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Cancer Patients Need to Treat Sleep Disorders

CancerWise - February 2008

By Darcy De Leon

Patricia Pillow

Breast cancer survivor Patricia Pillow had heard that radiation therapy could cause fatigue, so when she began feeling very tired after treatment, she thought she knew why. As time went on, she also began having trouble falling asleep and staying asleep.

"It was terrible. I'd be awake for hours, or I'd fall asleep and be right back up again," says Pillow, a widow who recently moved from Houston to Magnolia, Texas. "I was a mess. I wasn't sleeping. It felt like I was getting a series of cat naps. During the day I was tired, and a few times I started to doze off while driving."

During treatment, Pillow lived alone in a recreational vehicle park near
M. D. Anderson. It wasn't until she returned home where she lived with her sister, Janet Claffey, who noticed her snoring and gasping for breath during sleep, that Pillow began to wonder if she might have a sleep disorder.

A referral to M. D. Anderson's Sleep Center led to a diagnosis of obstructive sleep apnea syndrome, a condition in which the airway closes and a person repeatedly wakes up after breathing stops. Pillow's problem has since significantly improved by using a breathing device called CPAP (Continuous Positive Airway Pressure).

“Inadequate sleep can lead to serious health problems and accidents,” says Diwakar "Dave" Balachandran, M.D., sleep center director and an assistant professor in the Department of Pulmonary Medicine. “Getting enough quality sleep is important for everyone, especially cancer patients, who need rest to tolerate treatments, recover and maintain their health and quality of life.”

Pillow wakes up more than 100 times during study

It's estimated that between 50% and 80% of cancer patients have some kind of difficulty sleeping, Balachandran says.

Patients may have had a sleep disorder prior to cancer or may have developed sleep problems as a result of the cancer or cancer treatment. Anything that blocks a person's airway or causes it to swell can cause sleep apnea, Balachandran says. Sleep problems also can be caused by restless-leg syndrome and periodic limb movement disorder, conditions in which a person's leg or other limb moves involuntarily during sleep, waking the person.

Causes of sleep apnea in cancer patients include:

  • Chemotherapy or radiation to the head and neck
  • Weight gain from cancer drugs

People with chronic, insufficient sleep or sleep apnea have a higher risk of diabetes, high blood pressure, obesity, cardiovascular disease and death, Balachandran says. Sleep disorders also affect the immune system and endocrine (hormonal) function, since hormones are produced during certain levels of sleep.

Pillow had been diagnosed with borderline hypertension before she arrived at the sleep center in October 2007. She reported trouble with her memory and continuous exhaustion despite sleeping nine hours a night and taking 30-minute naps several times a week, Balachandran says.

Pillow learned she had classic sleep apnea symptoms:

  • Incidents when breathing stops and other people notice
  • Loud snoring

She then underwent a sleep study, which measured:

  • Brain activity
  • Eye movement
  • Muscle activity
  • Heart rate
  • Pulse rate
  • Air flow
  • Respiratory effort
  • Blood oxygen saturation
  • Sleeping position
  • Snoring

During the study, her oxygen level, which needs to remain in the high 90s, dropped into the 80s and near 70 as she entered "dream sleep" or the level known as rapid eye movement (REM). She also had 165 incidents in which she stopped breathing or her breathing slowed, causing her to wake up 126 times.

“Every minute she had more than two breathing events, so no wonder she was tired,” Balachandran says. “When you stop breathing, your carbon dioxide level rises, and your oxygen level drops. Your brain responds by waking you up, so you can open your airway.”

Treatment tested during second sleep study

Based on the study results, Pillow underwent a second sleep study using CPAP. It involved wearing a face mask connected to tubing that blew pressurized air into her mouth to keep her throat open during sleep.

“The air goes in through the nose or mouth and acts as a stent to keep the airway open during sleep,” Balachandran says.

During the treatment study, Pillow's oxygen levels remained above 90, and the number of times she woke up dropped from 126 to 38.

Pillow can further reduce the number of arousals by losing weight, Balachandran says. People with a body mass index (BMI) of 30 or greater are at risk for the sleep disorder, he says.

(BMI can be calculated through the National Institutes of Health Internet site.)

Happy dreaming comes at last

Losing weight is definitely on Pillow’s to-do list. In the meantime, she couldn’t be happier with how treatment has improved her sleep, daily functioning and quality of life.

“It has been a remarkable change," Pillow says. "I was having a terrible problem with not being able to sleep. I had big circles under my eyes and looked awful. When I went back for my five-week followup appointment in the sleep center, the circles were gone. I felt good and had more energy because I was sleeping through the night."

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