Sleeping well

We spend one-third of our lives (around 8 hours every day) either sleeping or trying to put ourselves to sleep. Ever wondered why do we need all that sleep? The simple answer is – sleep helps protect your physical and mental health along with the quality of life. Inadequate amount of sleep at night can lead to low levels of melatonin, elevated blood cortisol levels, and an overall impact on health.

Cancer and Sleep

There are many evidences that link sleep with cancer incidence, progression and mortality:

• Cancer patients are more prone to insomnia.
• The sleep hormone (Melatonin) can help in eliminating cancer cells and reducing the side-effects of chemotherapy. However, if you don’t get adequate sleep in the night, then Melatonin is suppressed.
• Lack of sleep also elevates the level of blood cortisol (stress hormone) in our body which can suppress the immune system and speed up tumor growth.
• Inadequate sleep can also result in an increase blood glucose levels which help in the growth of the tumor.
• Cortisol can also increase the body’s resistance to insulin and might stimulate the ability of certain cancer cells to grow and metastasize.
• Disruption of sleep might lead to depression in prostate cancer patients.
• Patients fighting breast cancer and not having regular blood cortisol levels have less-active natural killer cells. This invariably leads to reduced survival rates.
• The five-year survival rate in colorectal cancer patients is higher for those who have normal sleep rhythms.
• Lack of sleep is also associated with outcomes like slower healing, higher fatigue, pain, and anxiety, reduced appetite, etc.

Sleeping Well

• Identify if you have insomnia (primary or secondary).
• Try to regulate your sleep cycle by following a schedule. However, if you insomnia that has lasted for more than three weeks without showing any signs of improvement and has started interfering with your daily functions, then you must consult a doctor.
• There are some conventional sleep medicines available but they are known to have side-effects like depression, withdrawal insomnia, and can be habit-forming.
• In a control trial of women undergoing primary breast cancer treatment, it was found that those who were given relaxation training and cognitive restructuring, showed a great improvement in sleep quality and fatigue.
•  In another study of women suffering from breast cancer, it was found that a diet rich in vegetables, fruits, whole grains, and foods rich in omega-3 fatty acids improved sleep and reduce fatigue.
• Qigong has also been found to improve sleep quality by reducing stress levels.
• Acupuncture can help treat moderate to severe insomnia.

Sleep Hygiene Tips

• Exercise every day.
• Ensure that your bedroom is quiet and dark.
• Maintain a schedule of your sleeping hours, activity hours, and work hours.
• If you take afternoon naps, limit them to around 30 minutes.
• Ty to follow a fixed bedtime routine.
• Avoid alcohol and caffeine.
• No strenuous exercises 2-3 hours before sleeping
• Try to meditate or practice Yoga
• Follow the natural daylight – get some sun during the day and darkness at night.

Key Points

• Restful sleep is critically important to healing, well-being and quality of life.
• LHC is interested in restful sleep because research shows impacts on risk of cancer, cancer progression and survival, response to treatment, mood and pain.
• Insomnia is common, and even more so among cancer patients.
• Several lifestyle choices can impact sleep.

References & More Information

1. Credit: Beyond Conventional Care Therapies
2. ZenOnco.io Integrative Oncology Cancer Care
3. National Heart, Lung, and Blood Institute (NHLBI): Why Is Sleep Important?
4. Bush B, Hudson T. The role of cortisol in sleep. Natural Medicine Journal. 2010 Jun;2(6).
5. Walker L, Hepp N. Psychosocial Environment. Collaborative on Health and the Environment. September 2016. Viewed October 1, 2018.
6. Irwin MR. Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Current Psychiatry Reports. 2013;15(11):10.1007/s11920-013-0404-1.
7. Randall M. The physiology of stress: cortisol and the hypothalamic-pituitary-adrenal axis. Dartmouth Undergraduate Journal of Science. 2010 Fall. February 3, 2011. Viewed October 1, 2018.
8. Ryu TY, Park J, Scherer PE. Hyperglycemia as a risk factor for cancer progression. Diabetes & Metabolism Journal. 2014 Oct;38(5):330-6.
9. Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncology. 2010 Dec; 6(12):1863-1881.
10. Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clinical Science (London, England). 1999 May;96(5):513-23.
11. Hoyt MA, Bower JE, Irwin MR, Weierich MR, Stanton AL. Sleep quality and depressive symptoms after prostate cancer: the mechanistic role of cortisol. Behavioral Neuroscience. 2016;130(3):351-356.
12. Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. Journal of the National Cancer Institute. 2000;92(12):994-1000. 
13. Andersen BL, Farrar WB et al. Stress and immune responses after surgical treatment for regional breast cancer. Journal of the National Cancer Institute. 1998 Jan 7;90(1):30-6.
14. Eriguchi M, Levi F et al. Chronotherapy for cancer. Biomedicine and Pharmacotherapy. 2003; 57 Suppl 1:92s-95s.
15. Berger AM, Farr L. The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncology Nursing Forum 1999; 26(10):1663-71.
16. Aparna Ranjan, MD. Primary Insomnia. eMedicineHealth. Medical Editor: Melissa Conrad Stöppler, MD, Chief Medical Editor. Viewed on October, 1, 2018.
17. American Academy of Sleep Medicine. When to consult a sleep doctor: guidelines for insomnia, apnea, and other disorders. February 29, 2016. Viewed October 1, 2018.
18. Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Research. 2016;5:918.
19. Vargas S, Antoni MH et al. Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida. International Journal of Behavioral Medicine. 2014 Dec;21(6):971-81. doi: 10.1007/s12529-013-9374-2.
20. Zick SM, Colacino J et al. Fatigue reduction diet in breast cancer survivors: a pilot randomized clinical trial. Breast Cancer Research and Treatment. 2017 Jan;161(2):299-310.
21. Yang Y, Verkuilen JV, Rosengren KS, et al. Effect of combined taiji and qigong training on balance mechanisms: a randomized controlled trial of older adults. Medical Science Monitor. Aug 2007;13(8):CR339-348.
22. 20. Mao JJ, Xie S et al. The effect of acupuncture versus cognitive behavior therapy on insomnia in cancer survivors: a randomized clinical trial. 2018 ASCO Meeting Abstract. Journal of Clinical Oncology. 36, 2018 (suppl; abstr 10001).
23. National Sleep Foundation. Sleep Hygiene.  Viewed October 1, 2018.
24. Beyond Conventional Cancer Therapies
25. I-Heart Radio:
    1. Successful Sleep Strategies
    2. Rest and Renewal
26. Lonestar Medical Group Patient Education webpage: Insomnia
27. NCI:  Sleep Problems and Cancer Treatment