Insomnia and Cancer..

It has been suggested that premorbid sleep problems and shift work have been associated with a higher prevalence of cancer. I can certainly identify with that as I have had difficulties remaining asleep since my first pregnancy over eleven years ago!   Broken sleep became the norm as the children needed feeding or were sick. Often I would have gone to work with anything from one to three hours sleep. This is not unusual amongst parents with small children in today’s society so I duly accepted it as part of parenting.

Clearly a diagnosis of cancer compounds the problem. I’m sure many of you can identify with having poor quality sleep patterns ever since your diagnosis. For me I considered five hours of broken sleep a good night’s sleep. Most nights, especially around 3am, I prowled around the house trying not to wake anyone. When chemotherapy commenced, steroids kept me alert all night so I eventually relented, got up and read a book until morning.

I have tried to accept my chronic insomnia as another side effect of treatment. However, in the recent past things came to a bit of a head when I started experiencing symptoms of exhaustion during the day. I had enough! I decided to undertake some research into insomnia and cancer and found that there is a plethora of articles available on the subject. I observed that even though the medical field is taking note of the problem, that it was a symptom that was sometimes either under reported by patients or simply overlooked in a clinic situation. What was noteworthy was that if structured assessments and early interventions were implemented by the medical team, a patient’s quality of life improved.

My first step was to establish what I could do myself to improve my sleeping habits. After searching on the internet I found that by adopting some sleep hygiene principles, a person’s sleep pattern may improve. Here are some tips that helped somewhat:

  • Exercise every day, especially earlier in the day and avoid strenuous exercise close to bedtime.
  • Avoid stimulants such as tea, coffee, alcohol and nicotine prior to bedtime. Some suggest have your last cup of caffeine 4-6 hours prior to bedtime! This I have found a bit difficult as I do love my cup of tea but I have found that sleep is better when I reduce my intake of caffeine. (A work in progress!)
  • Avoid eating heavy or rich food late at night.
  • Exposing yourself to natural light during the day helps maintain the sleep-wake cycle.
  • If you need to nap limit napping time to 30mins a day.
  • Keep your bedroom dark and cool. Use eye mask and earplugs if necessary to block external factors like light or noise.
  • Maintain a good bedtime routine by going to bed at the same time each night and rising at the same time each morning. Try to avoid lie-ins at the weekends to maintain this cycle.
  • Avoid electronic screens in the bedroom such as tv, phone or tablet.

Management of contributory symptoms like fatigue, pain and hot flushes also benefited sleep for patients. I have experienced all of the above and set about managing those symptoms. I went for physiotherapy for my back pain after a clear CT scan and managed my fatigue with a combination of exercise and rest.
The next step was to manage hot flushes which have become a part of my life since treatment.     I did begin to wonder was it due to my hormonal (or lack thereof) status that was contributing to this insomnia. My GP was aware of my problems and had often prescribed short term medication for me to help over a particularly difficult bout of insomnia. I asked him about taking some medications for the hot flushes and in particular about taking Venlafaxine as there is evidence that recommends it as an alternative to hormone replacement therapy for women who have had breast cancer. The plan we agreed was to commence on a low dose initially and increase after a few weeks. Finally a positive result!   I seem to be sleeping for approximately seven hours a night, which is amazing for me. It is still not a completely restful sleep but it is so much better than before!

If none of the above have worked for you there are other alternatives to consider such as  Cognitive Behaviour Therapy (CBT), which has been suggested in many articles as a useful treatment for patients with chronic insomnia, and complementary therapies, which may induce relaxation and therefore aid sleep.

Finally after a long post, but hopefully informative, if you are experiencing insomnia try some or all of these tips, consult your GP and together you will most likely find a solution for your insomnia. I hope you enjoy a restful, restorative sleep pattern soon..

 One month on…..

I am pleased to say that my sleep pattern has improved immensely! The Venlafaxine hasn’t completely eradicated my hot flushes and I still wake at night with them but I fall back to sleep promptly afterwards.  I have not experienced any symptoms of exhaustion in the past month either.    By taking simple steps and assessing what was the cause  and taking measures to manage my chronic insomnia, I have succeeded in improving my sleeping pattern.

References
Davis, Mellar P. & Goforth, Harold, W. (2014) Long-term and short-term effects of insomnia in cancer and effective interventions. Cancer Journal. 20(5):330-44.
Deng, G. et al (2004) Complementary therapies for cancer related symptoms. The Journal of Supportive Oncology. 2 (5) 419-26.
Induru, Rafhara, R et al (2014) Cancer related Insomnia. American Journal of Hospice and Palliative Medicine. 31(7):777-85.
Matthews, E.E. et al (2014) Cognitive behavioural therapy for insomnia outcomes in women after primary breast cancer treatment: a randomised controlled trial. Oncology Nursing Forum. 41(3): 241-53.
Sievert, M.L. et al (2014) Patient and Clinician communication of self-reported insomnia during ambulatory cancer care clinic visits. Cancer Nursing. 37(2): E51-9.
sleepassociation.org.
sleepfoundation.org

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