In my clinical experience, most patients with advanced cancer have disorderly sleep, which can include difficulty entering into deep sleep, fitful sleep and nightmares, and serious trouble falling back to sleep after waking during the night. These disturbances tend to be more frequent during conventional treatment, and the resulting sleep deficits appear to account for much of the fatigue reported by people with cancer.
Stress and poor sleep often seem to go hand in hand. Pain and pain-killing medications can also disrupt sleep. However, while sleep problems are more common among people who feel stressed and in pain, they can also crop up when you have these things well under control. This is because the sleep disturbances that accompany cancer also reflect a fundamental form of imbalance, one that involves your entire physiology.
Since the 1960s, we've known that cancerous tissues don't proliferate, grow or behave on the same cycles as normal cells - hence their circadian rhythms are considered disordered. Moreover, we now know that a severe disruption in circadian rhythms - that is, a glitch or mishap in the body's internal clock - accelerates the growth and spread of malignant tumors.
Drs. Marie-Christine Mormont and Francois Levi of Paris University in Villejuif, France have carefully monitored the sleep-activity rhythms of many people with cancer. Using a device called an actigraph (a wristwatch that records the number of pulse accelerations per minute), they found that patients who were most often restless and out of their bed (i.e., not getting sound sleep) at night were five times more likely to die within two years of their diagnosis of metastatic colorectal cancer. In another study, the five-year survival rates for colorectal cancer patients with more normal sleep-activity rhythms were up to 50% better than those of patients with abnormal rhythms.
It follows that improving your quality of sleep, and establishing a normal daily rhythm of sleep and waking, are important steps toward bolstering your survivorship. Although we sleep about one-third of our lives, we take for granted just how critical sleep is to our ability to combat disease. Poor sleep robs us of our vitality, creativity and enthusiasm. Poor sleep exacts a heavy toll on our judgment and problem-solving ability. In fact, when your quality of sleep declines, so also does your overall health and well-being.
There are many ways to bolster sleep quality. Sedative drugs or hypnotics are not a solution, because they do not address the underlying circadian disruption and often aggravate it. Sleep research has indicated that these drugs are addictive and moreover ineffective over the long term. So to begin with, I recommend basic sleep hygiene as the underlying support for improving sleep. Then, depending on the level of disruption, I may suggest additional therapies to help re-establish a proper melatonin/pineal circadian profile.
The first step is to try to get to bed relatively early - ideally between 10 and 11 p.m. - and at the same time every night. Next, make sure you snooze in pitch dark, with no light of any kind nearby (including a lit alarm clock or charging cell phone). Another key strategy is to dim the lights or use candlelight more often in the evening, and then expose yourself to more sunlight (or full-spectrum light) the next morning and as much as possible throughout the day. Establishing good sleep habits and increasing daytime activity - particularly outdoors - is the foundation for improving one's sleep/activity cycle.
Sleep-enhancing Strategies
If you are losing sleep purposefully in order to meet other objectives, revise your priorities so that you are able to sleep 7-8 hours nightly.
Do not take naps in the daytime. If you must nap, take catnaps of no more than 20 to 30 minutes in length; long naps disrupt your night-time sleep.
Go to sleep and awaken at the same time every day.
Use the bedroom for sleep and intimacy only; not for work, reading or TV.
Do not eat within 2, and preferably 3 hours of bedtime. If you do eat close to sleep make it a very light snack (but best to avoid altogether). Heavy meals within a few hours of bedtime can be disruptive to a good night's sleep.
Avoid tobacco, alcohol, and caffeine - all of which can disrupt your melatonin supply. Melatonin is the night-time hormone that enables you to get to sleep more rapidly and stay asleep. It also has various anti-cancer and antioxidant effects.
Avoid electromagnetic (EM) fields from electric blankets, waterbed heaters, computer monitors, active electric sockets, etc. Night-time exposure to EM fields can further lower your melatonin supply.
Various prescription drugs lower your melatonin levels and should be used with caution. Certain anti-inflammatory drugs, anti-anxiety drugs, and calcium channel blockers used for high blood pressure, should either be avoided or taken early in the day.
Though many anti-depressant drugs actually can stimulate melatonin production, the most common one in use, Prozac, seems to have the opposite effect. Before changing any prescription meds, check with your doctor to make sure that it can be done or that it's done appropriately.
Unfortunately, because of the many physical and mental stresses imposed on cancer patients, good sleep support may not be enough. For more severe degrees of circadian disruption, I believe the best approach is to use a combination of strategies - attending to your diet, proper exercise, and relaxation techniques.
Mild herbal sedatives, tryptophan and melatonin are additional tools for helping you fall asleep. The safety of the long-term melatonin use of melatonin is not known and should be alternated with other health promoting sleep habits and aids. One example is tryptophan, which appears to work better for younger people. The herbal preparations typically recommended for insomnia include valerian root, chamomile, lemongrass, hops, and passionflower - all with well-documented calming and sedative properties. Dosages will vary depending on the herb, and adjustments can be made over time, usually to a lower maintenance level. As always, discuss the use of any supplements with your healthcare practitioner to avoid potentially problematic interactions.
Keith I. Block, MD, is an internationally recognized expert in integrative oncology. In 1980, he co-founded the Block Center for Integrative Cancer Treatment in Skokie, Illinois, and serves as its Medical and Scientific Director. He is the author of Life Over Cancer: The Block Center Program for Integrative Cancer Treatment.
Dr. Block is currently Director of Integrative Medical Education at the University of Illinois College of Medicine at Chicago. Additionally, he is the Scientific Director of the Institute for Integrative Cancer Research and Education, where he has collaborated with colleagues at the University of Illinois at Chicago, the University of Texas M.D. Anderson Cancer Center in Houston and Bar Ilan University in Israel.
Dr. Block is also the founding editor-in-chief of the peer-reviewed journal, Integrative Cancer Therapies (ICT). In 2005, he was appointed to the National Cancer Institute's Physician Data Query (PDQ) Cancer CAM Editorial Board, on which he continues to serve today.
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