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The Wrong Side of the Bed: Breast Cancer and Sleep Disturbances

CUREWinter 2023
Volume 22
Issue 5

Breast cancer treatment can disrupt patients’ quality and quantity of sleep, leaving them fatigued and restless during the day.

Sleepless woman suffering from insomnia, sleep apnea or stress. Tired and exhausted lady. Headache or migraine. Awake in the middle of the night. Frustrated person with problem. Alarm clock with time.  | Image credit: © terovesalainen - © stock.adobe.com

Patients with breast cancer often face sleep disturbances.

Getting a good night’s sleep during breast cancer treatment is vital to a patient’s emotional, social and physical well-being. However, many patients struggle due to anxieties and side effects from treatment.

Patricia Carter, who holds a Ph.D. in nursing and is an associate professor at the UT Austin School of Nursing, part of UT Health San Antonio in Texas, spoke with CURE about why patients with breast cancer experience poor sleep, how it can affect them and ways to manage it.

Carter said patients with breast cancer often struggle with sleep during treatment. Besides experiencing poor quality of sleep in general, many patients may also develop insomnia or restless legs syndrome. Additionally, patients who had sleep disorders, such as sleep apnea, before a diagnosis may see the problem worsen during treatment.

“It’s really very common,” Carter said. “More than half of people going through cancer treatments (experience poor sleep).

“Especially people with breast cancer, since it tends to be mostly women, and women tend to have more of a difficulty sleeping anyway — this just accentuates that even more.”

Why Does It Happen?

Carter, who is also a sleep scientist, explained that because cancer is traumatic, patients may try to push aside their worries or anxieties during the day, only to have them creep back at night. Patients lie awake with worry; they become concerned about not sleeping, but cannot doze off because of their fears. The cycle feeds itself.

“So that’s a combination of a psychological experience that they’re having with even just the trauma of the cancer diagnosis, and then all the worries and fears that come along with (it)," she said. "So, all of those worries come to us during that time we’ve psychologically experienced that, which disrupts our ability to sleep well.”

Moreover, sleep can be affected due to physical side effects of treatment. Many therapies can cause fatigue in patients; they also can affect hormone balance, which keeps everything in check. Carter noted that a lot of patients feel their days and nights have switched — because they are so fatigued from treatment, they are sleeping during the day but are awake all night.

Additionally, side effect management can cause sleep disturbance, such as Benadryl making patients drowsy during the day or steroids causing them to awaken at odd times during the night.

“So, there are a lot of things that go into how receiving cancer therapy to save your life actually really majorly disrupts your life and the pattern of your life,” Carter said. “And that disruption of the pattern of your life can disrupt your sleep, as well. It’s such a complex mosaic of, how do we perfectly balance all of these things so that we can achieve a cure, so that we can get our best rest and so that we can be our best person and live our best life? And it’s just a really delicate balance.”

Quality of Life Impact

Patients with breast cancer may be dealing with more than just a rough night of sleep that anyone can experience. What can make it more serious, or a disorder, is when it becomes a pattern of behavior, happening several nights a week for a few weeks in a row, Carter noted. Furthermore, it can become a significant problem by how much it affects the patient.

“We have to look at sleep similar to how we look at pain,” she explained. “The quality of sleep is what the individual defines it to be. We can look at all of these different objective measures ... but if all of that doesn’t come together and provide the individual with the energy that they need to do what they want to do during the day, then it’s not sufficient for them.”

Quality of life can be diminished because of this, Carter highlighted. Patients may feel so fatigued that they cannot do what they want, or their not sleeping at night leaves them without the energy for daytime tasks they need to accomplish. Fortunately, sleep is manageable, meaning it can be taken into the patient’s hands.

Carter said many patients have benefited from taking control of their sleep patterns and routine, improving their quality of life. They also find comfort in knowing it is something they can work on as their journey continues.

“With that freight train of cancer coming through their lives ... being able to have something, anything that they can have a little bit of control over makes them feel like they have a better quality of life for that moment,” she said. “And knowing that they can use those skills as they move throughout their therapy into survivorship, it helps them know that they can have just a little bit of control over something that they can wrap their hands around.”

Patients with breast cancer should care about their sleep and work to improve it because sleep affects every cell in the body. Growing research demonstrates that if a patient is sleeping well, their immune system function is improved — which in turn may fight the cancer better, Carter highlighted.

“So, if you’re sleeping well, your body is going to have a better chance; it’s going to have more energy literally to fight your cancer,” she added.

Moreover, a good night’s sleep will help a patient see “small rays of light,” and find more joy in life.

If a patient sleeps well, they will feel well and start to view the glass as half-full, Carter said.

“It affects you socially, emotionally, physically, psychologically, so it really impacts every single element of your life, every single day,” she concluded.

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