Cancer and Insomnia: Why it goes undetected and what can you can do to treat it

Cancer and Insomnia

Over 38% of cancer patients experience clinically diagnosable insomnia disorder during the first 1.5 years of cancer treatment. When Insomnia goes untreated, many other health consequences can occur.

Poor sleep has been linked to cardiovascular disease, depression, anxiety, diabetes, and more. This condition frequently persists for years later, though it is frequently overlooked by members of cancer survivors’ healthcare team.

What is Insomnia?

Insomnia is a common sleep disorder defined by night time and daytime symptoms. Night time symptoms include:

  • Persistent difficulties falling and/or staying asleep and/or non-restorative sleep.
  • Daytime symptoms of insomnia can include diminished sense of well being 
  • Compromised functioning such as difficulties with concentration and memory
  • Fatigue 
  • Concerns and worries about sleep.

The diagnosis is made when the symptoms persist for at least 1 month; insomnia is considered chronic if it persists for at least 6 months. Nearly one in 10 adults in the United States suffers from insomnia. As mentioned earlier, nearly half of all cancer experiences meet criteria for insomnia at one point in time.

Why hasn’t anyone talked with me about my sleep?

The National Cancer Institute emphasizes sleep hygiene as a key component of survivorship care. However, unless you are directly involved in a survivorship program, the chances are that no one has told you about the available treatments for insomnia.

One reason for not asking is that care Oncologists and Hematologists have limited time and may not choose to focus on “psychosocial oncology” services. Second, there is a severe shortage of healthcare providers trained in the effective treatments for insomnia. 

What about sleeping pills?

Chances are that you have learned about sleep medications such as Ambien through your doctor or an infomercial.  This is one of the common sleeping pills and is in the class of medications called hypnotics.

In addition to hypnotics, sometimes physicians and nurse practtitioners prescribe benzodiazepines such as Xanax (alprazolam) or Klonopin (clonazepam). While they can be effective, hypnotics  have even been linked to mortality and benzodiazepines have been linked to dementia. Many people are looking for something besides medications to help improve their sleep.

Is there another treatment option besides medications?

Yes! There is a treatment called Cognitive-Behavioral Therapy for Insomnia (CBTi) which has been proven effective for treating sleep problems. CBTi is designed to address cognitive and behavioral factors, which contribute to long-term insomnia symptoms.

Many studies have shown CBTi to be effective,and in some cases more so than medications! The treatment is multi-faceted and focuses on sleep restriction, stimulus control, sleep hygiene, and changing unhelpful thoughts about sleep. The average duration of treatment is only 6-weeks. 

 

In a recent study out of the Dana-Farber Cancer Institue and Harvard Medical School, Drs. Zhou, Partridge, and Recklitis (2017) investigated the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBTi) among breast cancer patients.

CBT-I was delivered in group format with 38 cancer patients. Most of the participants (58.6%) had breast cancer and the average age was 52.2 years old. The treatment program resulted in significant improvements in sleep efficiency, sleep quality, and insomnia symptoms. Less than 1 in 3 had discussed insomnia symptoms with their oncology providers in the prior year!

What can I do now to improve my sleep?

If you are one of the many Cancer survivors experiencing sleep problems, I recommend speaking to your doctor about available treatments. If you  decide to avoid medications and would instead like to pursue CBTi, contact Dr. Felleman or another psychologist in your area. Good luck!