3rdstreet

Endometriosis and Sleep

Endometriosis and Sleep

What is Endometriosis?

Endometriosis is a medical condition, usually marked by pain, in which tissue that normally grows inside the uterus is found in other parts of the body. This misplaced endometrial tissue is usually shed during a woman’s period, but in the case of endometriosis, it ends up trapped and may form cysts. Usually, the misplaced tissue is found in the fallopian tubes, ovaries, and tissues surrounding the uterus and pelvis. More rarely, it ends up in the vagina, bladder, rectum, or cervix.

In many cases, endometriosis may lead to fertility problems, including difficulty conceiving and recurrent miscarriages. Endometriosis is one of the leading causes of female infertility in the U.S. Estimates suggest that around 30-50% of women who have endometriosis will be infertile.

Endometriosis is fairly common. In fact, it affects over 11% of American women between the ages of 15 and 44. Worldwide, over 176 million women (about 10% of the female population from the onset of menstruation to menopause) are affected by endometriosis during their reproductive years. It’s most common among women ages 25 to 29.

The primary symptom of endometriosis is pelvic pain, especially during periods. Because pain is often associated with menstrual cycles, endometriosis often goes undiagnosed. On average, women wait 8.6 years between the first onset of their endometriosis-related pain and an official diagnosis.

Symptoms

The symptoms of endometriosis are as follows:

  • Pelvic pain/pain during menstruation
  • Pain during sex
  • Fatigue
  • Painful and frequent urination
  • Diarrhea, constipation, or IBS.
  • Nausea
  • Migraines/Headaches
  • Heavy or irregular bleeding

Causes

No one knows for sure what causes endometriosis. There are, however, a few known hypotheses that researchers are continuing to study. Some of these possible causes include:

  • Overproduction of estrogen: Scientists agree that endometriosis is exacerbated by estrogen. Many of the existing treatments meant to curb some of the symptoms of endometriosis are aimed at decreasing estrogen production.
  • Genetic predisposition: First-degree relatives of women who have endometriosis are likelier to develop the condition. This means that there is likely a genetic link when it comes to the onset of endometriosis.
  • Retrograde menstruation: One of the proposed causes of endometriosis is “retrograde” menstruation, in which tissue flows backward through the fallopian tubes during the menstrual cycle.
  • Immune system dysfunction: Because certain cancers and forms of immune system dysfunction are more common in women with endometriosis, some clinicians believe that faulty immune systems cause the disorder.
  • Surgery/physical trauma: C-sections and hysterectomies can cause symptoms of endometriosis if uterine tissue is accidentally moved to another area of the body.

Why does Endometriosis make it Harder to Sleep?

How does endometriosis disrupt sleep? There are many factors relating to endometriosis and its associated symptoms and potential complications that cause it to affect sleep health.

Here are a few of the primary ways that endometriosis can disturb sleep patterns:

Pain and discomfort
Most women with endometriosis report moderate to severe pelvic pain that increases before and during their period, as well as during and after sex. This pain, associated with endometrial inflammation, goes far beyond “normal” menstrual cramping and can negatively affect your quality of life.

If you’ve ever tossed and turned with pain at night, you know how much a painful night can affect your sleep. Pain is the most debilitating symptom on a daily basis for many women with endometriosis, and the associated sleep loss can exacerbate that pain even further.

Hot flashes
Women with endometriosis sometimes experience symptoms similar to the uncomfortable “hot flashes” often associated with menopause. Some anecdotal evidence suggests that this is because of hormone fluctuations, while others experience hot flashes as a side effect of medications commonly used to treat endometriosis.

Because hot flashes cause a corresponding surge in adrenaline, they’re not exactly conducive to sleep! Hot flashes are associated with chronic sleep loss and insomnia, and they’re one of the many reasons that women with endometriosis might struggle with sleep health.

Anxiety
Women with endometriosis experience higher rates of depression and anxiety than women with any other gynecological disorder. The negative effects of chronic pelvic pain and infertility or reduced fertility on mental health can exacerbate that anxiety even further.

Anxiety and sleep disturbances often go hand-in-hand. In fact, two-thirds of patients with sleep disorders have a psychiatric disorder as well. Anxiety activates our fight-or-flight response, ramping up the areas of our brain that helps with sleep regulation. This often contributes to a feedback loop, in which people struggling with anxiety and insomnia suffer from chronic worry about not being able to fall asleep, leading to a domino effect that creates a pattern of sleep loss.

Having to go to the bathroom at night
Endometriosis is associated with a range of bladder and bowel symptoms, including frequent urination. This is because, in women with endometriosis, cells that should be in the womb end up elsewhere–like in the bladder or bowels. The body sometimes responds with negative symptoms like an overactive bladder.

It’s easy to see why urgent, frequent urination could lead to sleep problems. Women with endometriosis are likelier to have to get up in the middle of the night to use the bathroom, and they may have trouble falling back asleep due to pain or other troubling symptoms. Anxiety over potential bed-wetting could exacerbate the problem.

Migraines
Women with endometriosis are likelier to experience migraines, and vice versa. Researchers aren’t sure of the reasons for the link, but there’s plenty of evidence to suggest that migraines and endometriosis often go hand-in-hand.

Unfortunately, migraine sufferers are also 2 to 8 times likelier to experience sleep problems, according to the American Migraine Association.

The link between migraines and poor sleep health is a complex problem: Migraines often make people have a harder time falling asleep. In turn, chronic sleep deprivation or oversleeping to make up for the lack of sleep that often accompanies a migraine can trigger–you guessed it–more migraines.

Longer and heavier periods
Endometriosis causes longer periods, shorter and more frequent cycles, and heavier menstrual flows for many women. It can also worsen PMS symptoms, from cramps and psychiatric symptoms to headaches and bowel-related issues, all of which can disturb sleep.

Because the hormone fluctuations associated with monthly cycles sometimes lead to sleep disturbances, including both hypersomnia and insomnia, it makes sense that women with atypically long periods would experience particularly severe sleep disruption.

Women with heavier flows may also experience anxiety around excessive bleeding. They might also wake up more frequently than normal in order to replace tampons or pads.

Distinguishing Between Fatigue and Sleepiness

Besides pain, one of the main complaints that women with endometriosis have is fatigue. When the body struggles to rid itself of unwanted tissue, it can lead to inflammation and exhaustion. Think about the last time you were really sick: No matter how much you slept, you probably still felt tired to the bone. That’s fatigue.

It’s important to distinguish between fatigue and sleepiness. Sleepiness and fatigue might go hand-in-hand in some cases, but they have distinct symptoms and effects on sleep health.

Fatigue can include both physical and mental exhaustion. If you have endometriosis and you’re feeling tired regularly, better sleep will help, but it might not be enough. Make sure that you’re seeking help from a medical professional to determine whether your exhaustion is due to chronic sleep deprivation or other symptoms associated with endometriosis.

Strategies for Sleeping with Endometriosis

Below we’ll look at three different areas to explore when figuring out how to achieve quality sleep with endometriosis.

Make sure You’re Getting the Best Treatment for You

Endometriosis often comes with a host of symptoms that can lead to sleep disruption. The good news is that there are many kinds of medical treatments available to ease your endometriosis symptoms–and get a better night’s sleep in the process.

Here are a few treatments that you can ask a qualified medical professional about if you hope to improve your sleep health while managing endometriosis.

Pain medication: Pain is the chief complaint of many women with endometriosis, and it’s also one of the primary reasons that sleep is often disturbed. Pain management is key to achieving a better quality of life with endometriosis. Particularly if you’re not experiencing other symptoms like infertility or problematic menstrual cycles, easing your pain is the first step to a better night of sleep with endometriosis.

Over-the-counter treatments for pain and inflammation, such as ibuprofen, might be enough. But if you find that your pain is persistent and severe, ask your doctor about other options.

Hormone therapy: The natural thickening, breakdown, and bleeding of endometrial tissues that happens before and during your menstrual cycle is also what causes many endometriosis symptoms to flare up. Managing the hormonal variations that regulate this cycle can significantly ease your endometriosis symptoms.

Options for hormone therapy that your doctor might recommend include progestin therapies, hormonal contraceptives, and other drugs that lower your estrogen levels. All of these therapies, when used for endometriosis, are designed to lighten, shorten, or stop your menstrual cycles in order to curb abnormal tissue growth and relieve your associated symptoms.

Surgery: The bothersome endometrial tissues can be surgically removed by a doctor, whether laparoscopically (more commonly) or, in very severe cases, via hysterectomy. While the tissue might grow back, many women do experience improved symptoms and a great deal of relief after surgery. And laparoscopic surgery in particular is minimally invasive, so your recovery time should be manageable.

Surgery to treat endometriosis has two primary goals: to ease pain and inflammation and to improve fertility. Surgery might also improve your sleep or any chronic insomnia you experience, especially if pain or anxiety related to infertility is keeping you up at night.

Fertility treatment: If endometriosis is causing you to have trouble getting pregnant, your doctor may recommend fertility treatments to help you conceive. Fertility treatments might include medication to stimulate ovulation, or more complex procedures such as in vitro fertilization.

Fertility treatments most likely won’t have a direct effect on your endometriosis symptoms or related sleep issues. Instead, managing your fertility alongside a medical professional might ease the anxiety and depression that often accompany infertility, thus improving any chronic sleep problems you might have.

Create the Ideal Environment for Sleep

Regulate the Temperature of Your Sleep Space and Body

The effects of painful menstruation, the possibility of hot flashes from prescribed medications, and the general rules of sleep hygiene all indicate that keeping a cool temperature is crucial to getting good sleep with endometriosis.

Keeping your body temperature well-regulated (“thermoregulation”) is key to achieving a good night’s sleep. With endometriosis symptoms, temperature regulation becomes all the more important for quality rest. There are a few ways to achieve thermoregulation while you sleep:

  • Keep your bedroom cool. The best temperature for falling asleep is between 60 and 67 degrees Fahrenheit. You shouldn’t be falling asleep shivering or waking up sweating.
  • Use lightweight, breathable bedding and a softer mattress. Firmer mattresses and body contouring mattresses will increase your body temperature at night, so opt for an airbed or innerspring mattress if you can.
  • Keep cool refreshments, such as water, near the bed at night. If you wake up unexpectedly, you can cool yourself down right away.

Practice Excellent Sleep Hygiene

It’s always important to practice good sleep hygiene. It’s especially crucial if you want to ease any disruption in your nightly rest that your endometriosis symptoms may be causing.

There are a few key principles that will maximize your chances of achieving better sleep health with endometriosis:

  • Know how much sleep you need: The average adult needs 7 to 7.5 hours of sleep a night. In general, you should aim to get at least 7 hours of sleep a night.
  • Go to bed at the same time every night and follow a bedtime routine: Try to go to sleep at the same time every night and wake around the same time every morning. Use a sleep diary or sleep tracker if you’re struggling to keep track.
  • Find a dark, cool, quiet place to sleep: A dark, quiet room that’s kept between 60 and 67 degrees Fahrenheit and as free of noise pollution as possible will give you the best possible night’s sleep.
  • Dedicate your bed only to sleep and sex: Treat your bedroom as a haven for rest. Don’t use your bed for work, texting, talking on the phone, or anything else that might distract you.
  • Limit screen time: It’s tempting, but try to stop using phones, computers, tablets, televisions, e-readers, or any other electronics that use blue light at least one full hour before bed.
  • Eat well, exercise, and get sunshine during the day: A healthy day makes for healthier rest. Getting sunshine during the day will regulate your circadian rhythm, while eating nutritiously and exercising strenuously will help you sleep better when it’s time.
  • Avoid substances like caffeine and alcohol before bed: Caffeine can jump-start your adrenaline, while alcohol disrupts essential REM sleep. Avoid both substances close to bedtime.

Use Relaxation Techniques while Trying to Sleep

Relaxation techniques such as meditation exercises can prove to be a fundamental part of your nightly sleep routine.

In terms of endometriosis, relaxation techniques can have a dual benefit: both in terms of aiding sleep and in easing related symptoms of anxiety and even chronic pain. Here are a few mindfulness meditation techniques you can use to help you drift off to a restful night of sleep.

Progressive Muscle Relaxation: Begin a progressive muscle relaxation practice by turning out the lights and doing some deep breathing. Focus on any areas of tension in your body. Then, tense and contract each muscle in your body for five seconds, followed by at least 30 seconds of full relaxation of that muscle. Do this with every part of your body, from the top of your head to your toes. Slowly, you’ll drift into a deep state of relaxation and let go of any remaining tension.

Mindful Breathing: Breathing meditation involves being mindful of your inhales and exhales in a relaxed state. Turn off your bedroom lights and get comfortable. Notice any tension in your body, and don’t try to breathe differently than you normally would. Follow the path of your breath, breathing in through your nose and out through your mouth. As you meditate, try to gradually make your exhales longer than your inhales. If you get distracted, don’t judge yourself: Simply refocus your attention (gently) back on your breath.

Counting Meditation: Thoughts invade our brain constantly, whether we want them to or not. Counting meditation is designed to get you to refocus your attention to something simple and straightforward: counting. After you get your room dark, cool, and comfortable, start to count slowly. You can count out loud or silently in your head. Either way, redirect your attention to the numbers anytime your mind starts to wander (but don’t be hard on yourself if it does!). Count until you reach a certain number, or until you fall asleep.

Guided MeditationGuided meditations can include all of the above, in addition to repetitive mantras or chanting, music, or storytelling. There are plenty of guided meditations available on YouTube and platforms like iTunes for you to follow along with. Using headphones or simply your phone, set your device to the right volume and follow along. As with the other forms of meditation, make sure that you’ve practiced good sleep hygiene by resting comfortably in a dark, cool room, and redirect your attention gently to the meditation leader’s voice anytime your mind wanders.

Use of Sleep Aids

If relaxation methods and sleep hygiene practices still don’t get you the rest you need with endometriosis, there are many sleep aids you can try. Here are a few of the most popular sleep aids on the market, as well as some of their potential side effects.

SLEEP AID DESCRIPTION AVAILABILITY SIDE EFFECTS
Antihistamines Antihistamines are typically used to treat allergic reactions, but can also cause drowsiness. Medications such as Unisom or Benadryl are most often used. Over-the-counter Side effects include dry mouth, dizziness, nausea, drowsiness, and difficulty concentrating.
Melatonin Melatonin is a hormone that regulates and spurs the onset of sleep. While naturally occurring, it’s available in supplement forms. Over-the-counter in the U.S. Melatonin can disrupt hormonal regulation. There are some cases showing it lowers sperm count in men. In higher dosages, melatonin can cause hypersomnia.
Sleep Teas “Sleep teas” are caffeine-free herbal teas that claim to improve sleep. Chamomile tea and valerian tea are the most popular. Health food stores, online Chamomile tea can cause allergic reactions and is a blood thinner. Valerian root can be addictive.
CBD CBD oil, or cannabidiol, is one of the chemical compounds found in cannabis. It helps with pain relief, relaxation, and sleep. Check your local laws to ensure legality. Side effects can include fatigue, dizziness, changes in appetite, diarrhea, and dry mouth.
Prescription Sleep Medicines Most prescription sleep medications act on the benzodiazepine receptors in the brain to cause sleepiness. “Z-drugs” include medications like zaleplon (Sonata), while benzodiazepine medications, such as temazepam (Restoril) are used to treat anxiety disorders and also have sleep-inducing effects. Prescription only Both non-benzodiazepine and benzodiazepine drugs can be habit-forming. They also may cause central nervous system depression, which can result in coma and death. No prescription sleep medications should be combined with alcohol.

Conclusion

Endometriosis is a common medical condition among women in their reproductive years. The pain and other symptoms that often result can lead to disrupted sleep and chronic sleep deprivation.

Still, ample resources are available. Hormonal treatments, surgery, fertility treatments, and pain management from qualified medical professionals can all help to ease the troubling endometriosis symptoms that often lead to sleep disturbances.

To manage sleep problems, women with endometriosis can practice good sleep hygiene and use sleep aids for a good night’s rest. With endometriosis, symptoms can be difficult, but relief is possible.

Resources for Endometriosis Treatment

If you or someone you know is experiencing sleep disruption associated with endometriosis, here are some helpful resources:

Sleep and Cancer

Sleep and Cancer

Getting a restful night’s sleep is a challenge for many cancer patients. Pain from the cancer itself, fatigue and discomfort from chemotherapy, and medication side effects are just a few of the things that make sleep elusive for cancer patients. Worse, not getting enough sleep weakens the immune system and can exacerbate symptoms or negative side effects.

An increasing amount of research has found links between poor sleep and several cancers. Keep reading to learn what the latest research suggests about the connection between cancer and sleep, and how you can get better sleep if you’re undergoing cancer treatment.

Does lack of sleep cause cancer?

Regularly getting a good night’s sleep is an essential part of your overall health. While sleep itself has not been deemed a causal factor for cancers, researchers have associated certain sleep disorders with an increased risk of cancer. The three main sleep issues correlated with cancer are chronic sleep deprivation, sleep apnea, and shift work sleep disorder.

Sleep deprivation and cancer

Anyone who has missed a night’s sleep understands the reality of sleep deprivation. Lack of sleep worsens your mood, increases fatigue, and reduces your ability to concentrate. Chronic sleep deprivation (getting less than sufficient sleep over a sustained period of time, usually 7 to 8 hours for adults) is associated with:

  • Poorer memory and cognitive processing skills
  • Weakened immune system
  • Weight loss or weight gain
  • Increased irritability and higher risk for depression
  • Poorer judgment

Individuals may experience sleep deprivation as a result of hectic work-life schedules, comorbid conditions such as depression or insomnia, or environmental factors like noisy bedroom environments.

Unfortunately, multiple studies have linked sleep deprivation with increased cancer risk.

  • Men with insomnia were twice as likely to develop prostate cancer, according to a 2014 study that followed more than 2,000 men over a five-year timeframe.
  • Individuals who averaged fewer than 6 hours of sleep per night (below the recommended amount of 7 to 8 hours) had a 50 percent increased risk of colorectal cancer, according to a 2010 study.
  • Lack of sleep is correlated with more aggressive forms of breast cancer, according to a 2012 study of postmenopausal women. They found that breast cancer patients who regularly slept fewer hours of sleep tended to have more aggressive forms than women who slept longer.

Sleep apnea and cancer

Sleep apnea describes sleep-disordered breathing where the individual literally stops breathing for up to a few seconds during sleep. The resulting gasping, choking, or loud snoring may wake the person up multiple times throughout the night, so they experience disrupted sleep. Sleep apnea is typically caused by an obstruction of the airways.

For some time, sleep apnea has been linked with obesity, diabetes, and cardiovascular disease. Recent research also suggests a link between sleep apnea and cancer. 80 percent of head and neck cancer patients also have sleep apnea. Spanish researchers found that individuals with severe sleep apnea had a 65 percent increased risk of cancer, and a Wisconsin-based study found individuals with the highest amount of apnea-hypopnea episodes were 5 times more likely to die from cancer than those without sleep apnea.

The chart below from the Wisconsin study shows the correlation between AHI and reduced cancer survival rate. AHI, short for Apnea-Hypopnea Index, measures the severity of an individual’s sleep apnea.

sleep apnea vs cancer survival rate

Animal studies replicate these findings. According to a 2014 study published in the journal Cancer Research, animal researchers linked the fragmented sleep from sleep apnea with accelerated cancer growth in mice. The researchers placed mice with tumors in low-oxygen environments (to mimic the effects of having sleep apnea), and their cancer progressed at an accelerated rate.

Researchers theorize that the oxygen deprivation associated with sleep apnea may be what’s causing the cancer. When the body doesn’t get enough oxygen, it grows more blood vessels as a way to compensate, which in turn enables cancer tumors and tissue to grow faster.

Shift work sleep disorder and cancer

Researchers have established a link between circadian rhythm disorders, in particular shift work sleep disorder, and increased risk of breast, colon, ovary, and prostate cancers.

Circadian rhythm disorders occur when an individual’s biological clock becomes out of synch with the external environment. Many of us have experienced jet lag, a circadian rhythm disorder that happens when you travel across time zones and your body hasn’t quite synchronized with the day-night cycle of your new location. Shift work sleep disorder affects shift workers, especially those on night shifts or rotating shifts, who are awake during times when the body expects you to be asleep. Common symptoms include insomnia, microsleep episodes, fatigue, and poorer mood and concentration.

Multiple studies have studied the effects of shift work on breast cancer risk. Women who worked night shifts for 4 years and those who worked fewer than 3 night shifts per week both had a 30 percent higher risk of breast cancer than women who did not perform shift work at all, according to a 2012 study published in the International Journal of Cancer. In the first group, the women had entrained their bodies to the opposite of the normal day-night cycle, having worked night shifts regularly for several years. The second group of women never got a chance to fully get used to one schedule over the other, daytime or night. Both scenarios increased their risk of breast cancer.

Even if shift workers get sufficient sleep, researchers suspect the issue may be the disruption to their “normal” circadian rhythms. During shift work, the body is exposed to light during times when it should be asleep. Besides regulating your sleep and wake cycle, your circadian clock directs a variety of biological functions, including organ function, hormone production, and body temperature. The impact to these other functions could also create a conducive environment for cancer to grow.

Most critically, though, disrupting your circadian clock can delay melatonin production (the hormone responsible for sleep) and impact the body’s overall levels of melatonin. When scientists alter the sleep wake cycles of rodents in the lab, cancer also grows at an increased rate. Researchers suspect these decreased melatonin levels may facilitate cancer growth.

For example, a 2003 Boston study found reduced melatonin levels were associated with an increased risk of breast cancer. Here, the researchers think the issue lies with the increased estrogen production, which occurs when melatonin levels are lower. Increased estrogen production is yet another risk factor for breast cancer.

Further cementing the link between melatonin levels and cancer, a Michigan State University study found that treating breast cancer stem cells with melatonin reduced the number and size of breast cancer tumors, suggesting that the antioxidant properties of melatonin could eventually be used as a treatment for stopping the growth of breast cancer tumors.

The increased cancer risk for shift workers may also have something to do with their cortisol levels. Cortisol production operates in inverse to melatonin – cortisol levels peak in the morning after sleep and decline during the day. Female night shift workers have a “shifted cortisol rhythm” and peak in the afternoon instead of at dawn when they’re supposed to.

How does cancer affect sleep?

Between 30 to 75 percent of people receiving cancer treatment have some sleep problems and about 25 percent of cancer survivors continue to have issues sleeping. Lung cancer patients tend to report the most sleep problems.

The side effects of cancer and treatment cause a host of issues that can make falling and staying asleep more difficult. Individuals with cancer may have increased anxiety and depression, two conditions that go hand-in-hand with insomnia. Extensive treatment can cause excessive fatigue and cancer-related sleep disorders. Hot flashes and night sweats are common side effects that make it challenging to get comfortable enough to fall asleep.

Generally, the three largest sleep issues affecting cancer patients are insomnia, excessive daytime sleepiness, and restless legs syndrome.

Insomnia

While insomnia isn’t typically a common side effect of the chemotherapy itself, many of the associated medication, especially steroids, can cause disrupted sleep. Worse, insomnia often exacerbates other symptoms and side effects from the cancer treatment. Some estimates report insomnia affecting one-third to one-half of cancer patients, which is two to three times higher than the general population.

Insomnia describes a general difficulty falling or staying asleep on a regular basis. Among cancer patients, the most commonly reported symptoms of insomnia include:

  • Frequent nighttime awakenings (76%)
  • Difficulty falling asleep (44%)
  • Waking up too early (33%)

Chemotherapy drugs can cause fatigue, so patients are more prone to nap during the day, leading to insomnia at night. The drugs used to manage the side effects of chemotherapy can also cause sleep problems: anti-nausea medications may cause drowsiness, while the energizing nature of steroids make it difficult to fall asleep.

Combine all this with the emotional distress of having cancer, and the anxiety and worry which may keep one up at night.

Excessive daytime sleepiness and fatigue

Excessive daytime sleepiness and fatigue are highly correlated with insomnia. In one study of cancer patients, those who reported fatigue were 2.5 times more likely to also have insomnia.

While fatigue and excessive daytime sleepiness are clinically distinct, they can feel similar to the individual living with them. Fatigue refers to a feeling of low energy and exhaustion, which often causes the individual to seek napping as a way of relief. As alluded to above, fatigue is a common side effect of cancer treatment. Individuals undergoing radiotherapy reported nearly double the amount of fatigue after receiving radiotherapy than before treatment. Fortunately, the fatigue returned to normal levels after a period of months.

cancer radiotherapy increases fatigue

As antiemetic medications are prescribed to reduce symptoms of chemotherapy-induced nausea and vomiting, they may introduce new sleep-related symptoms of their own, like excessive daytime sleepiness (EDS). EDS describes a sense of drowsiness that lingers throughout the day, even after adequate sleep. While EDS is different than fatigue, sufferers seek relief in similar ways: napping. If the individual naps for too long, it makes it much harder for them to fall asleep at night, creating a negative cycle of insomnia.

Restless legs syndrome

Cancer patients undergoing chemotherapy may experience disturbed sleep due to restless legs syndrome. Restless legs syndrome (RLS) is characterized by a strong urge to move the lower limbs in order to relieve a “pins and needles” sensation that develops when the individual is in a supine position.

The constant need to move their legs to find relief disrupts the individual’s ability to fall asleep in the first place, as well as their ability to stay comfortably asleep.

RLS may affect between 5% to 10% of people. Some studies have found cancer patients are twice as likely to have RLS, especially women with breast cancer and men 50 and older who have prostate cancer.

RLS also shares a direct relationship with increased levels of anxiety and depression, and lower quality-of-life scores among cancer patients. In turn, both anxiety and depression are highly correlated with insomnia.

Tips for getting better sleep when you have cancer

Getting sufficient sleep on a consistent basis improves your mood and your cognitive functioning, and it keeps your immune system strong. If you have cancer or care for someone who does, some of the following therapies or products may help you get more quality sleep.

Therapeutic approaches to better sleep for cancer patients

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) has proven helpful for cancer patients who suffer from insomnia.

CBT involves techniques that help the patient reframe their emotions and thoughts around sleep. Patients learn relaxation techniques and deep breathing exercise to quiet racing thoughts and help them fall asleep. They may also practice stimulus control techniques, which limit the time spent in bed and retrain the mind to see the bed as only for sleep. Progressive muscle relaxation involves tensing and relaxing the muscles in an ordered fashion that promotes restfulness.

Sleep restriction therapy

Sleep restriction therapy is another behavioral technique used to addressed insomnia. Individuals decide on a set sleep and wake schedule, and adhere to that no matter what. They don’t take naps during the day, and are only allowed to spend the allocated time in bed, regardless of whether they sleep the whole time. Ideally, eventually their daytime fatigue disappears and the individual trains their body to sleep during the scheduled time frame.

Light therapy

Light therapy employs light boxes, tables, or specialized lamps to help individuals who have an offset circadian clock, whether due to shift work, jet lag, or blindness. The individual sits in front of the light device for a set amount of time in the morning or afternoon, depending on how their circadian cycle is offset. A current clinical trial is testing the effectiveness of light therapy eyeglasses to help lung cancer patients who suffer from insomnia and fatigue.

Sleep products for cancer patients

Cooling mattresses

Cancer patients who experience night sweats or postmenopausal breast cancer patients with hot flashes often have difficulty staying asleep due to overheating. Mattresses with superior temperature regulation, such as innerspring mattresses and airbeds, stay cooler than memory foam mattresses that envelop the body.

Cooling pillows

Patients can also purchase cooling pillows for the home and to take with them to chemotherapy appointments. These pillows are made with more breathable materials—like moisture-wicking wool and gel-infused foam—which are designed to stay cool all night.

White noise machines

White noise machines, available as standalone devices or as smartphone apps, play static white noise, nature sounds, or calming melodies designed to soothe one to sleep. They’re often used by individuals with insomnia. There are even travel-size versions to take with you to chemotherapy. Just make sure you pick a different white noise playlist that you can associate with relaxation, as opposed to sleep. You don’t want to accidentally induce a midday nap.

Anti-snoring products

CPAP machine

Source: Wikipedia

There are many anti-snoring products that help keep the airways open and enable the sleeper to breathe properly throughout the night. Anti-snoring mouthpieces fit between the teeth to reduce symptoms, and nasal vents fit in the nostrils. For individuals with extreme sleep apnea, continuous positive air pressures (CPAP) machines are recommended.

 

CBD oil

CBD oil has been shown to provide various benefits for cancer patients, from pain relief to sleep. It’s also proven to be more effective than traditional medication in relieving chemotherapy-related nausea and vomiting Not to be confused with THC, CBD oil is a 100% non-psychoactive hemp extract that’s legal throughout the United States. CBD oils are available in a variety of product types, including oil tinctures, softgel capsules, gummies, and topical products.

Weighted blankets

Individuals with restless legs syndrome often find weighted blankets help reduce symptoms. Experts recommended getting a blanket that weighs 10 percent of your total body weight plus 1 pound.

Behavioral approaches to better sleep

Avoid naps

Naps are very tempting to anyone experiencing fatigue or daytime sleepiness, but they only reinforce insomnia. If possible, do your best to avoid napping during the day. If you absolutely need to nap for relief, limit your nap to 20 minutes at the most. This is short enough to keep you in light sleep, so it won’t disrupt your sleep cycle later that evening.

Practice good sleep hygiene

Good sleep hygiene involves going to bed and waking up at around the same time every day, reserving the bedroom for sleep and sex only, and avoiding heavy meals, caffeine, alcohol, and intense exercise in the hours leading up to bedtime.

Keep the bedroom cool and dark

A cool, dark bedroom is the optimal environment for sleep. Set up blackout curtains or wear an eye mask to block out ambient light at night, and turn the temperature down to somewhere in the mid-60 degrees Fahrenheit. That’s the recommended temperature for sleep, but if you’re experiencing night sweats, you may want to lower it even more.

Follow a bedtime routine

In addition to following a regular sleep schedule, you can further train your mind to prepare for sleep by establishing a pre-bed ritual. Engage in the same set of activities every night before bed. The activities should be calming, like meditation, aromatherapy, or a warm bath.

Additional resources

For better sleep:

  • Understand more about the unique sleep issues affecting shift workers, and treatment options and resources for individuals with shift work sleep disorder.
  • Learn more about how light therapy helps circadian disorders, and how you can get started.
  • Read more about cognitive behavioral therapy techniques and how it helps insomnia.
  • There are many products designed for helping individuals with disabilities get better sleep. Many of these products may also be helpful for addressing the pain and sleep issues associated with cancer treatment.

For all cancers:

  • The American Cancer Society offers a 24-hour helpline (800-227-2345) and Live Chat, as well as online support communities, local support groups, volunteer events, and research.
  • The National Cancer Institute is part of the National Institutes of Health. As the largest funder of cancer research globally, NCI publishes research and shares training for doctors and health professionals
  • Founded by testicular cancer survivor Lance Armstrong, the Livestrong Foundation provides online resources and community support programs, as well as one-one-one personalized care plans and support for patients and caregivers.
  • The Cancer subreddit connects cancer patients, survivors, and loved ones with each other to share stories, news, and support. There are also many subreddits devoted to specific forms of cancer.
  • The Cancer Forums claim over 50,000 members of cancer patients and survivors, loved ones, and caregivers. The site hosts over 20 forums dedicated to specific types of cancer.

For breast cancer:

  • Well known for making the pink ribbon symbol ubiquitous, the Susan G. Komen Breast Cancer Foundation is the largest breast cancer organization in the United States. They host Race for the Cure fundraising events and offer a helpline available during weekday hours ((877-465-6636).
  • The BreastCancer.org Community is an online forum of nearly 200,000 members, including current patients, caregivers, survivors, and family members affected by breast cancer.

For prostate cancer:

  • The Prostate Cancer Foundation is the largest organization focused on funding prostate cancer research and connecting patients with treatment centers and clinical trials.
  • ZERO works to provide education, financial assistance, and free case management to men diagnosed with prostate cancer. The organization also hosts fundraising walk/run events.

Women and Insomnia

Women and Insomnia

Women are more prone to insomnia than men. More women have frequent bouts of sleeplessness (several times a week) than men, and this tendency extends over all periods of life. Not only that, but as people age, the gap between women and men increases. Women under 45 years old have an incidence 1.4 times that of men of the same age. Among older populations, women are 1.7 times more likely to have insomnia.

Women are almost twice as likely to use sleep aids than men, according to the CDC.

Demographic use of sleep aids

Source: CDC

Do hormones cause insomnia? Many women experience insomnia when they have fluctuations in the serum levels of hormones. These times include during their monthly cycle, pregnancy, and menopause.

How does menopause affect your sleep?

Menopausal insomnia can begin with perimenopause – the stage before menopause women experience in their late 30s or 40s. On average, perimenopause lasts about 4 years, and ends when a woman hasn’t had her period for at least 12 months.

Perimenopause and menopause cause hormonal changes, at the same time when women are often undergoing other major lifestyle changes such as retirement and empty nesting. During perimenopause, women’s ovaries begin decreasing hormone production of estrogen and progesterone. Progesterone helps to promote sleep while estrogen affects emotional well-being. Decreased levels of these hormones can make it more challenging to emotionally deal with the stressors of the body changes of menopause, in addition to the lifestyle changes that occur at the same time.

20% of women experience depression during menopause, whether brought on by the loss of estrogen, the lifestyle changes that often accompany menopause, or a combination of the two. Depression is often a comorbid condition of insomnia, as are stress and anxiety.

Menopause causes other bodily changes, most notably hot flashes. 75% of women experience hot flashes during menopause. Hot flashes result in elevated body temperature and night sweats, both of which make it tougher to fall asleep and stay asleep. The energizing heat from a hot flash awakens the mind as well.  Cool temperatures are conducive to sleep, and the body naturally cools down before bedtime as part of the circadian rhythm. Hot flashes, especially ones that contribute to night sweats, interfere with the body’s ability to cool down and stay asleep.

As women transition into menopause in their 40s to 50s, other physical changes occur naturally, thanks to the aging process. Older adults may wake more frequently during the night, due to incontinence and reduced bladder control. Adults also spend less time in restorative REM sleep as they age and rise earlier, which can result in daytime sleepiness and insomnia.

Tips for managing menopausal insomnia

Anyone with insomnia may find relief by following a regular sleep schedule and practicing good sleep hygiene. However, menopausal women suffering from hot flashes and night sweats may find the following additional tips helpful.

1. Lower the bedroom temperature

A cool temperature in the mid-60 degrees Fahrenheit is ideal for sleep, but menopausal women may want to take it a few degrees cooler.

2. Keep cool reinforcements by the bed

Have a cool glass of water, an extra pillow or pillowcase, and an extra set of breathable pajamas near the bed, so you can easily change or cool down during the night from night sweats. You may keep a washcloth in a bucket of ice nearby as well.

3. Invest in a mattress with excellent temperature regulation

Certain mattresses trap heat more than others and can intensify the effects of hot flashes. The best mattresses for hot sleepers are firm innerspring mattresses or airbeds.

4. Try meditation, acupuncture, and relaxation exercises

Acupuncture has been shown to help relieve insomnia. Breathing exercises and meditation techniques can also help quiet the mind before bed.

5. Manage diet and exercise

Avoid alcohol and stimulants like caffeine, especially before bed. These interfere with sleep onset generally, but can also trigger hot flashes for peri- and postmenopausal women. Eat dinner two to four hours before bed, and exercise earlier in the day if possible (to avoid elevating your body temperature before bed). Exercise improves mood and exhausts the body, making it easier to fall asleep at night.

6. Use a white noise machine or smartphone app

Many people use white noise as a sleep aid to quiet the mind and induce a restful state. White noise machines are widely available, as are smartphone apps with white noise or nature sound libraries.

7. Ask your doctor about other treatment options

For moderate to severe hot flashes that interfere with sleep, some doctors may recommend hormone replacement therapy (HRT) or prescribe low-dose antidepressants like Prozac and Paxil. However, HRT is currently only recommended as a temporary solution, given its connection with increased risk for breast cancer, blood clots, heart disease, and stroke. Some perimenopausal women have found combination birth control pills effective for relieving insomnia symptoms.

Can your period give you insomnia?

Premenstrual syndrome (PMS) seems to cause both insomnia and hypersomnia. Different women experience different symptoms. Many menstrual symptoms like bloating and cramps cause physical discomfort that make it tougher to sleep. Emotional variability, irritability, stress, and fatigue can also can contribute to insomnia.

In the first half of the menstrual cycle (the follicular phase), the body increases estrogen production leading up to ovulation. After ovulation, in the second half of the cycle (the luteal phase), progesterone production rises and has a soporific effect. In the days before the period begins, both hormones levels drop which can cause insomnia.

Hormone levels during menstrual cycle

Source: BBC

Women experience less REM sleep in the luteal phase of their cycle, which may help explain insomnia during PMS, according to a 2010 study. During this stage, the increased progesterone production after ovulation increases the core body temperature by up to half a degree. Since REM sleep corresponds with the lowest body temperatures during the night, this may explain why REM sleep is tougher to achieve during the second half of the menstrual cycle.

Tips for managing PMS insomnia

Women with insomnia may find relief by following a regular sleep schedule and practicing good sleep hygiene.

1. Keep the bedroom cool and dark

A cool temperature in the mid-60 degrees Fahrenheit is ideal for sleep. Stop using electronics at least an hour before bed and avoid blue light.

2. Try meditation, acupuncture, and relaxation exercises

Acupuncture has been shown to help relieve insomnia. Breathing exercises and meditation techniques can also help quiet the mind before bed.

3. Manage diet and exercise

Avoid alcohol and stimulants like caffeine, especially before bed. Eat dinner two to four hours before bed, and exercise earlier in the day if possible (to avoid elevating your body temperature before bed). Exercise improves mood and exhausts the body, making it easier to fall asleep at night.

4. Use a white noise machine or smartphone app

Many people use white noise as a sleep aid to quiet the mind and induce a restful state. White noise machines are widely available, as are smartphone apps with white noise or nature sound libraries.

5. Ask your doctor about other treatment options

Sleep restriction has been found to reduce menses-related depression, as has bright light therapy for insomnia. Premenstrual dysphoric disorder (PMDD) also is associated with sleep disruption, although doctors more commonly address the anxiety symptoms than insomnia. Some doctors may prescribe antidepressants or Z-drugs for PMDD and PMS, which may help address related sleep problems.

Insomnia during pregnancy

Pregnancy-induced insomnia can often be caused by physical discomfort, especially during the first trimester, when the body is first introduced to all the physical, mental and emotional changes associated with pregnancy, and the third trimester, by which point over 75 percent of pregnant women report experiencing insomnia. Hormonal changes, reduced bladder capacity, pregnancy-related heartburn, leg cramps, and nerves about labor all contribute to insomnia for expectant mothers.

Tips for managing pregnancy-related insomnia

Women with insomnia may find relief by following a regular sleep schedule and practicing good sleep hygiene. However, pregnant mothers may find the following additional tips helpful.

1. Keep the bedroom cool and dark

A cool temperature in the mid-60 degrees Fahrenheit is ideal for sleep. Stop using electronics at least an hour before bed and avoid blue light.

2. Invest in maternity pillows

Reduce the physical discomfort caused by pregnancy by stocking up on multiple pillows. Sleep on your left side with a pillow at your back, with pillows to support both your arms and your legs.

3. Try meditation, stretching, and relaxation exercises

Breathing exercises and meditation techniques can help quiet the mind before bed. Stretching and prenatal massage can also reduce discomfort so it’s easier to get comfortable and fall asleep.

4. Manage diet and exercise

Minimize the stress on your bladder by reducing the liquid you drink at night. Avoid alcohol and stimulants like caffeine, especially before bed. Eat dinner two to four hours before bed, and exercise earlier in the day if possible (to avoid elevating your body temperature before bed). Exercise improves mood and exhausts the body, making it easier to fall asleep at night.

5. Use a white noise machine or smartphone app

Many people use white noise as a sleep aid to quiet the mind and induce a restful state. White noise machines are widely available, as are smartphone apps with white noise or nature sound libraries.

Other sleep disorders in women

In general, sleep disorders are more common in women than in men, and they play out differently, emerging throughout the reproductive life cycle. Although men are more likely to have obstructive sleep apnea than women, postmenopausal women are twice as likely to have OSA than premenopausal women.

Sleepiness leads to weight gain by discouraging physical activity. Depression leads to overeating. Social expectations of women may contribute to the greater prevalence of sleep disorders. They are more likely to be the primary caregiver than men and more likely to shoulder a larger share of the housework. Researchers have also found that on average women get 5% less deep sleep on average than men.

Women are more likely to have restless legs syndrome (RLS), and it’s even more common during pregnancy (by 26%). Researchers speculate RLS could be caused by an iron deficiency, which would explain why women with heavier periods are more likely to have RLS.

Women are also more likely to have depression, anxiety, and fibromyalgia all of which can contribute to insomnia.

Additional resources

Scroll to Top