According to the National Cancer Institute, close to 50% of people suffering from cancer also suffer from “sleep disturbance,” characterized by an inability to fall asleep and sleep soundly through the night. There are a number of reasons why cancer patients, including those with mesothelioma, may have trouble sleeping:
Stress/Anxiety: patients with cancer who are undergoing treatment undoubtedly face many stressful and anxiety-producing decisions. Often, patients who feel overwhelmed and tense are unable to fall asleep in a timely manner at night, or even at all. The many worries associated with their diagnosis and treatment dominates their thoughts, making it nearly impossible to relax and fall asleep.
Pain: patients undergoing cancer treatment may experience chronic pain due to chemotherapy, radiation, surgery and other procedures, like frequent drawing of blood. Sometimes, a patient who is confined to bed for an extended period of time may also experience aches, sore muscles, or headaches, not to mention the often painful side effects of chemo, including nausea. Pain may prevent a person from being able to get comfortable in preparation for sleep, and may also interrupt sleep.
Medications: certain medications given to cancer patients may disrupt sleep or prevent a patient from falling asleep altogether. Certain medications to treat heart conditions, asthma, depression, high blood pressure, thyroid conditions and more may discourage a cancer patient from falling asleep. Chemo drugs, specifically antimetabolites, are known to cause sleeplessness, as are benzodiazepines and anticonvulsants like phenytoin. Withdrawal from specific medications like tranquilizers, antihistamines and monamine oxidase inhibitor antidepressants also may cause trouble sleeping.
What are the Consequences of Not Getting Enough Sleep?
Cancer patients who are unable to get the sleep they need may find themselves struggling to get through their days. Feeling overtired and sluggish prevents those with cancer from maintaining a positive outlook throughout their treatment, may cause depression and mood swings, and may discourage them from actively participating in certain aspects of their treatment, such as occupational therapy or counseling sessions with a physician. They may feel withdrawn, frustrated and antisocial.
Sleep Disorder Symptoms Commonly Experienced by Cancer Patients
The most common indicators of sleep issues in cancer patients include night sweats and extreme temperature changes, respiratory troubles, pain, constipation, and feelings of anxiousness during the night.
How are Cancer Patients with Sleep Issues Treated?
Studies have shown that patients undergoing cancer treatment must be rested in order to endure the rigors of treatment, and most importantly, keep up a positive attitude. Patients dealing with cancer and subsequently suffering from a lack of sleep may consider discussing the following measures with their oncologist and treatment staff in an effort to promote nightly sleep:
- Avoiding caffeine and other stimulants
- Having a high-protein snack a couple of hours before bedtime
- Receiving a back rub or massage before bedtime to promote relaxation and alleviate pain and aches
- Wearing comfortable clothing to sleep, especially pajamas or lounge clothes brought from home
- Sleeping on the patient’s own sheets, blankets and pillows
- Establishing a routine for bedtime and wake-up time to “train” the body
- Coordinating with treatment staff and minimizing overnight disturbances if possible, i.e. limiting the number of times a nurse checks the patient’s blood pressure and preventing nighttime visitors
Cancer patients who engage in the above have reported a better night of sleep, and more productive days.
Other Treatments for Cancer Patients with Sleep Issues
Other therapies, such as hypnosis and yoga, may also help a patient fall asleep. Some people also believe that arranging a patient’s room according to the principles of Feng Shui may also lead to less geopathic stress. Music therapy, especially when it involves the playing of soft, relaxing music, is also helpful, as is encouraging a patient to keep a journal where they can write down all of the stresses of their day in preparation for sleep. Other quiet activities, like reading, knitting, or drawing can also help a cancer sufferer prepare for sleep. Activities like using a computer to surf the Internet, watching TV or playing video games are discouraged a few hours prior to bedtime, as they may prevent the brain and body from getting into “sleep mode.” Patients should also have a plan for how to handle sleep disturbance during the night. If a patient wakes up, sleep disorder experts recommend activities that do not highly stimulate the mind and body, such as taking deep, relaxing breaths, listening to quiet, instrumental music or drinking warm tea to gently urge the body back to sleep.
If possible, oncologists and patients agree that promoting better sleep without the use of medication is the best option. But sometimes, patients cannot fall asleep and stay asleep without them. If that becomes the case, a doctor or nurse may administer a drug such as valium or temezepam. With these and other similar drugs, the onset of sleep usually occurs in under an hour. Some patients may stay asleep for the duration of the night with one dose, but if that’s not possible, another dose may be given. Some physicians also believe that administering melatonin, the hormone produced by our bodies to help us sleep can also help cancer patients; however, melatonin may affect the efficacy of chemo treatments on malignancies, so it is sometimes avoided.
Other Related Issues Faced by Cancer Patients
Often, patients with cancer experience other health concerns that may compromise their ability to sleep, including Restless Leg Syndrome, or RLS. RLS is a neurological health condition characterized by a constant urge to move one’s legs. As many as ten percent of the population suffers from RLS, and while it is difficult enough to manage on its own, a patient with RLS who finds themselves diagnosed with mesothelioma or another type of cancer faces an additional struggle.
Patients who are confined to a bed for an extended period of time and suffer from RLS may be very uncomfortable, and treatment is therefore necessary. A patient’s oncologist will be able to ascertain which RLS medication is appropriate so drug interactions are avoided. Two drugs in particular, Pramipexole and Ropinirole, are common drugs prescribed to RLS sufferers.
The American Society of Clinical Oncology, or ASCO, released a report at their 2007 ASCO Annual Meeting that made a connection between RLS and cancer patients. The report indicated that there were a high number of cancer patients also dealing with RLS, but that RLS was diagnosed in cancer sufferers infrequently. Cancer patients with RLS reported higher levels of anxiety, more stress, and more trouble sleeping than cancer patients without RLS.
ASCO also found that patients undergoing chemotherapy were more likely to report the symptoms of RLS.Sources
National Cancer Institute – Center for Sleep Disorders
American Society of Clinical Oncology - Restless Leg Syndrome