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How To Master Good Sleep During Cancer Treatment: Insomnia and Cancer

Small changes in routine can fetch you quality sleep.

"Sleep is one of the most effective things we can do each day for the health of our brain and body” ― Matthew Walker, PHD

Having a good night’s sleep goes a long way in maintaining the quality of your life and with recovery during cancer treatment. Apart from the stress of having cancer, the fatigue associated with the treatment as well as the side effects of cancer treatment can all lead to sleep problems or insomnia. Sleep problems such as the ability to fall asleep and stay asleep can also be related to other treatment-related consequences including hot flashes and sleep apnea. These problems can be short term during treatment but also long term, lasting for many months or years post-treatment and recovery.

Assessing your sleep quality and quantity

Sleep quality is the measurement of how well you are sleeping, that is, whether your sleep is restful and restorative. It differs from sleep satisfaction, which refers to a more subjective judgment of how you feel about the sleep you are getting. Poor sleep quality is characterized by several factors. In general, If it takes you longer than 30 minutes to fall asleep, if you wake up during the night more than once, or if it takes you longer than 20 minutes to drift back asleep after waking up, your sleep quality is considered poor. A specialist can evaluate sleep quality through sleep studies and instruments such as the Pittsburgh Quality Sleep Index (PSQI). The PSQI is a series of questions about sleep-related behaviors and is used in both clinical and research settings. A common test is polysomnography, where patients are observed overnight in a sleep laboratory. Other tests can include multiple sleep latency tests, where the patient’s ability to fall asleep is measured, the maintenance of wakefulness test, and tests to determine the severity of daytime sleepiness. While these tests can be part of the evaluation, there are some well-known and not so well known sleep habits that can help you try to overcome insomnia. Often, it's a combination of tips and they work only if you are disciplined and consistent.

  • Stop exposure to blue light (your phone, iPad, TV, etc.) at least 2 hours before bedtime. Blue light suppresses the production of melatonin, the hormone that your body makes that makes you sleepy. Even small amounts of exposure can have a large effect on your sleep cycle. If you must get on your electronic device, wear glasses that block blue light or download an app such as f.lux to block blue light on your laptop or computer. You can also use your smartphone to download a blue light blocking application. These work on both android and apple devices.

  • Your bedroom should be dark and cool with a temperature between 65-73 degrees. If you have an electronic clock, keep the face turned away from you.

  • Don’t eat a heavy meal or exercise for 2 hours before bedtime.

  • Learning to relax and help your body to sleep is an art and one thing that helps is learning to breathe the 4-7-8 technique. In this, you inhale for 4 seconds, hold for 7 seconds and exhale slowly for 8 seconds. Consistent practice is key. This is a great way to calm yourself.

  • The left nasal breathing exercise is another respiration technique. Shut your right nostril and mouth. Keep your eyes closed and concentrate on inhaling via your left nostril and exhaling via your left nostril. Allow your inhalation to be a little slower and your exhalation to be a little longer. It likely will not be possible the first time around. It may take some days or perhaps a few weeks, but the more you practise it, the better you will become at it. This technique teaches your parasympathetic nervous system to relax, which allows air to enter all of your body's cells and enhances restful sleep.

  • Stay away from alcohol and no caffeine after noon time.

  • Keep a sleep schedule - that means your sleep time and wake times should be the same every day. Lull your body into a rhythm that works for it, not against it.

  • Taking a warm bath about an hour or so before your sleep time or even soaking your feet in warm water can help you fall asleep.

  • Try not to drink a lot of fluids about 2 hours prior to going to sleep. Waking up to pee can affect your sleep quality and make it harder to go back to sleep.

Cancer and sleep issues

As a cancer patient, If you continue to have trouble sleeping, talking to your cancer care team or your family doctor can get you the support you need.

  • Tell your doctor if you're experiencing difficulties sleeping. Treatment for concerns like pain or any other side effects including bladder issues or stomach issues may help you sleep better.

  • Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote relaxation and sound sleep These techniques include meditation, muscular contraction and relaxation, guided visualisation, and biofeedback.

  • Establish good nighttime routines. Always go to bed when you're tired, in a dark, silent room with a comfortable bed. If you can't sleep, get out of bed and go back to sleep only once you are ready. While daily exercise is part of good health, exercising at hours close to bedtime may make falling asleep challenging.

  • If other methods fail, your cancer care team may suggest sleep medicine for a limited time. The type of sleep medication will be determined by your individual issues (such as difficulty falling or staying asleep) as well as based on other medications you take.

A good night’s sleep is critical for your physical, emotional and mental well being apart from helping you to think with clarity, maintain optimal blood pressure, improve your appetite, and enhance your immune system. Chronic insomnia or sleep disturbances can result in mood disturbances such as depression or anxiety which can further worsen your ability to deal with cancer related issues.

While there are so many supplements that are recommended on the web and by your friends and family, they may interact with your cancer treatment or may not suit you. These include over the counter supplements such as melatonin and valerian root. These supplements can interfere with your cancer treatment so please let your health professionals know before starting any supplement and definitely try these techniques before you start on supplements. They just might do the trick!

Connect with your Cancer care team

If you have insomnia, make a list of questions to ask ahead of time to help you prepare for your appointment. Here are some questions that can help you frame your discussion with your care team:

  • Why am I having such a difficult time falling asleep?

  • Do any of the medications I am taking cause insomnia?

  • Should I go to a sleep clinic? Will my insurance cover it?

  • Are there any brochures or other printed material that I can have?

  • In what ways can I enhance my sleep?

  • Is it necessary for me to take sleeping pills?

Reason to hope: Adolescents and young adults who have survived cancer often continue to suffer from insomnia long after treatment ends, interfering with a range of daily activities. In a study published today by Pediatric Blood and Cancer, researchers at Dana-Farber Cancer Institute show that an online program developed specifically for AYA cancer survivors can significantly alleviate insomnia and improve the overall quality of life.

Pediatric Blood & Cancer, 2020; e28506 DOI: 10.1002/pbc.28506

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Reason to Hope

There is new research from Brigham and Women’s Hospital that indicates a Western-style diet that is rich in red and processed meat, sugar and refined grains/carbohydrates is tied to higher risk of colorectal cancer through the intestinal microbiota.  Gastroenterology, 2022;DOI:10.1053/j.gastro.2022.06.054 

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