What Causes Insomnia for People With Cancer?

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Causes of Cancer Related Insomnia

Woman with insomnia
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Insomnia in people with cancer is very common but has received little attention relative to the dangers it poses. Not only does insomnia significantly impact quality of life for people with cancer, but it appears to have a negative effect on the survival rate.

Insomnia is defined as difficulty falling asleep lasting 30 minutes or more and/or nighttime awakenings adding up to 30 minutes or more, associated with daytime tiredness.

Since it is helpful to understand causes before discussing treatments, let's begin with outlining some of the causes and risk factors for insomnia in people with cancer. These include the biochemical changes associated with the growth of a tumor, cancer treatments, symptoms related to cancer and cancer treatments, as well as sleep routine and coexisting medical conditions.

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Growth of Cancer Causing Insomnia

The growth of cancer can cause insomnia. Istockphoto.com/Stock Photo©vitanovski

 The growth of a tumor by itself affects the biochemical and molecular processes taking place in the body. If you remember people commenting on the sleep a growing teenager requires, the picture becomes more clear.

While there is little that can be done directly for this cause of insomnia, other than treating the cancer it is a reminder that often many causes of insomnia and fatigue work together in people with cancer to cause symptoms. Controlling those causes over which we do have some control, becomes of increasing importance.

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Physical Changes Caused by the Cancer

Physical changes from cancer can cause insomnia. Istockphoto.com/Stock Photo©shawshot

When talking about physical changes accompanying a diagnosis of cancer, surgery is often the first thought. Surgical procedures for cancer can lead to insomnia in many ways. The repair process that takes after surgery increases biochemical processes which can, in turn, lead to insomnia and fatigue. In addition, sleeping during the day (such as with a general anesthetic) combined with the inevitable sleep disruptions at night to check on vital signs, can lead to a situation in which insomnia begins very early in cancer treatment.

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Cancer Treatments

Cancer treatments can contribute to insomnia. Istockphoto.com/Stock Photo©Trish233

Both chemotherapy and radiation therapy can lead to cell death, which in turn leads to molecular changes predisposing to fatigue and sleep disruption. Many drugs used along with chemotherapy can alter sleep schedules.

Steroids, such as dexamethasone, often cause a state of hyperarousal for a few days, which in turn may be followed by a greater need for sleep. People with cancer may wish to work with their doctors to schedule their chemotherapy infusions and does of steroids earlier in the day to help reduce this cause of insomnia.

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Symptoms of Cancer and Cancer Treatments

Cancer symptoms may cause insomnia. Istockphoto.com/Stock Photo©jean-marie guyon

There are many symptoms of cancer and cancer treatment which can play havoc with sleep.  Some of these include:

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Cancer Emotions

Emotions related to cancer may cause insomnia. Istockphoto.com/Stock Photo©jessicaphoto

Common emotions that accompany a diagnosis of cancer can be brutal to the ability to fall asleep. As our minds review what is happening, the symptoms of anxiety and depression often seem amplified when the sun goes down.

Stress and the release of stress hormones also plays a role, and this stress can persist throughout life following a diagnosis of cancer. First, there is the stress of diagnosis, followed by the fear of recurrence or progression if a cancer is stable, or the fear of death if a cancer continues to progress or recurs. The next article will review some ways in which control of stress can have a very positive impact on controlling this common cause of insomnia.

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Physical Inactivity

Inactivity may contribute to insomnia. Istockphoto.com/Stock Photo©bind

Getting less exercise during the day can make sleeping at night more difficult, and there are many situations in which physical inactivity becomes the norm with cancer. Sedentary behavior can be forced by hospitalizations, chemotherapy sessions, radiation sessions, travel for oncology visits, and due to the pain and side effects of cancer itself.

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Co-Existing Medical Conditions

Concurrent medical conditions can cause insomnia. Istockphoto.com/Stock Photo©Rallef

Medical conditions in addition to cancer are an important cause of insomnia. A few conditions which are strongly correlated with insomnia include:

  • Sleep apnea is a common condition marked by short periods of apnea (literally, no breath) during the night. You may associate sleep apnea with being overweight or snoring, but check out these surprising signs of sleep apnea to keep in mind.
  • Thyroid problems are common in general, and may occur in relation to cancer or chemotherapy as well. If other causes don't seem to be adding up to cause your insomnia, ask your doctor about this possibility.  Check out these 10 things to know about thyroid disorders and fatigue.

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Environment

An un-restful environment may contribute to insomnia. Istockphoto.com/Stock Photo©feelphotoart

If you have ever tried getting a good night's rest in the hospital, you know how important it is to have a good sleep environment. Noises, bright lights, and a television can all disrupt sleep initiation. There are certainly times that the hospital is the best place to be, but take a minute to talk to your nurse. Sometimes little things, such as puling a curtain, or moving to a room where there is less commotion, could make all the difference.

It's not just the physical environment which can be noisy. Thinking about your fears, about discussions with friends or family members who have upset you, or trying to write a to-do list in your mind, can keep you up as well.

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Poor Sleep Habits

Poor sleep habits can contribute to insomnia with cancer. Istockphoto.com/Stock Photo©RyanKing999

People who ditch the bedtime routine have more difficulty falling asleep. It takes a while for the body to calm down after watching the news or discussing a stressful topic. Sometimes all that is needed to eliminate this cause of insomnia is a regular sleep schedule preceded by habits which let your body know that it's time to rest.

Excess time spent in bed, or napping for an extended period of time in the late afternoon, can make it difficult to fall asleep at night. Having unrealistic sleep expectations may also be a factor in insomnia. If your body is healing from cancer treatments you may require more sleep -- but not necessarily an entire day spent in bed.

Sources:

American Society of Clinical Oncology. Sleep Problems: Insomnia. Accessed 11/30/15. http://www.cancer.net/navigating-cancer-care/side-effects/sleeping-problems-insomnia

National Cancer Institute. Insomnia in Cancer Patients. Updated 05/22/15. http://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq#section/_3

Roscoe, J. et al. Cancer-related fatigue and sleep disorders. Oncologist. 2007. 12 Suppl 1:35-42.

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