Sleeping through the Cancer
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"Fatigue is one of the most common complaints of women with breast cancer and often is the reason chemotherapy is prematurely terminated. Women with breast cancer need to understand the importance of a good night's sleep.” Researcher Sonia Ancoli-Israel, PhD, from the University of California, recognized this in her research on patients with breast cancer. Published in Supportive Care in Cancer, this research suggested that disturbed sleep and fatigue are a result of cancer and occur even before any treatment begins. Using actigraphy, a method to study sleep-wake patterns and circadian rhythms by assessing movement, and analyzing sleep questionnaires, Ancoli-Isreal and her researchers examined the relationship between the complaint of fatigue and sleep and circadian rhythms before and after chemotherapy in women with breast cancer. The results concluded that the average participant slept only six hours a night and napped for over an hour during the day. The study also found that sleep was reported to be disturbed and fatigue levels were high before chemotherapy treatment.
Is it Chemotherapy or the Cancer?
Chemotherapy involves administering toxic chemicals that fight against cancer cells. Many of these drugs are toxic against our healthy cells commonly producing side effects such as hair loss, nausea, vomiting, diarrhea, hot flashes, depressed immune system, fatigue and poor sleep. Although these side effects vary according to the type of drug and cancer, fatigue and sleep disturbances appear to be prevalent throughout. The treatment itself may be the culprit. However, side effects to the medication such as nausea and hot flashes during the night contribute to poor quality sleep. As indicated by the study, chemotherapy is not the only source for fatigue and poor sleep. So, what else is creating the problem? Is it the cancer or is there something more?
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Although there is no conclusive evidence pinpointing specifically how cancer leads to fatigue, there are a few possible explanations. Cancer is an unregulated/abnormal replication of cells within the body. This “hypermetabolic” state in the cancer cells takes energy needed by our body and competes for nutrients that our normal cells require. Nutritional deficiencies lead to fatigue. Cancer also impacts our sleep. In advanced stages, severe pain becomes a large contributor to poor sleep. An increase in frequency of pain will increase the difficulties in getting a good night’s sleep. The stress affiliated with cancer can worsen feelings of fatigue. Stress can result from dealing with the disease and the "unknowns".
Why Worry?
Have you ever found yourself tossing and turning at night with your mind racing about all the things that you have to accomplish the next day? If so, you are one among many others who understand that worrying affects sleep. If the level of worry that exists in cancer patients is substantially larger, is it possible that worrying alone is creating poor sleep in cancer patients?
After a patient is diagnosed with cancer, there are a lot of questions and concerns on the patient’s mind. He/she might worry about the severity of the diagnosis, undergoing treatment, length of treatment, success of treatment, side effects and the future. These concerns consume time and energy and interrupt normal sleeping behaviour. Techniques to reduce the level of worrying such as journalling, counselling, meditation and supporting the stress response may help.
Understanding Sleep
Sleepless nights are a common occurrence in our society and as a result many triggers such as psychological stress, chemical or hormonal imbalances, illness or aging may occur. Sleep disturbances are popular complaints among individuals with cancer. It is estimated that 45% of cancer patients have difficulty sleeping compared to 12 to 15% of the general population.
One theory on sleep proposes that our body tries to rejuvenate and heal itself during this time. The more rested we are, the more capable we become in coping with day-to-day activities and challenges. If this is true, then is it possible that poor quality sleep in cancer patients hinder their recovery?
Treatments such as chemotherapy and radiation therapy demand a lot from the body. With plenty of rest and good quality sleep, cancer patients will be in a healthier state and will find that the treatments will become less difficult and more effective. Understanding the contributing factors for reduced sleep can provide insight on the process of cancer.
Does Fatigue Fuel the Fire?
Fatigue is a daily lack of energy characterized by unwarranted whole-body tiredness not due to activity or exertion and not relieved by sleep. Fatigue can prevent a person from functioning normally. Cancer patients tire easily. Even with afternoon naps, their sleep is insufficient to fix the problem.
Cancer patients often describe fatigue as "paralyzing". Depression and fatigue often go hand-in-hand. Like the chicken or the egg, many wonder which came first. Research on breast cancer patients suggests that women who had a “fighting spirit” were much more likely to survive compared to those with a helpless and hopeless attitude. Extreme fatigue and subsequent low energy and attitude are the basis for cessation of many chemotherapy treatments. Various therapies such as psychotherapy, meditation and hypnosis have shown to be helpful in altering negative attitudes.
Improving Sleep and Fatigue in Cancer Patients
The direct connection between fatigue and the quality or quantity of sleep or to the sleep/wake circadian rhythm cycle remains unknown. It is important for cancer patients to have strength and energy to combat emotional and physical stresses. The best way is to treat the underlying problem. Luckily, many researchers continue to strive for further understanding in order to make cancer more manageable. In the meantime, cancer patients can improve the quality of life by modifying their lifestyle behaviour to conserve energy through planning ahead, prioritizing work, breathing deeply and maintaining good nutrition.
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