Poor Quality Sleep: A Silent Source of Disability in Breast Cancer
authored by Hrayr Attarian, MD, FACCP, FAASM, Member of the SWHR Network on Sleep
Poor quality sleep is a major contributor to reduced quality of life and can have a negative impact on mood and energy, cognition, metabolic and immunological function, as well as leading to weight gain. 
Sleep-related complaints are quite common in women with breast cancer, affecting around 70 percent of them.  In fact, more than 60 percent of women with either metastatic or non-metastatic disease are diagnosed with insomnia. [1,2] This prevalence exceeds both age-matched healthy adults and women with other cancers. 
There are many causes for sleep disturbances in breast cancer sufferers, including age, socioeconomic status, lifestyle choices and other coexisting medical conditions. Some of the prominent contributors to poor sleep, however, are the treatments themselves.
Chemotherapy and radiation therapy are associated with more sleep disturbances than hormonal treatments and surgery. In fact, surgery reduced the occurrence of insomnia from 69 percent to 42 percent in a group of women with non-metastatic breast cancer. 
Causes for chemotherapy-related sleep disturbances include distressing side effects such as nausea, vomiting, diarrhea and frequent urination. A one-year, longitudinal study showed that both subjective and objective measures of sleep got worse with each cycle of chemotherapy in 80 percent of women with breast cancer.
Radiation can cause painful reactions to the area of the skin where it is applied and this pain can interfere with sleep.
In addition to the pain, frequent hospital stays, stress, depression, fatigue and even negative body image issues due to surgery all can lead to significant deterioration in sleep quality. Additionally, menopause-like "vasomotor" symptoms of hot flashes and night sweats can disturb sleep and are common with either chemotherapy-induced ovarian failure or as a result of hormonal treatments.
But cancer therapy and its side effects are not the only contributors to sleep disturbances. The size of the tumor and its aggressiveness or degree of spread also adversely impact sleep. The quality of a woman's sleep before her diagnosis with breast cancer is also an important contributor to the likelihood and severity of insomnia after diagnosis. 
Despite the prevalence of disturbed sleep and related fatigue in breast cancer survivors, there are relatively few studies looking into remedies for it. The most promising treatments are not pharmacological; instead, these treatments are behavioral interventions and complementary and alternative therapies. Structured yoga,  exercise programs  and bright light exposure  all have been shown to improve sleep and overall well-being in breast cancer survivors.
In severe cases of insomnia, a short-term, structured cognitive behavioral therapy program also has been shown to be effective in significantly improving sleep and quality of life in breast cancer patients.  Sleep medications should only be used for very brief periods and only for acute cases of insomnia, because there isn't enough data available on the long-term effects of use. 
It is imperative to increase awareness of sleep disorders in women with breast cancer and to come up with effective and safe treatments to improve both sleep and quality of life in this population.
The Society for Women's Health Research (SWHR) is dedicated to bringing together experts to study sex and gender differences in sleep and the state of women's sleep health. Click here to learn more about SWHR's Interdisciplinary Network on Sleep.
About the author: Hrayr Attarian, MD, FACCP, FAASM, is a member of the SWHR Network on Sleep and is an associate professor of neurology at Northwestern University, Circadian Rhythms and Sleep Research Lab for the Society for Women's Health Interdisciplinary Network on Sleep.
The Society for Women's Health Research is the national thought leader in the study of sex differences, dedicated to transforming women’s health through science, advocacy and education.
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