Solving Advanced Breast Cancer's Poor Sleep Problem

It’s probably no news to anyone with metastatic breast cancer that poor sleep is part of the rocky diagnostic and treatment journey of this disease. The disease itself can lead to sleep disturbance.¹. Being diagnosed doesn’t make anyone sleep any better, thanks to the anxiety associated with living with a cancer diagnosis. Add radiation, chemotherapy, and surgical treatments and it’s a wonder those living with and fighting ABC are sleeping at all.²

Sleep research

Research published last fall (Tejada, et al)³ considered different categories of cancer patients including gynecological, gastrointestinal, lung, and breast, to examine and evaluate sleep problems during chemotherapy.

They followed more than 1300 patients at six different time intervals during treatment periods. They wanted to:

• Establish a severity index for sleep problems in people with cancer
• Identify new ways to improve sleep in people with cancer
• Create personalized sleep hygiene plans for people with cancer
• Determine when sleep aids are most beneficial for people with cancer

So, why does any of this matter to someone with metastatic breast cancer?

People with cancer can’t sleep

It’s estimated that between 30 and 88 percent of cancer patients suffer from sleep disruption.³

What is sleep disruption?

Sleep disruption is anything that interferes with one’s normal nighttime sleep. That could mean insomnia, fragmented sleeping patterns, too much sleep during the day, and circadian rhythm disorders, which are common in people with cancer.⁴

Why can’t you sleep when you have cancer?

Sleep problems come hand in hand with cancer.³ The two are linked by:

• Fatigue
• Depression
• Vascular and endocrine problems
• Poor quality of life and disruption of activities of daily living
• Potential metastasis

The chemo connection

Previous research shows that breast cancer patients experience sleep disruption across three different cycles of chemotherapy:⁵

1. Before chemotherapy
2. After a fourth cycle
3. At one year, post-chemotherapy

That older study showed sleep disturbances worsened following cycle 4.

However, Tejada et al notes, this research didn’t measure the severity of sleep problems. Their more recent research aimed to fill in these blanks. The research team actively measured the ways chemotherapy changes sleep and tried to map sleep disruption severity in those going through chemotherapy.

To better understand sleep disruption severity, they reviewed:

• Quality of sleep
• Quantity of sleep
• How long it took to fall asleep
• Frequent night-time awakenings
• Too-early awakenings
• Use of sleep aids
• Excessive daytime sleepiness

What did they find?

Sleep problems among breast cancer patients going through chemotherapy crossed a range of severity, from Low to High to Very High, and that “a significant number of patients receiving CTX (chemotherapy) have very high levels of sleep disturbance for more than 6–8 weeks.”

Tejada et al concluded that they hope this data prompts oncologists to provide more thoughtful, proactive treatments for sleep problems in those undergoing chemotherapy.

What can be done to improve sleep during chemotherapy?

Exercise

The positive effect of regular exercise on sleep is well known. Regular exercise not only reduces sleep problems and supports better sleep, but it also improves quality of life. Regular exercise also reduces symptoms like anxiety, depression, fatigue, and other cancer-related symptoms.⁶

Weight Management

An interesting side observation: Tejada et al found that patients with higher BMI (body mass index) experienced more severe sleep problems. The researchers pointed out that “although we did not evaluate for obstructive sleep apnea (OSA), this condition is common in patients with a higher BMI. In particular, excessive daytime sleepiness, a cardinal feature of OSA, interferes with nocturnal sleep.” If you're overweight and known to snore loudly, you might consider undergoing a sleep study. Treating sleep apnea can help your body fight back against cancer.

Prioritizing sleep

Research published in Sleep in 2014 makes it clear: “Better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with metastatic breast cancer.”⁷

Fighting cancer means outsmarting it enough to stop it in its tracks. Getting adequate, uninterrupted sleep is a key strategy for defending against its spread. When the brain and body get a full night’s sleep (complemented by short daytime naps), it can:

• Bolster the immune system⁸
• Improve daytime function⁹
• Elevate mood and sense of well-being¹⁰
• Make it harder for cancer to spread¹¹

Practice good hygiene sleep

How can you get better sleep when cancer and treatments may be to blame for poor sleep? Do what you can with sleep hygiene.

Support your circadian rhythms

Here are a few ways you can stabilize your circadian rhythms.¹²

• Sleep in a dark, quiet space kept at a cooler temperature.
• Put away electronics at bedtime to ensure you don’t inadvertently disrupt your circadian rhythms; exposing your eyes to blue light emissions from these devices can shut off production of sleep hormones.
• Talk to your doctor about a circadian-friendly chemotherapy routine; this could lead to treatment success and fewer side effects.¹³

Comment or share with us below if you have had trouble getting sleep before, during or after your chemotherapy treatment?