House Call: Sleep Problems in Cancer Patients
Getting a good night’s rest is important for everybody, especially cancer patients, who often experience fatigue from the disease or its treatment.
Sleep disorders can impair cancer patients’ quality of life and even treatment outcomes, but fortunately these disorders can usually be managed.
Sleep disorders and their effects
According to the National Cancer Institute, as many as half of patients with cancer report some type of sleep disorder.
The five major sleep disorders are
- insomnia, the inability to fall asleep and stay asleep;
- sleep apnea, breathing stops of 10 seconds or more during sleep;
- hypersomnia, difficulty staying awake during the day;
- circadian rhythm disorder, the inability to sleep and wake at the right times; and
- parasomnia; acting in unusual ways—for instance, walking, talking, or eating—while falling asleep, sleeping, or waking from sleep.
The most common sleep disorders in cancer patients are circadian rhythm disorder and insomnia. In fact, cancer patients are twice as likely to experience insomnia as are people without cancer. Sleep apnea also is more common among cancer patients than in the general population and may be caused by the location of the tumor or side effects of medications.
Sleep problems can be made worse by many cancer-related factors, including pain, anxiety, depression, side effects of treatment, and overnight hospital stays.
Unfortunately, poor sleep can have a negative impact on cancer treatment. Cancer patients who are not sleeping well may feel pain more intensely and may have more trouble tolerating some treatments than do well-rested patients. Because sleep affects the immune system, sleep disruption may also reduce the body’s ability to fight infection.
Managing sleep problems
To determine whether a cancer patient has a sleep disorder, a doctor will perform a physical examination and take a medical history, asking about daytime and sleep habits, exercise routine, and medications. Sometimes a sleep test called polysomnography will be given. Conducted during an overnight stay at a sleep center, the test provides information about the patient’s sleep stages, blood oxygen levels, breathing, muscle tone, heart rate, and general sleep behavior.
Fortunately, most sleep problems can be treated.
A person suffering from sleep apnea might be treated with a continuous positive airway pressure device, a face mask that helps keep the airway open during sleep. Other sleep disorders might be addressed by taking prescription medications, by making lifestyle changes that promote better sleep, by treating another illness that contributes to the sleep problem, or by relieving side effects of cancer or cancer treatment that disrupt sleep.
Medications for insomnia are usually only a short-term solution. More effective in the long run are managing stress and anxiety and treating a patient’s fatigue.
Cognitive behavioral therapy (CBT) also has proven effective in treating insomnia while reducing by half the need for sleep medications by cancer patients. CBT helps reduce anxiety about getting enough sleep.
Depending on the patient’s needs, CBT may include stimulus control therapy, which trains the patient to associate the bedroom only with sleep; relaxation therapy, which teaches techniques such as progressive muscle relaxation and guided imagery to relieve muscle tension and stress; and sleep hygiene, which teaches behaviors that promote healthy sleep. The new behaviors could include developing a relaxing bedtime ritual; getting out of bed if sleep is difficult and returning only when sleepy; and making the bed and bedroom more conducive to sleep by controlling light, temperature, and noise.
The American Cancer Society offers several tips that people with cancer can use to ensure they get a good night’s rest:
- Sleep as much as your body tells you to.
- Try to exercise at least once a day, but don’t exercise close to bedtime.
- Avoid alcohol in the evening and caffeine for 6–8 hours before bedtime.
- Drink warm, caffeine-free drinks, such as warm milk or decaffeinated tea, before sleep.
- Go to sleep in a quiet setting at the same time each night.
- Take prescribed pain relievers or sleeping medicine at the same time each day.
- Keep bed sheets clean and neatly tucked in.
- Have someone rub your back or massage your feet before bedtime.
Cancer patients should discuss any sleep problems with their health care team. Resolving sleep issues can improve a patient’s response to cancer treatment and address some related health problems such as high blood pressure. In addition, getting regular restorative sleep can improve a patient’s daily quality of life, immune system, and cognitive abilities.
– K. Stuyck
For more information, talk to your physician and request a consult with a sleep physician or call askMDAnderson at 877-632-6789.
OncoLog, June 2014, Volume 59, Issue 6