Kathy McKinney got through the surgery, the chemotherapy and the radiation.
Why, she wondered, did she still feel so bad?
Even though her treatment at MD Anderson had been successful, she spent her days groggy and tired.
“It felt like a hangover,” McKinney says, “but I am not a drinker.”
Relief came after a referral to the sleep experts at MD Anderson, one of only a few cancer hospitals in the country with a sleep lab onsite.
It just makes sense, says Diwakar Balachandran, M.D., professor of Pulmonary Medicine and sleep center director.
“Sixty percent of all cancer patients have some type of sleep disorder.”
McKinney quickly was diagnosed with sleep apnea, a problem she probably had before her breast cancer. Other patients tell Balachandran that they slept perfectly well before their diagnosis and treatment, but not after.
Sleep trouble and treatment
Claudine James, for example, developed sleep problems after treatment for breast cancer in 2000.
“My biological clock is off,” James says. “I’m really fatigued during the day, but I could easily stay up all night.”
Patients like James reinforce Balachandran’s conviction that cancer and cancer treatments can trigger sleep issues – and his hope that dealing with those issues can have a positive effect on cancer outcomes.
He is only half-joking when he says the anticipation of such breakthroughs disturbs his own sleep.
“Animal models suggest a link, but we haven’t found it in humans,” Balachandran says. “That’s the promise … the Holy Grail.”
A young doctor’s awakening
Balachandran grew up in Chicago and attended medical school at Northwestern University. During a pulmonary critical care fellowship at the University of Chicago, the young doctor was introduced to the developing field of sleep medicine. Specialists had to be experts in pulmonology, neurology and chronobiology – the study of the natural physiological rhythms of organisms. And, a passion for research helped, too.
After a second fellowship in sleep medicine at Beth Israel Deaconess Medical Center in Boston, Balachandran was hooked. When he and his wife moved to Houston in 2003, he helped start a sleep lab for underserved patients in what was then the Harris County Hospital District. In 2005, he moved to MD Anderson, where he, Lara Bashoura, M.D. and Saadia Faiz, M.D., both associate professors of Pulmonary Medicine, opened the sleep center the following year.
The power of sleep
Since then, the staff has treated and maintained research data on almost 4,000 cancer patients. One challenge, Balachandran says, has been to convince both patients and oncologists that sleep problems are important and shouldn’t be ignored during cancer treatment.
Balachandran and other experts already have shown that improved sleep quality can relieve cancer-related symptoms including fatigue, pain and mood disturbance. Also, numerous studies illustrate that treating cancer-related insomnia reduces inflammation, which may have an impact on the disease. What Balachandran hopes to prove one day is that sleep treatments can have a positive effect on tumor growth, metastasis and mortality.
Meanwhile, McKinney, 58, and James, 48, are grateful for the relief they’ve received.
To deal with her sleep apnea, McKinney uses a CPAP machine and mask every night at bedtime. They allow her to start each day refreshed and rested.
“Before the CPAP, I couldn’t even complete a sentence,” says McKinney, a retired elementary school secretary. “Now I’m kayaking, gardening and driving back and forth from Houston to our lake house. I can do anything I want to do.”
James, a federal administrative judge, still wrestles with the unfortunate combination of sleepiness and insomnia. But after consulting with Balachandran and spending two nights at the sleep lab, she takes medication to help her with the daytime sleepiness. At night, on her own, she is able to get five hours of rest. She doesn’t take a sleep aid because she wants to keep her prescriptions to a minimum.
“I was worried that the sleep problems could destroy my career, but with my medication, they’re manageable,” James says. “Dr. Balachandran definitely made my life better.”