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Breast Cancer's Impact on Sleep

Treatments, and Stress, Can Rob Patients of Rest

By Nancy Larson

Updated November 13, 2009

(LifeWire) - Getting adequate sleep -- and the right kind of sleep -- is important to good health. Yet nearly half of all cancer patients, and perhaps even more breast cancer patients, have difficulty sleeping. So what causes such sleep problems, and what can be done about them?

Sleep disturbances during breast cancer treatment can have many sources, including the emotional toll of a cancer diagnosis, the physical impact of its treatment and the side effects of medications, often including those prescribed to reduce other treatment-related side effects.

Sources of Sleep Disturbance

The very therapies that help save lives can keep patients from getting the sleep they need. Sleep-disrupting side effects include:

  • fatigue
  • pain
  • night sweats or hot flashes
  • nausea and other gastrointestinal problems, such as diarrhea and constipation
  • anxiety

Fatigue is common in chemotherapy and radiation therapy. In chemotherapy, the effects can last for days after treatment ends and sometimes longer. Fatigue due to radiation therapy can persist for up to 3 months after the last session.

If pain is the problem, better pain control might be the answer. For example, pain may be controlled with Percodan (aspirin and oxycodone) or another pain reliever prescribed by a physician.

Patients whose cancer needs estrogen to grow -- known as estrogen receptor-positive breast cancer -- may be prescribed Nolvadex (tamoxifen), which reduces the estrogen available to cancer cells. Tamoxifen can slow tumor progression and reduce the risk of recurrence. Unfortunately, it may also induce insomnia and sleep-disrupting hot flashes and night sweats.

Steroids that are often prescribed to combat the nausea and vomiting of chemotherapy can also cause insomnia, especially if taken within a few hours of bedtime.

Anxiety and depression can also interfere with sleep, as can a lack of or reduction in exercise.

If you're facing any of these sleep problems, you do have options.

"Need Some Sleep"
Photo © Mayr
Tips for a Good Night's Sleep

One important step is to have your doctor review all your prescription and over-the-counter (OTC) medications, including herbal remedies and dietary supplements, to see if they're contributing to your difficulties. Your physician might suggest changing your daily medication schedule to lessen the problems.

Altering other aspects of your daily or nighttime routine can also help. Try to practice good "sleep hygiene," which requires maintaining a consistent schedule for waking and sleeping, and avoiding anything near bedtime that could cause sleep to be more difficult.

Specific steps to take:

  • Set a regular bedtime and wake-up schedule, and stick to it.
  • Get daily exercise, but not within 3 hours of retiring to bed.
  • Avoid caffeine after 3 p.m., or earlier if it still causes problems.
  • Resist napping, especially in the afternoon.
  • Monitor your fluid intake. As evening nears, don't drink so much that you'll be up during the night.
  • Avoid heavy snacks or alcohol within 3 hours of bedtime.
  • Reserve your bedroom for sleeping and sex. Keep the television and computer out of the bedroom.
  • Keep the room dark, quiet and cool.
  • Relax for an hour before bedtime by taking a bath or reading a book.
  • Practice relaxation techniques, such as deep breathing.
  • If sleep doesn't come after 20 minutes, get up and do something relaxing.

When to Consider Sleep Medications

Before resorting to sleep medications, you may want to ask your doctor about other options. If anxiety or depression is the problem, you might consider therapy or a support group. Your physician might also recommend antidepressants or anti-anxiety medications. However, note that these medications can cause daytime drowsiness and other side effects.

You might also discuss herbal remedies, such as St. John's Wort, chamomile tea or black cohosh. There's little scientific evidence for the effectiveness of these therapies, but they do have few or no side effects with short-term use of less than 6 months. It's important to note, however, that patients on tamoxifen should avoid taking St. John's wort; the supplement can reduce the amount of the drug in the body, and therefore its effectiveness. Black cohosh is said to combat the hot flashes of the menopausal transition and may help with those associated with estrogen-limiting medications, such as tamoxifen.

If sleep problems worsen or persist beyond 4 weeks, you may want to try a sleep medication. Your physician might suggest OTC or prescription sleep medications, but these, too, can disrupt sleep cycles. Although best regarded as a last resort, sleep medications may offer short-term relief.

The widely prescribed sedative Ambien (zolpidem) might be an option, but this drug and other so-called sedative-hypnotics can also have significant downsides. In December 2006, the FDA called for stronger consumer warning labels for this class of drugs with respect to the risk for severe allergic reactions (anaphylactic shock), angioedema (severe facial swelling), and risky behaviors that could include preparing and eating food while asleep, as well as sleepwalking and sleep-driving.

Suggested Reading
Melatonin - the Sleep Hormone

Sources:

American Cancer Society staff. "Black Cohosh." Cancer.org. 26 June 2007. American Cancer Society. 21 May 2008.

American Cancer Society staff, "Chamomile." Cancer.org. 26 June 2007. American Cancer Society. 28 May 2008.

American Cancer Society staff. "Feeling Tired vs. Cancer-Related Fatigue." Cancer.org. March 2006. American Cancer Society. 19 May 2008.

American Cancer Society staff, "Getting a Good Night's Sleep May Be Challenging for a Cancer Patient." Cancer.org. 7 Nov. 2001. American Cancer Society. 28 May 2008.

American Cancer Society staff, "St. John's Wort." Cancer.org. 19 June 2007. American Cancer Society. 28 May 2008.

Benca, R.M. "Diagnosis and Treatment of Chronic Insomnia: A Review." Psychiatric Services. 56(3):332-43. March 2005 332-343. 20 May 2008.

Childs, Dan. "FDA Orders Stronger Warning Labels for Ambien, Other Sleep Drugs." ABCNews.go.com. 14 March 2007. ABC News. 28 May 2008.

Cleveland Clinic medical staff. "Fatigue and Cancer Fatigue." ChemoCare.com. 2005. Cleveland Clinic. 16 May 2008.

Cleveland Clinic medical staff. "Sleep Problems." ChemoCare.com. 2005. Cleveland Clinic. 16 May 2008.

"FDA Alert: FDA Requests New Warnings on Sleep Aides." Neurology.jwatch.org. 3 April 2007. New England Journal of Medicine. 28 May 2008.

Garreau , Jennifer R. "Side Effects of Aromatase Inhibitors Versus Tamoxifen: the Patients' Perspective." The American Journal of Surgery. 18 June 2006. 496-498 . 21 May 2008.

Harvard Medical School Division of Sleep Medicine staff. "Twelve Simple Tips to Improve Your Sleep." Harvard Medical School Division of Sleep Medicine. 18 Dec. 2007. Harvard Medical School. 20 May 2008.

PDQ Supportive and Palliative Care Editorial Board. "Sleep Disorders PDQ." Cancer.gov. 9 Jan. 2008. National Cancer Institute. 16 May 2008.
Roscoe, Joseph A. "Cancer-Related Fatigue and Sleep Disorders." The Oncologist. 2007;12 (suppl 1): 35-42. 21 May 2008 1-9. 21.

Silber, Michael H. "Chronic Insomnia." New England Journal of Medicine. 353:803-81025 Aug. 2005. 803-810.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Nancy Larson is a St. Louis-based freelance writer with 20 years of experience. Her work has appeared in dozens of national and local publications.
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