Sleep is essential for both our physical and mental health. World Sleep Day 2021 is an opportunity to raise awareness of sleep for those with cancer, and beyond into survivorship.

People differ in their need for sleep, but the recommendation is for at least 7 hours of sleep every 24 hours.1 Getting good quality sleep is also essential for wellbeing. Many people experience difficulty getting enough good-quality sleep.

One of the most common sleep disturbances is insomnia.   Insomnia is the inability to get to sleep or to stay asleep lasting for at least one month and resulting in clinically significant daytime impairment or distress.2

Insomnia, or sleep disturbances, has been found to be more common among those who have had a cancer diagnosis than among those who have not had cancer.3-5 Insomnia can continue for many cancer patients after their treatment finished.  An Irish study of 3348 men with prostate cancer found that as many as 1 in 5 experienced insomnia up to 2-18 years after their diagnosis.5

Insomnia, or sleep disturbance, has been shown to effect mood, physical symptoms, pain sensitivity, fatigue, and quality of life among men and women who have had cancer.  Therefore, it is important to understand the causes or risk of insomnia and possible strategies to manage insomnia and sleep disturbance among cancer.  In the US, The National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) recommend the evaluation of sleep disturbances and evidence-based treatment of insomnia during routine survivorship care.6

What are the risk factors for insomnia among those with cancer?

A number of factors have been shown to increase the risk of insomnia among those with cancer have been identified. These include the following;

Treatments:

  • Hormone treatment
  • Steroids
  • Cancer treatments (some chemotherapies and targeted therapies)

 

Cancer or treatment side-effects

  • Urinary symptoms
  • Pain
  • Bowel symptoms
  • Experiencing anxiety and/or depression
  • Hot flushes
  • Itching

 

Predisposition

    • History of insomnia
    • Younger age at diagnosis

 

Management of Insomnia

The management will depend on the underlying causes.  Many ways to manage insomnia among people with cancer have been found to work.  These include;

  • Good sleep habits
  • Sleep medication
  • Cognitive behavioural therapy
  • Mind-body therapy (e.g. yoga, mindfulness)

 

Anybody who is experiencing sleeping difficulties should discuss this with their cancer care team or GP.   Finding ways to manage insomnia can result in an improvement in wellbeing.

 

Resources used for this article:

  1. Centres for Disease control and prevention. https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html
  2. American Academy of Sleep Medicine. The international classification of sleep disorder, revised: Diagnostic and coding manual. 2nd ed. Illinois: American Academy of Sleep Medicine; 2005.
  3. Leysen L, Lahousse A, Nijs J, Adriaenssens N, Mairesse O, Ivakhnov S, Bilterys T, Van Looveren E, Pas R, Beckwée D. Prevalence and risk factors of sleep disturbances in breast cancer survivors: systematic review and meta-analyses. Support Care Cancer. 2019;27(12):4401-4433. doi: 10.1007/s00520-019-04936-5.
  4. Schieber K, Niecke A, Geiser F, Erim Y, Bergelt C, Büttner-Teleaga A, Maatouk I, Stein B, Teufel M, Wickert M, Wuensch A, Weis J. The course of cancer-related insomnia: don’t expect it to disappear after cancer treatment. Sleep Med. 2019 Jun;58:107-113. doi: 10.1016/j.sleep.2019.02.018.
  5. Maguire R, Drummond FJ, Hanly P, Gavin A, Sharp L. Problems sleeping with prostate cancer: exploring possible risk factors for sleep disturbance in a population-based sample of survivors. Support Care Cancer. 2019 Sep;27(9):3365-3373. doi: 10.1007/s00520-018-4633-z.
  6. Zhou ES, Partridge AH, Syrjala KL, Michaud AL, Recklitis CJ. Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv. 2017 Feb;11(1):74-79. doi: 10.1007/s11764-016-0564-1.
  7. Asok A, Sreekumar S, Tk R, Cc A, P UD, K P. Effectiveness of zolpidem and sleep hygiene counseling in the treatment of insomnia in solid tumor patients. J Oncol Pharm Pract. 2019 Oct;25(7):1608-1612. doi: 10.1177/1078155218801062.
  8. Johnson JA, Rash JA, Campbell TS, Savard J, Gehrman PR, Perlis M, Carlson LE, Garland SN. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016 Jun;27:20-8. doi: 10.1016/j.smrv.2015.07.001.
  9. Haller H, Winkler MM, Klose P, Dobos G, Kümmel S, Cramer H. Mindfulness-based interventions for women with breast cancer: an updated systematic review and meta-analysis. Acta Oncol. 2017 Dec;56(12):1665-1676. doi: 10.1080/0284186X.2017.1342862.
  10. Kreutz C, Schmidt ME, Steindorf K. Effects of physical and mind-body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis. Breast Cancer Res Treat. 2019 Jul;176(1):1-15. doi: 10.1007/s10549-019-05217-9.