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Better Night's Rest Might Improve Outcome

CancerWise - January 2007

By Renee Twombly

Helping cancer patients sleep may seem like a minor issue, but physicians understand that therapy often promotes loss of sleep and that patients with sleep disorders are less likely to tolerate treatment regimens.

“Studies say that between 50% to 80% of cancer patients complain about difficulty sleeping, so we need to understand the relationship between sleep and cancer and how we can improve a patient’s quality of life and care,” says Diwakar Balachandran, M.D., assistant professor in the Department of Pulmonary Medicine and director of the Sleep Disorders Clinic at M. D. Anderson.

Prescribing a good night’s sleep

For instance, a patient recently came to the clinic with a common story to tell, and Balachandran was there to listen and lend a hand. This breast cancer survivor, one year past treatment, was drowsy all day and depressed, and she suffered from lack of energy. Balachandran suggested she sleep overnight in a special M. D. Anderson laboratory and found she had severe obstructive sleep apnea.

Balachandran prescribed a device to help her get a good night’s rest, and within two weeks the patient discontinued medications for depression and made plans to return to work.

Disorders are treatable

To further understand the role of sleep in cancer and treatment, M. D. Anderson opened the Sleep Disorders Clinic in October 2006. It includes a four-bedroom, state-of-the-art sleep laboratory that is believed to be the only facility of its kind in the nation at a comprehensive cancer center.

At the clinic, patients see sleep specialists. Some sleep disorders may be correctable with biofeedback techniques or by simply managing a patient’s sleep environment.

“Going to bed at the same time every night or only when you are sleepy, and not watching television in bed can make a big difference,” Balachandran says.

Other patients have a series of tests that record physiological changes that occur during sleep, such as eye movement, muscle activity, heart and brain rhythm.

Help offered for common disorders

The two most prevalent sleep disorders in the general population - and very likely in cancer patients - are:

Sleep-disordered breathing (including sleep apnea) - People with sleep apnea stop breathing at times during the night. This is due to an airway that is blocked by the tongue or because the brain “forgets” to signal the respiratory system to breathe.

Those with sleep apnea often don’t realize they have the condition. It can lead to other problems such as high blood pressure, heart disease and stroke.

Treatments include:

  • CPAP (Continuous Positive Airway Pressure) - Face mask that blows pressurized air
  • Lifestyle changes
  • Medical attention to co-existing illnesses

Sleep-related movement disorders - People with movement disorders feel the need to move around and have trouble falling asleep.

In cancer patients, the problem can stem from anemia or damage to the nerves in the feet. This may be the result of chemotherapy.

Other sleep disorders include:

  • Excessive daytime sleepiness
  • Disorders, such as night terrors or sleepwalking, that interrupt sleep
  • Nocturnal seizures

Most conditions are treatable, Balachandran says.

“There are therapeutic options for pretty much all of the sleep disorders we study,”
he says.

Studying the sleep-cancer connection

In addition to providing access to the latest diagnostic and therapeutic tools, the sleep clinic will initiate research into the relationship between sleep and cancer.

Sleep disorders can have an impact on treatment, Balachandran says:

  • Fatigued patients are:
    • Less likely to comply with therapy
    • Likely to miss appointments
  • Perception of pain is sharper in the sleep deprived
  • Some disorders increase inflammation, which may contribute to cancer growth
  • Sleep is linked to the immune system, and disruptions can alter immune function

“We don’t know if sleep disorders affect how successful cancer therapy can be, but one of the research goals of the center is to explore that link,” Balachandran says.

“It may be that we can improve the treatment outcome of our patients while also providing more restful sleep,” he says. “That would be a great benefit.”

M. D. Anderson resources:

© 2015 The University of Texas MD Anderson Cancer Center