Tag Archive for: sleep

Navigating Anxiety and Stress Following Follicular Lymphoma Treatment

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Navigating Anxiety and Stress Following Follicular Lymphoma Treatment from Patient Empowerment Network on Vimeo.

What are some ways for follicular lymphoma patients to cope with emotions after treatment? Cancer patient Lisa Hatfied shares coping methods and health lifestyle advice for dealing with stress and anxiety.

See More from START HERE Follicular Lymphoma

Related Resources:

What Are the Signs It Is Time to Treat Follicular Lymphoma

 How Can I Manage Anxiety After Follicular Lymphoma Diagnosis

 What To Do When Newly Diagnosed With Follicular Lymphoma

Transcript:

Lisa Hatfield:

After you are done with your follicular lymphoma treatment (including stopping any maintenance therapy), you may feel anxiety or stress and ask yourself “Well now what?” This range of emotions is normal. One woman  shared, “After a year in remission, dealing with the aftermath of follicular lymphoma has been tough. Initially, the news of remission brought euphoria and excitement that lasted the whole day. However, soon after, I found myself feeling numb—and then grappling with guilt for feeling that way.

You may feel similar to this woman or you may feel like the other shoe is about to drop (i.e. concerned about recurrence in the future). Here are some tips to help manage this stress and anxiety: 

  • Manage your expectations. Give yourself a break and set realistic expectations. After you stop maintenance therapy, you may not feel 100% back to normal right away so give yourself grace 
  • Research has shown that fear of recurrence can be reduced when your healthcare team is able to give people statistics about curability or remission length. Ask your healthcare team if you find comfort in statistics. 
  • Talk to a counselor and seek antidepressant or anti-anxiety medications
  • Exercise and relaxation techniques like meditation and mindfulness may also help
  • Continue healthy lifestyle factors, just like you did during treatment, including good diet/nutrition, getting enough sleep, etc. 
  • Join a support group designed to help people who have completed treatment. It can be helpful to hear what other people do to manage their anxiety/stress and know you are not alone in feeling this way. 

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Can Mobile Health Apps Lower the Burden of MPN Symptoms?

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Can Mobile Health Apps Lower the Burden of MPN Symptoms? from Patient Empowerment Network on Vimeo.

How can the burden of myeloproliferative neoplasm (MPN) symptoms be lessened through the use of mobile health apps? Blood cancer patient Lisa Hatfield shares common MPN symptoms that patients experience and explains wellness strategies and mobile app study results that decreased the symptom burden for patients.

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See More from MPN TelemEDucation

Related Resources:

How Can MPN Patients Continue to Use Telemedicine and Overcome Barriers

 How MPN Providers Want You to Prepare for Telemedicine Visits

 How MPN Patients Can Best Prepare for a Telemedicine Visit

How MPN Patients Can Best Prepare for a Telemedicine Visit

Transcript:

Lisa Hatfield:  

As an MPN patient, you might experience symptoms like fatigue, night sweats, difficulty sleeping, abdominal discomfort, bone pain and others. However, early data using integrative approaches for the treatment of MPNs are promising, including aerobic activity, yoga, meditation, and strength training, to reduce the symptom burden and improve inflammation. With the evolution of smartphone technology, mobile apps have been increasingly popular to document wellness strategies. With this in mind, the University of Arizona Andrew Weil Center for Integrative Medicine developed and successfully piloted a global wellness mobile app, My Wellness Coach (MWC), to guide MPN patients on self-management strategies for their symptom burden. 

The app had patients set at least two wellness goals with clear action steps within these seven areas: nutrition, movement, sleep, resilience, environment, relationships and spirituality to work on over the course of 12 weeks. Within the app, there were links to curated resources and tips. Participants were sent 24- to 72-hour interval reminders before and after each action step and a goal deadline to encourage action throughout the intervention. At the end of the study, improvements were observed in inactivity, impaired concentration, dizziness, numbness, sexual dysfunction, night sweats, bone pain, and quality of life. 

If you’d like to implement something similar to what the participants did, try the following: 

  • Reflect on why you want to change your symptom burden so you feel motivated  
  • Determine which of these categories: nutrition, movement, sleep, resilience, environment, relationships, and spirituality would you like to set goals in 
  • Create two goals from those categories and make them SMART- specific, measurable, attainable, relevant, and time-bound. 
  • Utilize resources available to you through support groups or online tools 
  • Set reminders on your phone or calendar for each step you need to take to complete your SMART goals

Mobile-based apps are another example of how MPN patients can use telemedicine in their day-to-day life and improve care.

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How Does COVID-19 Create Sleep Issues for Cancer Patients?

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Are you having sleep problems during the COVID-19 pandemic? A recent Swiss study showed that people’s sleeping hours are more regular during the global crisis, but self-reported sleep quality has decreased, according to Science Daily. Besides that, some groups like cancer patients are more likely to experience sleep deprivation during such challenging times.

There are several factors that might affect the sleep quality of people diagnosed with cancer. They include the diagnosis, cancer treatments, medical bills, and an uncertain future. Stress and anxiety due to coronavirus disease can also cause a disruption of everyday schedules. Sleep disorders themselves can worsen cancer symptoms, which creates a vicious cycle.

Cancer Survivors and Sleep Disorders

Getting a good night’s sleep can already be tough for cancer patients. Studies show that over three-quarters of people with severe disease have sleeping problems, according to the Cancer Treatment Centers of America.

The good news is today’s scientists and physicians have a better understanding than in the past about how sleep works and how to improve sleep quality.

Sleep provides many health benefits for overall physical, mental, and emotional health. This is especially true for people battling severe diseases like cancer. For example, it can boost your body’s immune system, which makes it more effective at fighting off cancer cells.

On the other hand, lack of sleep can have the opposite effect. This can weaken the immune system and slow down recovery from sickness or injury. Serious sleeping disorders can also create an imbalance of the cell-impacting hormones cortisol (stress hormone), and melatonin (sleep hormone).

Sleep: Its Influence on People Living with Cancer (video)

Other Effects

Besides affecting cancer cells and tumors, poor sleep can also have other negative effects related to:

  • Obesity
  • Diabetes
  • Heart disease
  • Heart attack/stroke
  • Mental health
  • Sleep

One theory is that melatonin might be the root cause that affects these health conditions and episodes. However, more research is needed. The body normally produces more melatonin at night as it gets dark outdoors and the human body winds down for rest and repair.

COVID-19 and Sleep Problems

Fun Fact: The acronym COVID-19 stands for corona (CO), virus (VI), disease (D), and 2019 (19). There are various possible factors related to the global epidemic that might affect people’s sleep, even if they haven’t tested positive for respiratory disease:

Anxiety, Stress, and Depression

The ongoing COVID-19 outbreak has become a global financial crisis that could cost the United States alone $16 trillion, according to the Los Angeles Times.

Quarantines, layoffs/furloughs, and school closures have caused stressful situations for people, and it’s even worse for those with severe diseases like cancer.

Even indirect factors like COVID updates have created more stress and duress. This is why it’s important to avoid reading or watching daily news after 7 PM or so. Negative news can affect your psyche and make it tougher to doze off at bedtime. A better option is good news.

Disrupted Daily Doings

The “new normal” during the ongoing pandemic might affect the quality of sleep. More stay-at-home time can cause wholesale schedules in daily schedules. That, in turn, can result in a sedentary lifestyle of sitting down and fewer gym workouts. This can negatively affect sleep unlike the option to make the right selection of mattress.

Blue Light

Studies show that blue light from sources like computer monitors, mobile devices, and fluorescent light bulbs can disrupt people’s sleep patterns.

Besides that factor, people might have more screen time during quarantines and lockdowns as they use their PCs/Macs, tablets, and smartphones to get COVID updates

and interact with friends and family. This can increase the risk of tossing and turning due to insomnia.

COVID-19, Sleep, and Cancer: It’s Complicated

As noted, several factors can negatively affect the sleep quality of cancer patients. When you add factors like a worldwide pandemic to the mix, this situation becomes ultra-complex.

Coronavirus and Sleep

The ongoing COVID-19 crisis isn’t just about the contagious virus itself, which makes it a whole lot more serious than a sleepless night when counting sheep and a warm glass of milk doesn’t seem to work.

Here’s the problem. Your ability to fall asleep and stay asleep during a pandemic probably isn’t related to the respiratory condition itself. Instead, it’s the effects of everyday life that have been turned upside-down because of the virus.

The effects of a global pandemic can include different factors related to work, school, and home. People can also experience emotional problems like worry, anxiety, and depression. Besides affecting your sleep schedule, it can even negatively impact your general health. So it’s a double-whammy.

COVID-19: The Importance of Sleep (video)

Stress and Sleep

While taking steps like picking a comfortable mattress can help you sleep like a baby, stress can have the opposite effect. In fact, insomnia can affect your ability to fall asleep and stay asleep, according to the Cleveland Clinic.

Stress triggered by stress hormones like cortisol can affect various biological processes, including sleep. If you’ve already received a cancer diagnosis, then a viral pandemic can make the situation even worse.

Pandemics and Sleep

The current pandemic can increase stressors and create an uncertain future due to the disruption of everyday life. This is due to extraordinary changes to daily life, including social distancing, virtual work, and home-schooling.

More Sleep for Cancer Patients During COVID Quarantines

Cancer survivors can take some basic steps to get more shut-eye during the current quarantines/lockdowns:

Sleep-friendly Environment

Dark, quiet, and cool rooms can all help to help cancer patients get a good night’s sleep during a global pandemic. It’s important to create a sleep-inducing environment that can help you fall asleep, and then cycle through the five sleep stages multiple times. If you dream you’re probably in ‘deep sleep.”

There are various steps you can take:

  • Minimize artificial lighting with options like night lights and dimmer switches
  • Clear your mind of everything and focus on falling asleep
  • End all daily news consumption before 7 PM
  • Use heavy curtains and blinds to block outside light
  • Avoid heavy meals, exercise, and caffeine/alcohol close to bedtime
  • Ditch all thoughts about the current COVID-19 pandemic
  • Use aromatherapy through sprays, diffusers, and massages at bedtime
  • Delay dealing with personal problems until the next day
  • Eliminate loud sounds and use sleep aids like noise machines
  • Do meditation, yoga, or light exercise to prepare for bedtime
  • Use self-mantras to help you doze off when your mind races
  • Lower the thermostat to about 65°F (18°C) to promote quality sleep

Conclusion

Dealing with the year-long COVID-19 pandemic can be tough enough. The predicament becomes even tougher for cancer patients who must also handle disease-related issues like cancer diagnosis, symptoms, and treatments. That’s why it’s so important for survivors to take steps to stay calm, boost their immune system, and get a good night’s sleep. Sleeping well can help you fight the coronavirus while you battle cancer.

Is Laughter Really the Best Medicine? One Woman’s Mission to Help Others with MPNs

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Is Laughter Really the Best Medicine? One Woman’s Mission to Help Others with MPNs from Patient Empowerment Network on Vimeo.

Could laugher really be the best medicine? Patient advocate Summer Golden explains how she uses comedy to cope with her myelofibrosis (MF) diagnosis and shares her mission to inspire others.

Summer Golden and Jeff Bushnell have been married for over 20 years. When Summer was diagnosed with myelofibrosis (MF), Jeff took on the role of care partner and advocate. Summer uses her years of theatre training and comedy to cope with her condition and help others, while maintaining positivity about the future.

See More From the The Path to MPN Empowerment

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Expert Tips for Managing MPN Related Anxiety

Transcript:

Summer:

When I was initially diagnosed after some other false starts with an MPN, I was kind of shocked because I’ve never really been sick, and I don’t take medications, but I didn’t think about it – that sounds crazy; I can’t explain it. I just figured I’d be okay, and the main thing – I didn’t wanna give up this theater.

You know how when you’re my age, people talk about nothing but their illness sometimes? I just never been into that, so it wasn’t part of my personality.

I started doing comedy two years ago because a friend of mine was taking a comedy class, and I went to her showcase, and I thought, “I should try that, even though I’ll never be funny, I have no jokes, and I don’t know what I would say.” But, I went, and I did comedy in clubs for a while, and then I didn’t – I don’t really like drinking and dirty jokes, so I kind of got away from it off and on, and then, when I got into doing it about my myelofibrosis, then I saw a purpose in it, so I went back to it.

I was thinking about whether my life was gonna be changed, how this was gonna change me, so I emailed my comedy teacher in the middle of the night, and I said, “Do comedians ever talk about cancer, having it?” And, he said, “Only if they have it.” So, I emailed him back and I said, “I’m coming back to your class,” so I did. He assigned everyone to be in a showcase. I was gonna do mine about cancer. It was six weeks, so I had to find humor. I don’t know how I find it. I just kind of see things.

I was shocked because I thought people were gonna hate it, and I was gonna quit, and then I’d invited my doctor and two friends, so I thought I’d better not just not show up. But, people came up and said they were inspired. I was just amazed because I mainly –I don’t go out of my way to think of – I do think of things that are funny, but it’s just – it’s a real thing. I try to keep my comedy real.

It’s helped me by being in control. I don’t pay much attention to the symptoms because I’m kind of over them.

Just helped me feel like I’m doing what I can do, and so far, it seems to be working, as long as I get enough sleep.

How do I think comedy could help other people who have health problems? I can tell you one way I thought to help somebody. I wanna start a class for people, but so far, there hasn’t been a lot of interest, but I think I could really help people doing that because I know how to write comedy.

If they really wanna do that, they would be a type of person that has humor, and they could do it, but you’ve gotta realize sometimes, people get a lot out of being sick. There are a lot of rewards, and so, they might prefer to have those rewards. For my way of thinking, if they wanna do humor, it’ll make a big difference, and if somebody wants to do it, they could call me, and I’ll help them.

Three Night Time Activities To Help Cancer Patients Fall Asleep Quickly

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Battling cancer is, undoubtedly, tough. On any given day, you might find yourself feeling so sick that you can’t even get out of bed. Being relegated to bed and struggling to even fall asleep can feel utterly disheartening. Adopting some healthy habits in your sleep routine can help to ease your body and mind into sleep more quickly and easily, letting you get some much needed rest and recharge.

Why Does Cancer Alter Your Sleep?

There are a lot of side-effects that you might experience as a result of your cancer treatment. Though one of the most common side-effects is fatigue, many patients also find that they have difficulty sleeping, which only exacerbates their feeling of  fatigue and sleep-deprivation. These sleeping problems can be the result of many factors such as newly developed sleep disorders, physical triggers, and psychological triggers.

Sleep Disorders

It is incredibly common for cancer patients to experience insomnia, which refers to any number of factors that make it difficult for someone to fall asleep and/or stay asleep. People with a serious illness are at an increased risk for insomnia. In fact, while about 20% to 30% of the healthy population suffers insomnia, over half of all cancer patients have reported facing periods of insomnia.

To be clear, insomnia is not caused by cancer, but it is a precipitating issue that results from the physical and emotional stress that often accompanies a cancer diagnosis.

Other sleep disorders may also manifest, such as sleep apnea, hypersomnia, circadian rhythm disorders, parasomnia, and restless leg syndrome. All of these make it difficult for sufferers to fall asleep and sleep soundly through the night, therefore deteriorating sleep quality and causing daytime fatigue and exhaustion.

Physical Triggers

Cancer can cause a great deal of pain and discomfort, which makes it understandably difficult to fall asleep as well. Tumors and treatments alike may result in troublesome pressure in isolated spots on the body or all throughout, as well as gastrointestinal issues, breathing problems, fevers and itching, to name just a few physical symptoms. When your body is uncomfortable, it is incredibly difficult to relax and lull yourself into restful sleep.

Psychological Triggers

Additionally, cancer comes with its fair share of life changes and psychological stressors. Fear and anxiety related to your diagnosis and prognosis alone can be enough to keep you up at night.

Following your diagnosis, you might also experience career, relationship, and body image changes which cause additional stress. We understand that cancer can be a distressing experience, and many patients are at an increased risk for anxiety and depression.

If you are experiencing any troublesome side-effects, whether they are related to your sleep pattern, your physical well-being, or your mental health, it is important to consult your oncologist and other medical professionals for their advice and assistance in easing your symptoms.

How Having A Routine Makes It Easier To Fall Asleep And Sleep Well

For the sake of your health and quality of life, sleep is perhaps the most important thing you can do for yourself. A good night’s sleep can increase productivity, improve mood, and expedite the body’s natural healing processes. This is a vital part of everyone’s life, not just those who are battling illness—still, up to half of all Americans report not getting enough high-quality sleep each night.

If you are kept up by physical pain or emotional stress, implementing a bedtime routine that works to calm your mind and body in preparation for sleep might be the change that you need. Your routine does not have to be overly complicated, especially if you don’t have a whole lot of time or energy in the evening, but a few moments of intentionality before bed can work wonders for your sleep quality and relieve daytime fatigue and sleepiness.

1) Take A Bath

We all like to be warm and cozy in bed at night (hello, fuzzy blankets!) but it is actually really important for your core body temperature to be fairly cool in order to induce sleep effectively. Our bodies follow circadian rhythms which dictate when to sleep and when to wake up. At night, your body naturally cools down and begins to release melatonin and other sleep hormones. Taking a bath or warm shower before bed can have several positive benefits to your sleep, not the least of which being a reduction in your core body temperature.

It may seem counterintuitive that soaking in hot water helps to cool you down, but when you get out of the tub the water begins to evaporate from your skin, cooling your core and cuing your circadian rhythm to do its thing. Baths also improve circulation, ease aches and pains, and help you relax and disconnect before bed.

If you decide to implement a bath or shower into your bedtime routine, go ahead and make it a real treat for yourself. Even just fifteen minutes of uninterrupted relaxation time can have major benefits. Light a calming candle or turn on soothing music, allow yourself to let go of any stressful thoughts or to dos and just breathe. We recommend bathing about one to two hours before bed so that your body has enough time to fully cool down and reap all the cleansing rewards of your pre-slumber soak.

2) Stretch

Practicing some simple yoga stretches before bed can also help sooth your mind and body before bed. In fact, exercising regularly has been seen to have major benefits on sleep quality. Even if you are someone who abhors spending time in the gym or for whom running is a form of torture, you can get in touch with your body and improve your sleep with just a few gentle stretches or a basic yoga practice before bed.

Getting your body moving releases endorphins and enhances mental clarity. If you plan on participating in a workout where you break a bit more of a sweat, we recommend scheduling that earlier in the day so your body isn’t too warm or wired before bed. Stretching and breathing exercises, however, have the same positive benefits and can be done right before bed as they help to relax your mind and body.

Not only does yoga loosen up your muscles and help to relieve pain, it also encourages mindfulness and developing a trust in one’s own body. After a cancer diagnosis, it can be difficult to have faith in your body’s ability to keep you healthy. When you practice yoga, however, the process allows you to see your strength and flexibility improve over time. You will be amazed by what your body is able to do!

Getting in touch with your mind and body through a yoga practice or stretching routine has also been seen to have positive spiritual benefits for practitioners. No matter what your spiritual discipline is, taking time out of your day to clear your mind and ground your body can be enlightening and spiritually encouraging. Use the time that you are stretching to engage in prayer, meditation, or simply focus on controlling your breathing.

3) Keep A Journal 

Do you find that as soon as your head hits your pillow it begins swirling with all of your unfinished tasks and worries? You are not alone! Writing in a journal each night before bed can help to ease your mind and stave off stress and anxiety that commonly keeps you up at night.

What you decide to write is up to you. You can jot down a recount of what you did throughout the day, or make a plan for what you intend on doing the following day. Perhaps you have a mantra of aspiration phrase that encourages you? Try writing this down each night or compose a list of things that you are grateful for or proud of from each day. If you are struggling with day time fatigue, using your journal as a place to record your daily fatigue level (on a scale of 1-10) and the activities that you participated in throughout the day can be useful for figuring out your fatigue triggers and working to manage your energy efficiently.

Ultimately, having a place to clear your head and process your thoughts is a great addition to any bedtime routine. It does not have to take a whole lot of time, nor does it have to follow any sort of structure. This journal should be for you and you alone, so don’t overthink it, just get to jotting (and then get to snoozing!)

Wrapping Up 

Ultimately, changing your routine can create a sense of regularity and control, helping to ease your mind and body into sleep. Routine changes, however, are no substitute for medical care and a strong support system. So, if you are having trouble sleeping, do not hesitate to mention it to your doctor as this might be a symptom of a larger problem.

Can Diet and Exercise Reduce MPN Symptoms?

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Can Diet and Exercise Reduce MPN Symptoms? from Patient Empowerment Network on Vimeo. 

What can YOU do to make a positive impact on your overall MPN care? Researchers Dr. Jennifer Huberty and Ryan Eckert review the latest research on how movement and diet can benefit people living with myeloproliferative neoplasms (MPNs).

Dr. Jennifer Huberty is an Associate Professor at Arizona State University. She focuses her research on the use of complementary approaches to manage symptoms and improve quality of life for patients living with myeloproliferative neoplasms. More about Dr. Huberty here: chs.asu.edu/jennifer-huberty.

Ryan Eckert currently works at Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. Ryan is the Research Coordinator for the MPN QoL Study Group and assists in research related to complementary health approaches in myeloproliferative neoplasms and other hematological disorders. More about Ryan here: mpnqol.com/research-team.

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Improving Life with MPNs: The Latest Research and How to Get Involved

Transcript:

Ryan:

So, as far as the benefits of exercise for MPN patients, there’s many, and so, I guess starting with cancers as a whole, there’s a lot more research that’s been done in recent decades that looks at the effects of various forms of exercise and physical activity on other cancers. They just tend – researchers tend to do a lot more of that work in breast cancer, lung cancer, colon cancer, et cetera.

And so, the research in exercise for MPN patients is actually really new, and nobody outside of Dr. Huberty in conjunction with Dr. Mesa and a few other researchers have done any research related to exercise specifically in MPN patients. Our yoga studies that we’ve done have been the first venture down that route for MPN patients. But, what we do know in general is that exercise has obviously systemic effects across the whole body.

So, you’re gonna get health benefits just in general from exercise, but as far as for MPN patients specifically, some of the things that we’ve seen with our yoga studies, which is obviously a form of physical activity, is that we’ve seen sleep improve in MPN patients, so we’ve seen a reduction in sleep disturbances or disruptions in their sleep, a quicker time to fall asleep, and then, less waking up throughout the night – so, just better sleep in general.

We’ve seen some reductions in fatigue that have been reported by MPN patients who have gone through our yoga studies, and then, we’ve also seen a few other reductions in some other symptoms, such as anxiety and reduced depressive symptoms, a little bit of reduced pain is another one we’ve seen. So, just in general, we’ve seen some of those effects on MPN patients through some of our yoga studies.

Dr. Huberty:

So, in terms of adding to what Ryan just said, I would just say that exercise – maybe yoga or walking – is good for your body. It’s good for your health. It’s a recommendation that we get 150 minutes of moderate-intensity activity every week. The more that MPN patients can be achieving that goal towards 150 minutes – yoga counting at that – the better off they’re gonna be, and it doesn’t have to be going for a run.

It can simply be going for a walk around the block. It can be standing at your desk when you’re working instead of sitting all the time. That’s not necessarily activity per se, but it is moving your body and less sedentary. So, I think just focusing on the more that patients can move their body every day, the better off they’re gonna be.

Dr. Huberty:                

So, yeah, the role of diet in MPN patients – so, this is the beauty about the quality of life study group, because we have all these wonderful investigators that are part of the team, and we do have Dr. Robyn Scherber, who’s at Mays with Dr. Ruben Mesa. She’s doing some work with keto diet right now, so it’s very new, so I don’t know if you’re familiar with the keto diet, but it’s very high-fat and very low-carbohydrate, extremely low levels of carbohydrates. I wouldn’t tell any patient to go start doing those things unless they’ve talked to their physician for sure, but we do know that based on how you eat does certain things to your body.

So, MPNs have high inflammatory markers, and so, we wanna decrease inflammation; we probably wanna eat foods that are going to be anti-inflammatory. So, berries, let’s say, is a good example of fruits that are anti-inflammatory, almonds are anti-inflammatory, and I’m not a dietitian by any means, it’s just that things that I know to be true for my own diet because everybody should be thinking about having an anti-inflammatory diet.

Processed foods are not healthy. They are higher-inflammatory. Breakfast foods, eating out, and the foods that you get when you eat out a lot are going to be more inflammatory than not. So, just those small things – lots of vegetables. Vegetables are very good. Lots of greens. But, there is research going on – again, just like exercise and yoga, it’s in its infancy because MPN has been an under-studied population for years, and we’re trying to power through and make that difference.

Helping Cancer Survivors Sleep

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This blog was originally published by Cancer Today by Cheryl Platzman Weinstock, here.

A clinical trial comparing acupuncture and cognitive behavioral therapy found that they are both helpful for people who are experiencing sleep problems after cancer treatment.

by Cheryl Platzman Weinstock

​Photo by Marjot​ / iStock / Getty Images Plus

PEOPLE WHO HAVE BEEN DIAGNOSED with cancer often face sleep problems stemming from the physical effects of cancer treatment as well as psychological or spiritual concerns related to the diagnosis.

A randomized clinical trial published April 9, 2019, in the​ Jo​urnal of the National Cancer Institute​ compared cognitive behavioral therapy for insomnia (CBTi) and acupuncture in patients who had completed treatment for a variety of cancers. Study results showed that participants assigned to the CBTi group experienced a greater reduction in insomnia severity over the course of the study compared with the acupuncture group. However, survivors treated with acupuncture also experienced meaningful improvement in their sleep.

The researchers assigned 80 patients to receive CBTi from therapists trained in the technique over the course of eight weeks. CBTi has previously been shown to be effective in improving sleep in cancer survivors. The therapy works in part by modifying unhelpful beliefs about sleep and providing relaxation training. Patients are also asked to limit their time in bed and use it only for sleep and sexual activity. Another 80 patients were assigned to receive acupuncture over the course of eight weeks. Participants in the study were 62 years old, on average, and had completed active cancer treatment.

The researchers asked the participants to fill out a questionnaire asking about insomnia symptoms both before and after receiving treatment for insomnia. Patients reported significant improvements after receiving either CBTi or acupuncture, both when surveyed immediately after their course of treatment for insomnia and about three months later.

“While overall we found that there is a statistically significant benefit of CBTi over acupuncture, the difference is actually small,” says Jun Mao, chief of integrative medicine at Memorial Sloan Kettering Cancer Center in New York City, who led the study. “I certainly think both treatments produce clinically meaningful outcomes and they persist.”

When they looked more closely at subgroups of patients, Mao and his research team found that CBTi was only significantly better than acupuncture at reducing insomnia for males, white people, people who had graduated from college and people without significant pain. For other groups, the two treatments had a similar effect.

Poor sleep can have a variety of effects, including increased pain, depression and fatigue, says Sandra Mitchell, a research scientist and program director in the Outcomes Research Branch at the National Cancer Institute in Rockville, Maryland, who was not involved in the study.

Although Mitchell says she believes additional studies are needed to look at the long-term effects of acupuncture and CBTi management, she says, “This study yields important and clinically actionable results that patients and providers can utilize in a shared decision-making approach.”

Weidong Lu, lead oncology acupuncturist at Dana-Farber Cancer Institute in Boston, says today many patients with insomnia are first put on medications, which can cause side effects. “I think it’s best starting patients on nonpharmaceuticals for mild- and moderate-level insomnia. Severe, long-term insomnia probably needs a combination approach” that includes drugs and other therapies, such as acupuncture and CBT, says Lu, who was also not involved in the study.

The trial was supported in part by the Patient-Centered Outcomes Research Institute (PCORI), a nongovernmental organization funded through a trust established by the Affordable Care Act to carry out research guided by patients and caregivers.

Jodi MacLeod of Collegeville, Pennsylvania, was one of the patient partners who provided input into the design and execution of the clinical trial. She was diagnosed with stage II breast cancer in 2004.

After treatment, “the expectation was that I would return to being a normal stay-at-home mom, but my insomnia was really disruptive,” she recalls. Her sleep problems led to mental fog and fatigue. Eventually, MacLeod’s husband rearranged his work schedule to help take care of their three young children.

“Back then, in 2005, insomnia and cancer wasn’t well researched and recognized. I actually thought it was my fault,” says MacLeod of her difficulty in sleeping.

MacLeod met Mao in 2006 when she enrolled in a study he was conducting at the University of Pennsylvania in Philadelphia on acupuncture and cancer-related joint pain. When Mao was ready to do his PCORI-funded research on cancer and sleep, he reached out to MacLeod for her help.

Among other contributions, MacLeod and her fellow patient advisers helped decide what questions the study would seek to answer, shape inclusion and exclusion criteria for the trial and recruit a diverse group of patients to participate, as described in a 2017 paper​ that MacLeod co-authored.

“It is satisfying and empowering to know that we’re leaving the cancer waiting room better than we found it,” says MacLeod. “Cancer patients now don’t have to go through what I did, because now there are effective insomnia treatments available.” ​

Cheryl Platzman Weinstock is a journalist who reports on health and science research and its impact on society.​

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July 01, 2019

How Anxiety Impacts Sleep

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Anxieties from the day can be inescapable by night. You can try so hard to sleep or to stay asleep, but worrisome thoughts cloud your mind and make it impossible to clear your mind enough to doze off. Issues like money, children, and work can seem overwhelming, where such anxiety-provoking topics develop into stress that causes your mind and body to stay awake. So what can you do?

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There are several comorbid factors to stress that can be problematic sources of your insomnia as well. Don’t let anxiety or these related matters control you though. Instead of trying to control the stressors in your life by thinking of them all the time, focus instead on what you can actually control:

Your Sleep Space

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Make your bedroom a stress-free sanctuary. Keep your bedroom dark, quiet, and cool, and use it only for sex and sleep. Since you can’t completely control anxiety, eliminate any other threats to your sleep quality, such as what type of mattress you sleep on. Consider what would the right mattress feel like for you, based on your individual sleep preferences. Use a fan to drown out extra noise, and make sure your pillows are comfortable too. Turn any clock away from you so you don’t get stressed out by seeing it is very late, if you are still awake. If you don’t fall asleep in 15 minutes, leave your bedroom and do something relaxing in another room.

Your Routine

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 Establishing daily and nightly routines is key for regular sleep, even on the weekends. Block out seven to nine hours for sleep every night, and make sure you wake up at the same time on both weekdays and the weekend. Stop consuming nicotine, alcohol, or caffeine at least three hours before your set bedtime, and avoid working, watching TV, or using a handheld mobile device in bed right before you try to fall asleep. Make it habit to set aside 30 minutes prior to bed to read, listen to soft music, or meditate, so you can relax, clear your mind, and settle into your bed as a stress-free tranquil zone.

How You are Staying Active

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 How active you are during the day impacts your sleep quality as well. Exercise is excellent for both physical and mental health, where exercising regularly helps you establish regular sleep patterns. You can take out your frustrations in exercise, where you leave the gym with a worry and frustration free head. Exercise also produces mood-enhancing endorphins – just remember to exercise only in the morning or afternoon, as those same endorphins will keep you up if you exercise right before bedtime. And your exercise doesn’t have to be major – even one brisk walk around your neighborhood each day has been demonstrated to help alleviate chronic insomnia. As exercise has been demonstrated to help you develop strength both physically and mentally, remember that mental health is a factor to also be considered when placing value and effort in improving your sleep life.

While increasing anxiety and decreasing sleep can seem like a never ending cycle, you can put an end to what feels so frustrating. By putting these principles and guidelines into practice, you are being proactive in making a difference for you. If you still have difficulty falling or staying asleep, reach out to family and friends for support, and consider seeing a therapist.

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