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A good night’s sleep is critical to help maintain optimal physical and mental health. It can boost your ability to think with clarity, improve your blood pressure and appetite, and support your immune system. Sleep problems/disturbances arise when one is unable to fall asleep easily and or to remain asleep for a long time. Sleep disturbances are experienced by more than 50% of patients with cancer.. They can harm their quality of life throughout the treatment journey and stages of the disease, and may continue even after treatment has ended.

What factors contribute to sleep disturbances?

Sleep problems could be caused by the side effects of treatment, the medicines that you are taking, prolonged hospital stays, and stress.1 Other factors include being female, older age, advanced cancer stage, and receiving chemotherapy. Night sweats and lymphedema occurring because of breast cancer treatments can also impact sleep quality in affected individuals.

How do sleep disturbances impact cancer patients?

Sleep disturbances can increase the chances of cancer occurring again, poor healing, reduced brain functioning, and poor productivity.3 These can also worsen side effects of cancer therapy and psychological problems linked to the illness. Among cancer survivors, interrupted sleep is linked to severe symptoms of depression and reduced quality of life. Difficulties falling asleep or remaining asleep at night can lower the ability to perform daily activities and may cause a gradual decline in physical and mental function due to inactivity.4 It is essential to evaluate and monitor sleep patterns during cancer treatment, as inadequate sleep can have a negative impact on the treatment journey.

How are sleep problems evaluated?

If you are experiencing inadequate sleep, your oncologist may recommend that you consult with a sleep specialist, who may use a polysomnogram, an instrument that records sleep patterns. It displays brain waves, breathing patterns, and other parameters, such as heart rate, which can guide the diagnosis and treatment of sleep disorders. These assessments may be conducted periodically, as sleep problems can vary over time.1 If you suffer from excessive daytime sleepiness, you could be checked for sleep apnea, a sleep disorder which causes the breath to frequently pause and start.

What are the ways to manage sleep disturbances in cancer patients?

Your sleep specialist can help improve the quality of your sleep.1 You will be asked about your history of sleep problems, weekday vs. weekend sleep behaviour, how long it takes to fall asleep, incidence of nighttime awakenings and returning to sleep, daytime feelings of restfulness or fatigue, whether you snore or gasp for breath during sleep, use of electronic devices before sleeping, and medication use.

Some of the steps taken to improve your sleep disturbances could include:

• Cognitive behavioral therapy (CBT) and relaxation therapy: These therapies are designed to help you relax. You may be asked to replace negative thoughts and beliefs about sleep with something more positive. Muscle relaxation, guided imagery, and self-hypnosis can also improve your sleep-related problems.

• Maintaining a routine or a schedule: It is important to adhere to and following a proper sleep schedule on all days of the week can go a long way in preserving the circadian rhythm, or the body’s internal clock, and improving sleep quality.

• Exposure to light: Exposure to sunlight during daytime and decreasing exposure to bright light towards evening can help to maintain melatonin levels. Melatonin is a hormone responsible for stimulating and maintaining good quality of sleep.

• Intake of stimulants: Certain beverages like coffee contain caffeine, which can potentially disrupt sleep by activating neurons in the brain. Moderating or reducing the consumption of caffeinated beverages, specifically in the afternoon and evening. Also, alcohol consumption, even in small quantities, near bedtime can negatively impact sleep quality.

• Maintain good sleep hygiene: Napping after 3 p.m. can hamper falling asleep at night and reduce overall sleep quality.4 Only when you feel sleepy should you go to bed, in a quiet and dark room, and a cosy bed. Avoid watching television or using a smartphone for a few hours prior to going to bed. Eat or drink moderately before bedtime.1 Though regular exercise can regulate the sleep cycle and fatigue, it is better to avoid vigorous activity just before bedtime.

• Use of sleep medicine: Your doctor may prescribe medications to induce sleep, for a short period, in case other methods fail to work. The prescription will depend on your sleep problem, which could be either difficulty in falling asleep or maintaining sleep, as well as other medicines that you are consuming at that point.

Patients with cancer go through different sleep disturbances and sleep disorders because of mental and/or physical problems. These are attributed to side effects of cancer treatment and psychological issues linked to it. These sleep disruptions need prompt medical attention to ensure patients’ smooth transition to normal life. Evidence suggests that providing medical help for sleep problems early in the treatment of cancer patients can improve outcomes and reduce depression.

Dr. Atul S. Narayankar
M.D DNB
Consultant Cancer Physician
MOC Cancer Care & Research Centre, Ghatkopar.