Cancer Survivorship: Insomnia and Sleep Disturbance
by Laurie Wertich, Medically reviewed 10/2018
Many cancer patients face sleep problems, such as difficulty falling asleep, frequent nighttime waking, rising too early in the morning, or excessive sleeping during the day. Such symptoms may occur in more than 70 percent of people with cancer. Stress and anxiety about one’s diagnosis, side effects of treatment, and many other factors can contribute. Moreover, poor sleep may contribute to other symptoms, such as fatigue or mood disturbances. Various medications for sleep work quickly and effectively, but they have their own side effects, including the risk of dependence.
Drugs to Treat Insomnia
Medications can also be used to help manage insomnia. Medications should be used in combination with good sleep practices and under the supervision of a physician. All of the following medications are taken shortly before going to bed.
Specific Sleep Medications:
· Zolpidem (Ambien, Edular, Intermezzo): These medicines help individuals fall asleep but often don't help them stat asleep. There is now an extended release version of Ambien that helps individuals stay asleep longer.
· Eszopiclone (Lunesta): Lunesta helps individuals both fall asleep quickly, and studies show people sleep an average of 7 to 8 hours.
· Doxepine (Silenor): Silenor blocks histamine and is approved for use in people who have trouble staying asleep.
· Suvorexant (Belsomra): Belsomra blocks a hormone that promotes wakefulness and causes insomnia but often causes individuals to feel sleepy the following day.
· Ramelteon (Rozerem): Works by targeting the sleep-wake cycle, not by depressing the central nervous system like many of the other medications. It is often prescribed for long-term use, and the drug has shown no evidence of abuse or dependence.
· Zaleplon (Sonata): Sonata stays active in the body for the shortest amount of time which makes it useful for falling asleep but not for staying asleep.
It should be noted the certain anti-depressant and anti-anxiety medications can also be helpful sleep aids as can come over the counter medications. Most over the counter sleep aids are antihistamines which cause drowsiness. They can create a sluggish feeling the next day and are notorious for causing dry mouth.
Complementary and Alternative Approaches
On the other hand, complementary approaches, such as relaxation and tai chi, take more time to learn but may lead to longer-term improvements in sleep quality. Although research on complementary therapies for insomnia and other forms of sleep disturbance specifically in cancer patients is relatively limited, studies of sleep issues in the general population show that complementary therapies—particularly mind-body approaches—may be helpful, and these results are likely applicable to people with cancer.
Managing Sleep Problems with Mind-Body Therapies
Particularly because of the role that stress, anxiety, and other mental factors play in sleep issues, it is not surprising that complementary mind-body therapies may be of value. An analysis that pooled data from 59 studies, for example, found that psychological treatment averaging five hours of therapy meaningfully improved patients’ ability to fall asleep faster and stay asleep longer. Moreover, the benefits lasted for at least six months. Other studies support those positive results.
A National Institutes of Health consensus panel concluded that complementary techniques, particularly relaxation and biofeedback, improve some aspects of sleep. The magnitude of the improvements is somewhat less clear.(1)
Tai chi, a slow-moving, meditative form of exercise, may also benefit those with trouble sleeping. In one small randomized trial of older adults with moderate sleep complaints, subjects received either 16 weeks of tai chi classes or a general health education program. Those who practiced tai chi experienced a significant increase in sleep quality compared with their counterparts who took health education. Specifically, measures of sleep quality, efficiency, and duration were improved.3
In general, mind-body therapies are an appealing approach for various cancer symptoms because they are inexpensive, can be used along with medicines or other conventional approaches, can be practiced on one’s own after initial training, have virtually no side effects, and are safe.
Managing Sleep Problems with Exercise
Besides helping decrease fatigue, boost physical fitness, and even lower the risk of cancer recurrence, general physical activity has been shown to improve sleep. One clinical trial conducted in Taiwan found that an eight-week, home-based walking program significantly improved sleep quality in cancer patients. Additionally, patients who exercised experienced reduced levels of pain and improved quality of life.
Another trial of breast and prostate cancer patients receiving radiation treatment had similar results. After taking part in a four-week, home-based exercise program, patients reported greater sleep improvements than did those who did not exercise. In a separate clinical trial of breast cancer patients receiving hormonal treatment, women who participated in a walking program 20 minutes per day, four days per week, reported improved sleep quality within four weeks of starting the program.(3)
The list of favorable studies goes on and on. Given the well-known and evidence-based benefits of exercise for so many conditions, it’s a no-brainer. Whether it’s jogging, swimming, walking, or even gardening, you’ll benefit from being as active as your condition allows.
- Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. National Institutes of Health Technology Assessment Conference Statement. Available at: https://consensus.nih.gov/1995/1995behaviorrelaxpaininsomniata017html .htm. Accessed July 25, 2016.
- Irwin MR, Olmstead R, Motivala SJ. Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of tai chi chih. Sleep. 2008;31(7):1001–8. doi: PMC2491506.
- Rogers LQ, Hopkins-Price P, Vicari S, et al. Physical activity and health outcomes three months after completing a physical activity behavior change intervention: Persistent and delayed effects. Cancer Epidemiology, Biomarkers and Prevention. 2009;18(5):1410-8. doi: 10.1158/1055-9965.EPI-08-1045.
Barrie R. Cassileth, MS, PhD, is Laurance S. Rockefeller chair and chief of the Integrative Medicine Department at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City. She has an extensive medical leadership career and is a recognized authority on complementary therapies and integrative medicine in oncology. Her work includes more than 170 publications in medical literature, more than 40 medical textbook chapters, and 22 books for physicians, patients, and families. She was a founding member of the Advisory Council to the US National Institutes of Health Office of Alternative Medicine, now the National Center for Complementary and Alternative Medicine; she previously served on the National and NY-NJ Regional Boards of the American Cancer Society and on multiple national and international committees. She is a staunch opponent of cancer quackery. She is founding president of the Society for Integrative Oncology. Since joining MSKCC in 1999, Dr. Cassileth has established prototypic research, education, and clinical programs in integrative medicine. Her most recent book, Survivorship: Living Well during and after Cancer, an evidence-based guide for patients and families, was published in April 2014 by Spry.
Excerpted with permission from Survivorship: Living Well during and after Cancer (Spry Publishing, 2014; $16.95) by Barrie Cassileth, PhD. © Copyright 2014 Spry Publishing. Available for purchase everywhere books are sold.