Sleep disorders in cancer

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Dr Michelle King advocates informing your doctor about your sleep issues to help have a better treatment plan in place that adds quality to your life, mental well-being and physical health.

Having a good night’s rest isn’t just about waking up, feeling refreshed and ready to face the day. If you’re not sleeping well it can impact your health, mental well-being and your prognosis. Poor sleep may cause you to feel irritable and depressed the next day. It can lead to concentration problems, forgetfulness, and fatigue. Further it can have a profound impact on how you experience pain. When most people hear the phrase sleep disorders, they usually think of insomnia. A diagnosis of cancer can cause this problem. You may struggle to fall asleep, wake frequently through the night or wake too early in the morning. Worries around your diagnosis can cause insomnia, as can pain and depression. Lesser-known sleep disorders which can impact your sleep are sleep apnoea and the periodic limb movement disorder you may get if you have restless legs syndrome. 

Your treating doctor may not ask if you have problems sleeping as the focus of the consultation is frequently about something else. If you are struggling to sleep, it’s important to bring this up with your doctor. 

Sleep apnoea 

This is more frequently associated with head and neck cancers. You might have had symptoms before being diagnosed but it’s only impacting the quality of your life now. You may not be aware that you have sleep apnoea but asking your partner if you have any of the following symptoms will help: excessive snoring, gasping for air while sleeping, stopping breathing for short periods, and/or having jerky, restless movements. With sleep apnoea your sleep may be very broken, and it can make you feel extremely sleepy during the day. If you’re taking pain medication which contains opioids this can worsen your symptoms.

Restless legs syndrome

If you’re experiencing uncomfortable, restless, painful, pins and needles or itching feelings in either your legs or arms, you may have restless legs syndrome. These sensations are usually relieved by moving around. They can get worse later in the afternoon and may keep you awake at night. There are several causes. Sometimes it could be due to kidney problems or an iron deficiency. Chemotherapy can cause it too. Treatment may involve both pharmacological and non-pharmacological interventions. 

Find the underlying condition

Your doctor should treat the underlying condition that is causing your sleep problem. This may involve getting blood tests done or a polysomnogram to assist in making the diagnosis. Together with treatment from your doctor, you can help yourself by following good sleep hygiene advice. But if this doesn’t help you may need to seek help from a therapist who can assist with relaxation techniques or cognitive behaviour therapy for insomnia (CBTi). 

CBTi is about learning how to recognise the negative thoughts and worries that keep you awake and how to change these thoughts and beliefs. Strategies for good sleep habits may include being taught relaxation therapy. These involve learning how to relax your muscles and practicing breathing exercises to reduce anxiety at bedtime. 

Sleep hygiene advice

• Reduce alcohol, nicotine, and caffeine intake before bedtime.
• Avoid rich, fatty, and spicy foods before bedtime.
• Exercise in the daytime, but not too close to bedtime.
• Avoid drinking large volumes of water before bedtime.
• Make sure the bedroom is well-ventilated, quiet, and dark. Use a white noise machine/app to mask noise if necessary and use blackout curtains if there are bright lights outside.
• Use a dim light in the bathroom as bright lights can make it difficult to fall asleep again.
• Limit use of technology to two hours before bedtime.
• Use a blue light app on your phone so that it doesn’t interfere with your brain’s melatonin production.
• Avoid napping in the daytime.

References

Dahiya, Saurabh, Manmeet S Ahluwalia, and Harneet K Walia. “Sleep Disturbances in Cancer Patients: Underrecognized and Undertreated.” Cleve Clin J Med 80, no. 11 (2013): 722-32.
Itani, Osamu. “Sleep Disorders in Cancer Patients.” 341-42Springer, 2021.

Levy, Michael, Thomas Smith, Amy Alvarez-Perez, Anthony Back, Justin N Baker, Anna C Beck, Susan Block, et al. “Palliative Care Version 1.2016.” Journal of the National Comprehensive Cancer Network 14, no. 1 (2016): 82-113.

Otte, Julie L, Janet S Carpenter, Shalini Manchanda, Kevin L Rand, Todd C Skaar, Michael Weaver, Yelena Chernyak, et al. “Systematic Review of Sleep Disorders in Cancer Patients: Can the Prevalence of Sleep Disorders Be Ascertained?”. Cancer medicine 4, no. 2 (2015): 183-200.
Simon, Steffen T, Anne Pralong, Lukas Radbruch, Claudia Bausewein, and Raymond Voltz. “The Palliative Care of Patients with Incurable Cancer.” Deutsches Ärzteblatt International 117, no. 7 (2020): 108.

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