CANCER & CHRONIC PAIN
Is there a link between poor sleep and cancer?
Whether poor sleep itself can directly contribute to causing cancer is still up for debate, but it’s thought that poor sleep may increase the risk of developing cancer or may aggravate a preexisting cancerous or pre-cancerous condition.
Problematic sleep as a symptom is a common issue for cancer patients. As many as half of all cancer patients struggle with disordered sleep related to their illness and/or treatment. The most common sleep issues for cancer patients include insomnia and abnormal sleep-wake cycles. These issues can be caused by the discomfort the cancer itself brings. Tumors can create pressure on the body’s organs and nerves as well as mess with system functions like digestion, urination, or breathing. The discomfort of sleeping in a hospital room, the side effects of treatments, and generalized anxiety about having and treating cancer are other causes for sleep problems among these patients.
Can cancer treatments lead to disrupted sleep?
Yes. The drugs used in cancer treatments can have a negative impact on sleep quality and quantity. These treatments include anticonvulsants, antidepressants, chemotherapy, hormone therapy, sedatives, steroids, and tranquilizers. The “weaning off” of certain drugs can also impact sleep processes, as well as the side effects of using these treatments over a long time, such as night sweats, generalized pain, anxiety, breathing issues, and GI or urinary discomfort or dysfunction. Sometimes the time of day in which dosing or treatment occurs (chronotherapy) can have an appreciable impact on the side effects or efficacy of cancer treatments as well as affect the patient’s sleep patterns.
What can cancer patients do to improve their sleep?
First and foremost, patients need to tell their cancer healthcare team about any sleep problems they might have developed. Because the sources for sleep disturbances for cancer patients are many, it could take some close examination to figure out root cause. It could be environmental, hormonal, behavioral, or a completely different health problem altogether. For instance, someone with lung cancer might also have sleep apnea. Once the source of the sleep disturbance is discovered, the doctors can then review all the options available for treating the problem.
Other things a cancer patient can do to help themselves through sleep troubles include:
- Sticking to a sleep routine.
- Turning your bedroom into a sleep sanctuary, a calming space away from the hectic, troublesome aspects of life where you can easily relax. Remove clocks, unnecessary or intrusive lighting, and all sources of unwanted noise. Use a white noise machine if that helps, or use earplugs, or an eye mask. Keep your bedroom cool and use multiple layers of blankets which can be removed and replaced at will.
- Exercising regularly at the pace best suited for you.
- Avoiding caffeine and alcohol.
- Learning and practicing relaxation techniques.
- Trying therapeutic massage or reflexology during the day.
- Seeing a therapist if you have issues with depression or anxiety. They can give you tools for dialing down stress responses at times when you need to relax most, like during sleep.
- Managing any pain issues that you experience as a result of having cancer or receiving treatment.
- Reviewing the timing of treatments with your healthcare team if you think some of the treatments are causing you to suffer sleep issues like insomnia.
Is there a link between poor sleep and chronic pain?
Yes! Pain might be sleep’s biggest enemy.The link is more like a vicious cycle.
Pain can cause someone to arouse hundreds of times a night for even just a few microseconds at a time. This is called alpha intrusion or microarousal and it can then interrupt their sleep patterns enough to make it harder for them to achieve deep sleep. Deep sleep (stage 3 and REM sleep) provides two critical components of sleep architecture that allow the body to repair itself at the cellular level and release human growth hormone into the body, as well as to consolidate memories, emotions, new learning, and experiences. Without these two stages of sleep, the brain and body will, over time, start to function less efficiently, leading to the potential for future chronic illness, higher risk for accidents, impaired cognitive performance, and the likelihood of mood disturbance.
Pain can lead to some restrictions in sleep positioning, which can keep you up at night. If you have reflux, for example, but you can’t sleep on either side due to arthritis in the hips, this could spell disaster because you will not be able to find a comfortable position no matter what you try.
A 2009 study showed that people who are sleep deprived tend to have lower pain thresholds, even in normal healthy individuals. Lack of sleep potentially increases inflammatory responses in the body, which can disturb the body’s ability to cope with pain responses.
For some, multiple health conditions that include chronic pain make it hard to exercise regularly, even when exercise is prescribed as a helpful pain management tool.
Can treating chronic pain lead to disrupted sleep?
The bad news: Some pain medications can cause insomnia or sleep apnea. If you suffer from insomnia or suspect you might have a sleep breathing disorder, and you are taking drugs for chronic pain, you should have a conversation with your doctor and pharmacist about your options.
What can patients with chronic pain do to improve their sleep?
The obvious, yet difficult to apply, solution is to treat the root cause of the pain. No pain means better sleep. But pain management is a challenge for some people who have multiple health problems and additional medications to consider, as well as drug allergies and concerns about interactions.
Some nonpharmaceutical steps you can take to offset sleep problems related to pain include:
- Avoiding caffeine 5 hours before bedtime. Caffeine may be usefully administered to treat migraines and other headaches during the day, but it will lead to insomnia at night.
- Avoiding alcohol. Alcohol is a drug that can have numerous negative impacts on the body, especially when mixed with other medications. The biggest problem with alcohol is that it can rob the body of deep sleep, where repair of both mind and body takes place. It may help you fall asleep, but it will lead to more harm than good over the course of the night.
- Avoiding exercise right before bed. Exercise changes the chemical composition of the body and can lead to higher level of wakefulness hormones—like adrenaline—which can make sleeping harder.
- Taking cat naps in the afternoon to offset lost sleep from the night before. Don’t oversleep! Ten to twenty minutes can be refreshing.
- “Banking” sleep. If you expect to undergo surgery in the near future, try to get extra sleep before you go in for the procedure. This added “bank” of sleep can help speed up recovery, sometimes significantly.
- Trying different kinds of therapeutic pillows and mattresses. Some people with chronic pain sleep best in a reclining chair. Others prefer a wedge pillow for sleeping upright. Still others will put a pillow between or beneath their knees or raise the head of their bed a few inches to find added comfort.
- Keeping your room cool and use multiple layers of light bedding that you can replace and remove at will. A too-warm room can make sleeping uncomfortable because it can alter the body’s thermal regulation. Feeling too hot or too cold may make pain unbearable.