By Anna Medaris Miller for U.S. News
Traci Gordon never had a problem falling asleep or staying asleep. In fact, she has a sleep disorder that causes her to sleep too much. “I could sleep through a whole weekend,” Gordon says.
That all changed when Gordon, a 47-year-old administrative assistant in New York, began chemotherapy for breast cancer about seven years ago. The treatment threw her body into an artificial state of menopause, which caused unrelenting night sweats.
“My memory of it was waking up five, six, seven times a night, absolutely dripping,” Gordon says. Each time, she would change her clothes, stand in front of the air conditioner and wonder how much of her fatigue was caused by the cancer, how much was caused by the treatment and how much was caused by her inability to sleep through the night. “It was really having an impact on top of everything else,” she says.
Sleep problems during cancer are ubiquitous, affecting up to 80 percent of people undergoing chemotherapy, says Oxana Palesh, an assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University Medical Center who develops and tests sleep interventions for cancer patients and survivors. One of her studies found that insomnia is about three times more prevalent among cancer patients being treated with chemotherapy than it is in the general population. When you have cancer, Palesh says, "it's much more common to have sleep problems than not."
But at the same time, sleeping well during cancer treatment is critically important in fighting the disease. Without solid rest, the body’s level of cortisol -- known as "the stress hormone" -- goes up and the count of “natural killer cells,” or NK cells, that help fight cancer go down, says Dr. Laeeq Shamsuddin, medical director of the sleep clinic at Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois.
Poor sleep might even shorten some cancer patients’ survival, Palesh’s preliminary work suggests. “There is a lot of comorbidity between poor sleep and depression, poor sleep and post-traumatic stress disorder, poor sleep and increase in pain,” says Palesh, who directs the Stanford Cancer Survivorship Research program. “Literally, it doesn’t make one thing better.”
When Good Sleep is Out of Reach
Anyone who’s ever lain awake counting sheep, stressing about a work project or ruminating after a fight with a partner knows how hard it is to get a good night’s rest just when you need it most.
Now add cancer to the mix, and it’s easy to see why quality sleep is fleeting. A cancer diagnosis is scary, stressful and anxiety-provoking; cancer treatment can cause side effects including pain, gastrointestinal problems and nausea; and life with cancer often means sleeping at odd hours or in unfamiliar places like a hospital. “Everything they say to promote healthy sleep habits… you’re not doing that,” says Gordon, who’s currently undergoing chemotherapy again for breast cancer in her other breast.
For Kym Sinclair, a 31-year-old nurse in Santa Cruz, California, some of the most significant sleep disruptions from cancer were psychological. As a former college athlete with no family history of cancer, Sinclair’s Hodgkin’s lymphoma diagnosis at age 27 came as a shock. “I went from being the single ER nurse living in downtown Sacramento with my own cute little apartment to ‘I’m dependent on other people, I’m not working and I’m now the patient,’” she says.
That abrupt loss of identity sent Sinclair on a tailspin toward anxiety and depression. “All I wanted to do was sleep and get away from it… but the anxiety and depression keep you up,” she says. “That’s your first dance with not being able to sleep but wanting to do nothing but sleep.”
As she began chemotherapy, Sinclair struggled with side effects, including bone aches, vomiting, nausea, gastrointestinal distress and the chills -- all of which put a good night’s sleep further out of reach. “You just can’t ever get comfortable. You just constantly feel like you have the flu,” she says.
And when Sinclair tried to catch up on the sleep she missed by napping during the day? There was the neighbor mowing the lawn or the other neighbor’s dog barking. “All you want to do is sleep, but life goes on,” she says. “It can’t just stop because you want to take a nap.”
Achieving Sweet Dreams
Gordon, the administrative assistant in New York, clearly remembers waking up after her first solid night’s sleep following her first battle with breast cancer. It was exactly one month after she finished radiation treatments, and her period returned. “I sat up in bed the following morning, and I was so disoriented,” she recalls. “My body was just kind of in shock -- what just happened? What day is it? And that’s what really drilled home just how much my sleep had been disrupted.”
Gordon’s current treatment is causing some of the same sleep problems she had before, but she’s looking into solutions like acupuncture at her cancer center’s integrative health department. She’s also more persistent when it comes to asking her health care providers how treatment might affect her sleep. When Gordon pressed a nurse for details on chemotherapy side effects, for example, the nurse mentioned that the steroids -- prescribed to quell some of the treatment’s side effects -- could make her more wired. “I was so relieved that she had told me that rather than me tossing and turning,” Gordon says.
It's important that patients talk to their primary care doctor or oncologist about sleep during cancer treatment in part because sleep disorders -- among people with and without cancer -- are treatable, says Cancer Treatment Centers of America’s Shamsuddin. In most cases, he says, the approach to treatment is the same. “There are about 70 known sleep disorders out there, and any one of those can obviously affect cancer patients,” he says. “Treating them helps to improve [patients’] tolerance to chemotherapy, radiation therapy, as well as their physical, psychological and cognitive functioning.”
With sleep apnea -- the most common sleep disorder -- patients at CTCA’s sleep center are counseled on behavioral changes known to help with the condition, such as weight loss and sleeping on their sides rather than their backs. Patients with more severe cases might get a continuous positive airway pressure machine, a device that helps keep airways open.
“[Cancer patients] are going through so much, and they’re going to be fatigued from the chemotherapy regardless,” Shamsuddin says. “But if we can at least avoid them being fatigued from sleep apnea or any other sleep disorder, that’s going to affect their quality of life and their energy level and their overall outlook tremendously.”
For Sinclair, who has been cancer-free for three years and now works in an oncology unit, learning to make time for naps, limit visitors and take care of herself through yoga, massages and other integrative therapies helped during treatment and beyond. Before cancer, she says, “I could work a 16-hour shift and go grab a beer with friends afterward and then go to sleep for 10 hours… I knew how to function on little rest.” Now, she's always in bed by 9 p.m. “It’s been a difficult behavior to change,” she says.
Still, developing healthy sleep behaviors early is necessary, says Palesh, who is testing an intervention that brings mental health professionals to cancer patients' bedsides to educate them about sleep problems during treatment and the importance of addressing them. Her team also uses behavioral strategies to help patients associate their beds with sleep -- not reading, watching TV, working or being awake.
"We don’t want to see patients who recover and [finish] chemo and radiation and whatever other treatment they receive and still suffer long-term sleep problems," Palesh says. "It’s always easier to treat things when they first appear than when they become chronic.”
When You Have Cancer And Can't Sleep originally appeared on U.S. News & World Report.
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