Sleep used to be considered a passive state where not much happened in our bodies and minds. Nothing could be further from the truth.
Many necessary physical and psychological activities take place when we are sleeping. When we are deprived of sleep, from either insufficient or poor quality rest, we feel irritable, lethargic, have poor concentration and are more prone to accidents. When someone is diagnosed with a serious disease like mesothelioma, sleep problems are common.
If sleep is not a passive state, then happens when we sleep? Sleep is divided into two distinct phases: NREM and REM. Both of these phases have different functions, and we cycle regularly through these phases throughout the night.
Maintenance to Keep Body Running
Our metabolism slows down and our brain waves slow significantly during NREM sleep. Blood pressure, heart rate and breathing rate also decrease, but digestion increases. It is during this time that our body does vital repairs at a cellular level, and our immune system is most active.
Stage 1 NREM sleep lasts about 5-15 minutes and we feel like we are drifting in and out of sleep. During stage 2, we lose awareness of our surroundings and our heart rates, breathing rates and brain waves begin to slow. This stage lasts about 10-15 minutes.
Stages 3 and 4 last about an hour and we become difficult to rouse in these stages of sleep. It is during these stages that most of the physiological repair takes place within our bodies. Think of these stages as routine maintenance to keep our systems running properly.
Brain Needs a Boost
REM sleep is when our brain performs its maintenance. Our brain is very active in REM sleep and our heart and breathing rates increase. Our voluntary muscles are unable to move during this phase of sleep. Cognitive restoration takes place during REM sleep.
Our brains file memories of events, thoughts and emotions from the previous day and eliminate the insignificant events. It is believed that psychological and emotional recuperation occurs in REM sleep. Most of our dreams occur in REM sleep and our eye movements, heart and breathing rates correspond to what is happening in our dreams.
We cycle through these different sleep phases several times throughout the night. Each complete cycle takes about 90 minutes. We spend more time in NREM sleep during the first half of the night and more REM sleep in the second half.
Mesothelioma and Sleep
There are many reasons why sleep can be affected when someone has mesothelioma. The causes of the sleep problems can be divided into several categories:
- Treatment-related factors: Bone pain caused by chemotherapy, peripheral neuropathy, post-operative pain and steroid-induced insomnia can keep mesothelioma patients awake.
- Psychological factors: Worrying and stress can lead to insomnia and depression can lead to both insomnia and hypersomnia (sleeping too much).
- Disease-related factors: Discomfort due to fluid buildup in the lungs or abdomen or pain resulting from tumor growth can impact the ability to get good sleep.
- Lifestyle factors: Increased caffeine intake to combat tiredness, lack of exercise and changes in daily routine stemming from treatment can affect our ability to sleep.
Understanding the cause of your sleep problems will help you better communicate your sleep problems to your health care team, enabling them to better address the issue.
Support Group for Patients & Families
Our monthly online support group helps patients and families cope with the effects of mesothelioma.
Medications and Supplements
Many people turn to prescription medication, over-the-counter sleep aids and natural supplements for help with their sleep problems.
There are two classes of medication that doctors routinely prescribe to help their patients sleep: Hypnotics and anti-anxiety medications (benzodiazepines.) Medications like Ambien, Lunesta, Restoril and Sonata are all hypnotics and are strictly used to help people get a full eight hours of sleep at night.
When people have trouble falling asleep due to worrying or anxiety, benzodiazepines are a good choice as they are short acting and decrease worrying and other anxiety symptoms. Examples of benzodiazepines are Xanax, Valium, Klonopin and Ativan. Clinical research shows these medications are helpful and safe to use with cancer patients struggling with sleep problems.
When people do not want to take a prescribed medication to help them sleep, they turn to over-the-counter (OTC) sleep aids.
These medications all contain antihistamines (like benedryl) as their active ingredient which causes drowsiness. Examples of OTC sleep aids include: Tylenol PM, Advil PM, Unisom and Sominex. Some patients report that OTC sleep aids can have unwanted side effects like feeling very tired the next day. Both prescribed and OTC sleep medications are safe to use and recommended for short-term use for insomnia.
Many cancer patients prefer to try natural options to help get some sleep. Melatonin is the most popular natural sleep aid. It is a relatively safe supplement that works for some people who are struggling to fall asleep. Clinical studies on its effectiveness have produced mixed results. For more information on the use of melatonin, see www.sleepfoundation.org.
Valerian root has been another popular supplement. However, the National Cancer Institute is conducting a clinical trial to determine if valerian root is safe for cancer patients to use as a sleep aid.
Chamomile is sold as either a tea or root extract and is safe to use. It reportedly has a calming or relaxing effect. There is no clinical research that indicates it an effective sleep aid. Caution should always be used with any supplement as they are not regulated by the FDA. Because supplements are not regulated, there is no process to ensure that the supplement contains the correct dose of its active ingredient. Always let your oncologist know what supplements you are taking as they may need to be discontinued before surgery or during certain treatments.
Many mesothelioma patients struggle with sleep problems during their cancer experience.
It is helpful if patients can tell to their health care team what is contributing to their sleep problems (pain, anxiety, agitation, etc.) so that the cause of the problem can be addressed. The good news is there are a variety of pharmaceutical, OTC and natural supplements that can help mesothelioma patients get a good night’s sleep.
Questions and Answers from the June Online Support Group
Q: My mother only received two sessions of chemotherapy for peritoneal mesothelioma, but she’s extremely fatigued already. She’s sleeping around 12 hours a day. Is this normal?
A: Yes, this behavior is completely normal. Everyone responds differently to chemotherapy, but fatigue is the most commonly reported side effect. Some people become extremely fatigued, especially at the start of chemotherapy. The body is coping with the treatment and fighting the cancer, which consumes a lot of energy. Also, this could be a natural bodily reaction because during sleep our bodies do a lot of work to repair cells.
Q: Do people adapt to the effects of chemotherapy while undergoing the treatment? Do the side effects diminish at all?
A: This will vary from person to person. Some people experience few side effects, while others endure challenging side effects that recur after every chemotherapy session. A person’s overall health and the strength of their immune system may impact how long side effects last. Also, certain chemotherapy drugs cause more side effects for longer durations of time than others. There are medications to help with side effects, so be sure to communicate with your oncologist.
Q: Is there anything we can do to help with the fatigue caused by chemotherapy?
A: Yes, there are several things you can do to help with fatigue. Make sure to eat plenty of protein with your meals, this will help sustain energy and aid the body in repair. Getting at least eight hours of sleep every night may reduce fatigue during the day. Taking short naps during the day can revive energy. You can ask for assistance with physical tasks, which will help you conserve energy. When you feel up to it, light exercise like walking around the block can combat fatigue.
This material was shared in the June 11, 2014, mesothelioma online support group.