We're making so many great gains in the fight against cancer. More people than ever are living long, full, active lives after a cancer diagnosis, through treatment and beyond. One thing that's not happening for people with cancer? They are not getting enough sleep. For people coping with cancer, sleep problems are an all-too-common complication that doesn't get enough attention. Disruptions to sleep often occur during treatment and unfortunately can linger even after the cancer itself has been eliminated or brought under control. Two recent studies reveal just how prevalent sleep problems are for people with cancer.

In one study, researchers analyzed the sleep quality of 962 cancer patients. All were coping with a first-time diagnosis of the disease, and had surgery scheduled as part of their treatment. The researchers assessed the cancer patients' sleep using an insomnia diagnosis interview right before surgery. They repeated the sleep interview several times for the next 18 months. They found that disrupted sleep and insomnia were extremely common among these cancer patients during and after their treatment:

• 59% of patients had insomnia symptoms at the outset of the study
• 28% were classified as having insomnia syndrome, a condition where insomnia is more severe and almost unshakable.
• Over the course of the 18-month study period, the patients' disordered sleep did improve somewhat. At the 18-month mark, 36% of patients still had insomnia symptoms. While an improvement, this is still higher than the general population.

Women seemed to fare worse than men when it came to sleep. The highest rates of insomnia symptoms were found in people with breast and gynecologic cancers, while the lowest rates were linked to prostate cancer. Among the patients with the most severe insomnia, those with insomnia syndrome, researchers found that these people were unlikely to see improvement to their sleep during the course of the 18 months.

In a second study, researchers wanted to explore a possible link between inflammation and the behavioral symptoms of sleep disturbance, fatigue and depression in women with breast cancer. The researchers evaluated 103 women who had received a diagnosis of early-stage breast cancer and had completed their primary course of treatment. The treatments differed-some women had surgery, others radiation and chemotherapy. The women reported on their own sleep, and researchers also tested their blood for so-called "inflammatory markers"-specific readings in their blood that indicate inflammation in their system. As in the first study, these researchers also found extremely high rates of sleep disturbances among their patients, who were all at the end of their primary treatment cycle:

• 60% of women reported problems with fatigue and sleep
• 25% reported feeling depressed
• Women who had undergone chemotherapy were more likely to have problems with sleep, fatigue and depression than women who had received other types of treatment
• The researchers found an association between inflammation and fatigue-especially for women who had undergone chemotherapy-but not for sleep or depression.

As these studies indicate, sleep problems pose a serious and compounding challenge for cancer patients, who are already coping with stressful, often painful and debilitating treatments. In many cases, the sleep disorder can outlast the disease itself. Once insomnia takes hold, it is not likely to go away on its own, and requires its own treatment.

Researchers in both studies have recommended cognitive behavioral therapy (CBT), as well as gentle, mind-body focused exercise, as possible remedies for cancer patients struggling with their sleep. And there is data to prove that it works. In one study, an internet based insomnia CBT therapy helped improve:
• Insomnia severity
• The amount of time it takes to fall asleep
• The amount of time patients spent in bed asleep
• The "soundness" of their sleep
• And feelings of restoration upon awakening

I've long been a proponent of cognitive-behavioral therapy and mind-body therapies as treatments for insomnia and other sleep problems. There's evidence that CBT can be more effective than drug therapies for sleep-a particular advantage for cancer patients who may not be able or inclined to add another medication to their routine. CBT has also been shown to be effective in alleviating pain-which of course helps sleep as well, and may also provide the cancer patient added relief during their waking hours. Mind-body therapies such as yoga and tai chi are other drug-free options that have shown promise in treating sleep and chronic pain.

Helping cancer patients find ways to improve their sleep while they're still in treatment may help improve the course of their treatment itself. Treating sleep problems quickly after they arise will absolutely affect the way these patients feel-their mood, their energy level, their mental health-and how they experience the whole of their lives while they are going through treatment and after they've left cancer behind.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep DoctorTM

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