Beating sleep problems after cancer
We need sleep to regenerate—it’s when we make healthy cells to help put up our best fight against cancer. But once we’ve heard the “c” word, too often, sleep is harder to come by. This article is about why that is; sleep conditions we should know about; and ideas for catching quality z’s—some will probably be new to you.
We ideally need seven to nine hours of shut-eye each night for optimal health, but 39 percent of adults don’t get this, and of those who do, most encounter interrupted sleep, says Dr. Laurence Altshuler, chief of Oncology Intake at Cancer Treatment Centers of America. Many of his patients are in that group that’s having trouble.
“Depression, anxiety, pain, nausea and neuropathy all interfere with sleep. Some medications are troublesome too, like steroids, drugs for digestive disorders, and beta blockers to protect the heart during treatments. You may take sleep medications, but you don’t generally get deep sleep,” says Dr. Altshuler.
Rapid eye movement sleep to recharge
Rapid eye movement sleep is important for proper hormone secretions, which in turn affect multiple functions.
“Sleep affects thyroid-stimulating hormone, which regulates your whole body. Getting at least seven hours helps keep the stress hormone, cortisol in check, which is imperative for a healthy immune system and for our body’s repair function. Cortisol spikes can also lead to insulin spikes, which you want to avoid to control growth factors that promote cancer,” says Dr. Altshuler.
Watch out for sleep apnea
People with this condition intermittently stop breathing for short periods during sleep, and blood oxygen levels drop.
“Getting enough air into the lungs is especially important after cancer. Otherwise tumors say ‘we need more oxygen,’ and they make more blood vessels to carry that oxygen to cancerous cells,” says Dr. Altshuler, adding pain medicine puts us at higher risk for a specific condition: central sleep apnea.
A 2012 University of Wisconsin study further supports the good sleep and cancer risk connection: finding people with sleep apnea have nearly a five-fold higher risk of cancer mortality.
“The good news is sleep apnea can be treated to completely resolve this increased risk,” says Dr. Altshuler.
It’s done with one of several devices that entail wearing a mask, to continually monitor and adjust air pressure as needed.
Many integrative practitioners suggest cancer patients undergo an overnight sleep study to assess for apnea of any kind, as 25 percent of adults have the condition but 90 percent of them don’t realize it. You will be attached to monitors that track heart and brain activity, breathing, blood oxygen, and other functions. This test is almost always covered by insurance, including Medicare.
Tips for good sleep
We’ll start with the myths.
- One: warm milk does not have ingredients to lull you to sleep. It contains tryptophan, but research suggests you would have to consume mega volumes (in turkey, about 40 pounds) to promote sleep. Also, tryptophan does not induce deep sleep.
- You may want to bypass counting sheep. Research shows this can actually make sleep harder to come by. But in the same study, participants asked to imagine a relaxing scene fell asleep about 20 minutes sooner than on other nights.
More ideas to help you sleep:
- Adopt the same bedtime routine every night.
- Don’t go to bed hungry; have a light snack. And about the milk myth: one researcher suggests if you have just a little milk with carbohydrates, the combination may help.
- Turn computers and tvs off at least 30 minutes before bedtime, and know even LED light from alarm clocks can interfere with sleep. The light stimulates your brain and interferes with melatonin, a hormone that helps you sleep.
- Do something relaxing just before bed, like reading, which relaxes your brain in a similar way as meditating.
- Exercise, but not within three hours of sleep. Morning and early afternoon exercise are best.
- Limit naps to half an hour, and at least six hours before bedtime.
- Consider jasmine aromatherapy (fragrance-free). You can buy pure jasmine spritzers at herb shops and spas.
Herbs and supplements
Melatonin is good; with 3 to 5 mg working for many people, but Dr. Altshuler prescribes his patients 20 mg.
“We do this because there is substantial evidence that melatonin appears to enhance chemotherapy and kill tumor cells,” he says.
He also recommends combining melatonin, zinc and magnesium.
“I suggest seeing an herbalist or naturopath for the right dose, but one study showed 5 mg melatonin, 11.25 mg zinc, and 225 mg magnesium helped almost all participants,” says Dr. Altshuler.
Valerian root especially helps slow the mind. Dr. Altshuler usually prescribes a 400-mg capsule. But you can get valerian root in teas, which may be more effective combined with passionflower.
What if herbs and good habits don’t take you into slumberland?
“I still want my patients to sleep, so if nothing else works, as a last resort I suggest pharmaceuticals,” says Dr. Altshuler.
Sominex, Unisom and Tylenol PM are first-generation antihistamines that promote sleepiness with few to no untoward effects. And generic (diphenhydramine and doxylamine) is as effective, but much less expensive.
“If neither herbs, supplements or over-the-counter medications work, I suggest Ambien, and starting at the lowest dose of 5 mg,” says Dr. Altshuler.
National Cancer Institute on sleep and cancer
Sleep, stress and cancer: how to get a better night’s sleep
Sleep tips Mayo Clinic
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