Insomnia and Breast Cancer
Importance of the study: Despite exhaustion and fatigue from treatment and stress, between 30% and 50% of cancer patients report problems falling asleep. This study set out to examine how common insomnia actually is in women with breast cancer.
Study design: Three hundred women who had been treated with radiation for non-metastatic breast cancer completed a questionnaire designed to target women who had problems sleeping. Researchers then conducted phone interviews with just those women and evaluated the nature, severity, duration, and course of the women's insomnia.
Study results: Nineteen percent of the women met the researchers' criteria for "insomnia syndrome." In most cases (95%), the women had chronic insomnia, in which they were unable to fall asleep, stay asleep, or enjoy a restful sleep over an extended length of time. A third of the women reported that their insomnia began after their breast cancer diagnosis, while 58% reported that the cancer either caused or aggravated their sleep difficulties. Factors associated with an increased risk for insomnia were sick leave, unemployment, widowhood, and chemotherapy.
Take-home message: It is perfectly normal to have problems sleeping during this traumatic time of your life. New insomnia can start and old insomnia can get worse after breast cancer. Yet insomnia can be one of the biggest hurdles to recovery. How are you going to get the energy and rest you need to heal if you can't sleep well?
If you continue to have problems sleeping, keep a record of your pattern of insomnia for two weeks. When do you go to bed? Do you fall asleep immediately? When do you wake up? What wakes you up? Also keep track of what you are eating, drinking, and doing during the day and just before bed. Are you are spending your late-night hours watching TV news of terrorism? Are hot flashes waking you up at night? Is pain interfering with your ability to sleep?
Then share this record with your doctor and come up with a "plan for sleep." Finding the right combination of mindfulness, medication, and lifestyle changes may take a lot of trial and error, so be patient (even though we know it can be so hard).
Also, the American Academy of Sleep Disorders recommends the following:
- Try to sleep only when you are drowsy.
- If you are unable to fall asleep or stay asleep, leave your bedroom and engage in a quiet activity elsewhere. Don't let yourself fall asleep outside the bedroom. Return to bed when-and only when-you're sleepy. Repeat this process of often as necessary throughout the night.
- Maintain a regular wake-up time, even on days off work and on weekends.
- Use your bedroom only for sleep and sex.
- Avoid napping during the day. If you become overwhelmingly tired during the day, limit yourself to a single nap of less than one hour, no later than 3 p.m.
- Distract your mind. Try reading, watching a video, or listening to books on tape, even if you need to go into another room.
- Avoid caffeine within four to six hours of bedtime.
- Avoid the use of nicotine close to bedtime or during the night.
- Don't drink alcoholic beverages within four to six hours of bedtime.
- While a light snack before bedtime can help promote sound sleep, avoid large meals.
- Avoid strenuous exercise within six hours of bedtime.
- Minimize light, noise, and extremes in temperature in the bedroom.