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Problems with Sleep

Posted 5/19/2015

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  In order to have a decent quality of life, you have to sleep at night. We all have different sleep needs and patterns before we are diagnosed with cancer, but it is safe to suggest that no one's sleep is improved by this diagnosis. In the beginning, anxiety and sadness and stress may keep us awake. Everything seems worse in the middle of the night, and there is plenty to worry about in the early days.

  As treatment commences, physical issues often add to sleep troubles. After surgery, it can be hard to get comfortable and pain may awaken you. Chemotherapy often includes various medications that impact sleep. We laugh about our hyper activity on steroids; it may be funny to be up cleaning closets at 2 AM the first time, but the novelty wears thin, and we need sleep. Many people regularly use ativan or another mild medication to help with sleep during these months, and I am almost always a big fan of such decisions (to be made, of course, with your doctor). Yes, ativan is addictive, but it is not so hard to slowly decrease and then stop use when treatment ends. And, again, my mantra: you have to sleep.

  Personally, I am a world class sleeper and am always, or almost always, asleep within five minutes of turning out the light. Maybe three minutes. When my first marriage was coming apart, I was not sleeping, and that fact was more proof than anything else of how troubled I was. Even cancer didn't have that same effect for me, and I have been really grateful for my sleep blessings. I also know that I can't take credit for them; I am just lucky.

  This is an introduction to an interesting and useful article from The Journal of Community and Supportive Oncology about sleep disturbances in cancer patients. Here is the introduction and a link to read more:

Sleep disorders in patients with cancer
Ruben Guzman-Marin, MD, PhD,a and Alon Y Avidan, MD, MPHb

Quality sleep is an essential element to tissue
repair, proper immune function, and
mental health. Chronic lack of sleep has
been associated with depression, anxiety,
and decreased cognitive function.1 In people with
cancer, poor quality of sleep reduces quality of life,2
but unfortunately, most patients with cancer do not
mention sleep problems unless explicitly asked. Sleep
problems are common in this group of patients and
may lead to a variety of sleep disturbances, which the
International Classification of Sleep Disorders (ICSD
III)3 groups into 8 categories: Insomnia, Sleep-related
breathing disorders, Central disorders of hypersomnolence,
Parasomnias, Circadian rhythm sleep-wake
disorders, Sleep-related movement disorders, Isolated
symptoms, Apparent normal variants and unresolved
issues, and Other sleep disorders
Most of the work addressing quality of life issues
in patients with cancer has focused primarily on
insomnia and fatigue, but both patients living with
cancer and long-term survivors are at risk of having
other sleep problems.4,5 Moreover, primary sleep
disorders – including sleep-disordered breathing,
such as obstructive sleep apnea, and motor disorders
of sleep, such as restless legs syndrome (RLS) – have
received little attention from the oncology community
even though they are common in the general
population.6,7 In this review, we present a conceptual
framework on how sleep disorders may be present
in patients with cancer, and the diagnostic features
and management for the key sleep disturbances.


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