed if after 15 or 20 minutes you are still awake. And the most important strategy is to stay in bed only for the duration of your sleep. Another goal is to re-associate the bed with sleeping. So people with insomnia are instructed not to do other things in their bed than sleeping and sexual activities. For cancer patients who feel fatigued, we suggest they nap early on during the day, ideally before three in the afternoon, and to nap in places other than their bedroom.


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