Sleeping Well
Also known by these names
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The Importance of Sleeping Well
Key Points
- Restful sleep is critically important to healing, well-being and quality of life.
- BCCT is interested in restful sleep because research shows impacts on risk of cancer, cancer progression and survival, response to treatment, mood and pain.
- Insomnia is common, and even more so among cancer patients.
- Several lifestyle choices can impact sleep.
- BCCT advisors suggest behavioral, dietary, movement, mind-body and natural products approaches to promoting restful sleep.
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Getting adequate sleep and rest is considered an essential lifestyle strategy to include in an integrative cancer care plan. Integrative cancer care specialists such as Keith Block, MD; Gary Deng, MD; Lise Alschuler, ND, FABNO; and Nasha Winters, ND, FABNO, all emphasize the importance of balancing one’s biorhythms (also called circadian rhythms) to create an internal environment that is hostile to cancer cells while also promoting healing and health. The sleep/rest/activity cycle is one of those rhythms. Dr. Deng considers sleep as one of the 6 Pillars of Good Health (the others being exercise, diet, stress management, relationships and meaning).
One study found that patients with advanced lung cancer suffering greater circadian activity/sleep cycle disruption suffer greater interference with function, greater anxiety and depression, poorer nighttime sleep, greater daytime fatigue, and poorer quality of life than comparable patients who maintain good circadian integration.
Sleep (especially sleep at night) is the time when our bodies maintain optimal functioning of our immune, cellular, metabolic and endocrine (hormonal) systems. For more information about the importance of sleep, see the National Heart, Lung and Blood Institute's page: Why Is Sleep Important?
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Good sleep is necessary not only for physical health, but for mental and emotional health as well. Poor sleep, or even too much sleep, is linked to many physical, mental and emotional problems:
Good sleep is necessary not only for physical health, but for mental and emotional health as well.
- Weakened immunity
- Insulin resistance
- Inflammation
- Impaired digestion and detoxification
- Changes in gut bacterial balance
- Obesity
- Depression
- Fatigue
- Irritability
- Anxiety
- Chronic diseases including cancer
Melatonin, Light and Sleep
Melatonin is produced naturally by the pineal gland during the early hours of night, signaling and initiating the transition from wakefulness to sleep. Individuals who experience sleep difficulties may have disrupted melatonin production.
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One factor that influences melatonin production is bright light. Such light exposure late in the evening—and especially blue-spectrum light such as from most television, computer, mobile phone and other screens—can disrupt melatonin production and delay the initiation of sleep. Treatments for sleep disruptions such as delayed sleep-wake phase disorder may curtail exposure to bright and blue-spectrum light in the evening.
During the day, melatonin production diminishes as our production of serotonin and cortisol increase. Bright light in the morning boosts serotonin and cortisol while also diminishing melatonin production, leading to greater wakefulness and setting the stage for the next evening's production of melatonin.
To optimize our natural melatonin cycles and benefits, research indicates that we should curb bright light in the evening and increase bright light exposure in the morning. Preliminary research also shows that bright light therapy in the morning can improve sleep in people with cancer.
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Electromagnetic Fields and Sleep
Electromagnetic fields (EMFs) may possibly have a detrimental effect on circadian rhythms, although the idea is controversial. Some evidence suggests that EMFs may affect melatonin metabolism and the circadian rhythm:
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- A 2017 review found an effect of 900-MHz and 60-Hz EMF on melatonin metabolism and the circadian rhythm.
- A 2014 review concluded that “despite divergences in the reported results, ELF-MF and radio frequency electromagnetic field have to be considered as factors possibly influencing the circadian system function, because a substantial number of studies demonstrated the changes in melatonin and cortisol secretion as well as in sleep after exposition to these fields.”
- A 2013 study found that weak EMFs disrupt melatonin and change the circadian rhythm.
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Health Effects of Poor Sleep Quality
General Health
Inadequate sleep at night leads to these physical responses:
- Low levels of melatonin, a hormone naturally produced in the pineal gland that helps regulate sleep and wake cycles.
- Elevated blood cortisol levels, usually low at night but often elevated in those with chronic sleep disruption.
Chronically elevated blood cortisol and adrenaline can cause physical changes that impact health and functioning. These changes are sometimes referred to as “weathering” of the body, akin to the weathering of a flag in a consistent high wind..
Cancer
When circadian rhythms are disrupted by conditions such as shift work, short sleep duration, and exposure to light at night, we see increased risk of several cancers:
Cancer patients also report insomnia at twice the rate as the general population.
In adults with cardiovascular and cerebrovascular diseases, sleeping less than six hours a night was associated with almost triple the risk of cancer mortality compared with sleeping six or more hours a night.
Cortisol, Sleep and Cancer
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- Cancer incidence, progression and mortality are linked to stress and disruption of the circadian (daily) rest and activity cycle. Cortisol, our primary stress hormone, helps regulate the sleep-wake cycle. Cortisol in excess pushes several cancer processes forward, especially metastasis. Melatonin, the “sleep hormone”, is instrumental in eliminating cancer cells and reducing the side effects of chemotherapy. However, when hours normally spent sleeping are supplanted with activities such as looking at a smartphone, computer or TV screen or working night shifts, melatonin is suppressed.
- A rise in blood cortisol in response to stress or poor sleep quality can speed up tumor growth. Cortisol suppresses immunity, which is critical in mopping up malignant cells that remain after cancer treatment.
- The combination of cortisol and adrenaline increases blood glucose levels. Chronic high blood glucose episodes can be a direct or indirect mediator of the increase in tumor cell growth.
- Cortisol also increases insulin resistance and seems to stimulate the ability of some cancer cells to grow and metastasize.
- Breast cancer patients who don’t have normal cortisol rhythms have less-active natural killer cells and have reduced survival compared to others.
- Although the mechanisms are not yet known, high cortisol levels and disrupted sleep-wake cycles are connected to these outcomes:
Treating the Cancer
- Patients with metastatic colon cancer who have restful sleep between 11pm and 7am have responded better to treatment. They also function better, don’t have as many disease symptoms, and have dramatically longer survival. In one study, those with the most abnormal sleep/activity rhythms were five times more likely to die within two years after their diagnosis.
- Disrupted sleep, which is a sign of disrupted stress hormone rhythms, seems to make side effects of chemotherapy more intense, whereas good-quality sleep and normal rhythms can minimize these side effects.
- Chronic inflammation is linked to sleep disturbance. Cancer treatment itself causes a marked increase in inflammation which can result not only in impaired sleep, but also depression, fatigue and cognitive dysfunction. Impaired sleep can then increase inflammation. Chronic inflammation is linked to higher cancer mortality.
Sleep and Cancer Outcomes
- Cancer acts more aggressively in people with low nighttime production of melatonin. Cancer patients with high melatonin levels tend to have better outcomes.
- Colorectal cancer patients who had normal sleep-activity rhythms had a 50 percent higher five-year survival rate.
Managing Side Effects and Promoting Wellness
- 2016 study suggested that sleep disruption leads to increased symptoms of depression in men with prostate cancer, possibly through dysregulating the stress response.
Reducing Risk
A 2014 review concluded that maintaining a regular and adequate daily amount of sleep contributes to prevention of colorectal cancer. A 2013 review reported that women and men chronically exposed to night-shift work have a 50 percent increased risk of developing colorectal cancer compared to day-shift workers.
Long sleep duration, sleeping nine or more hours per night, is also associated with an increased risk of colorectal cancer.
The Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons recommends regular sleep after curative treatment of colon and rectal cancer.
Clinical Practice Guidelines
2009 evidence-based clinical practice guidelines for integrative oncology state: “Any of the techniques, such as relaxation, meditation, and imagery, as well as autogenic training hypnosis, self-expression, and exercise, provide specific psychological and physiologic benefits, that is, decreases in stress; improvements in sleep, mood, and pain; a decrease in stress hormones; and improvement in immunity.” Evidence also supports use of Mindfulness-Based Stress Reduction (MBSR), yoga, and psychological interventions including behavioral therapies.
Managing Insomnia
Many people in modern society now suffer from insomnia, which is marked by these symptoms:
- Difficulty falling asleep
- Early awakening
- Frequent nighttime waking and inability to get back to sleep for an hour or two
- Not feeling refreshed in the morning
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Lise Alschuler, ND, FABNO, says that many factors can interfere with the quality of our sleep: “These include unresolved stress, a noisy bedroom environment, too much light in the bedroom, a bedroom that is too warm, hormonal issues such as hot flashes, too much alcohol, insufficient protein in the evening meal and side effects of medications.
Often insomnia is related to lifestyle choices and situations that take us away from our natural rhythms and that promote inactivity.
Often insomnia is related to lifestyle choices and situations that take us away from our natural rhythms and that promote inactivity:
- Overeating, or eating foods that interfere with sleep promotion, or eating late in the evening
- Staying up late and “screening”—looking at TV, computer and cell phone screens for long hours, especially late in the evening
- Overwork or nighttime work
- Chronic unmanaged stress
Neuropsychologist Michael Howard, PhD, lectures to healthcare professionals on understanding and managing sleep disorders. He advocates first determining if presenting insomnia is primary or secondary, for the causes and remedies are different:
- Primary insomnia is an independent sleep disorder and typically linked to thinking and worrying, two brain processes that prevent the activation system of the brain from responding to normal signals for sleep.
- Secondary insomnia is caused by physical or psychosocial events or issues including these:
- Shift work
- Job loss
- Divorce
- Emotional problems such as depression
- Environmental conditions such as a warm room
- Symptoms such as hot flashes, fever or pain
Secondary insomnia is far more common; the best way to manage it is to address the condition/symptom preventing quality sleep.
Immediately resorting to sleep medications for either type of insomnia is typically not optimal, as these medications are effective less than 10 percent of the time, they compromise one or more of the sleep cycles, and they come with side effects, some serious.
Of most benefit for primary insomnia are the psychological/behavioral/cognitive therapies that change thinking patterns and reduce worrying. Dr. Howard suggests the following steps for patients to manage primary insomnia:
- Practice good sleep hygiene (see the section on Balancing Sleep/Rest/Activity Biorhythms below).
- If more intervention is needed, seek professional help if the following three statements apply:
- The insomnia has lasted more than three weeks.
- It is not improving.
- It is interfering with your ability to function during the day.
- Consider working with a sleep specialist—a healthcare professional, typically in the medical or psychology fields, with specialty training in sleep medicine and sleep disorders.
- If the sleep specialist determines that primary insomnia is the problem, consider therapies/practices that deal with the thinking/worrying:
- Cognitive-behavioral therapy (CBT) and counseling
- Specific relaxation and exercise practices
- Behavioral conditioning
Integrative Therapies to Improve Sleep Quality
Balancing Sleep/Rest/Activity Biorhythms
Noted integrative cancer specialists Keith Block, M, and Lise Alschuler, ND, FABNO, suggest actions for balancing sleep, rest and activity and promoting restful sleep, including these:
- Practice good sleep hygiene:
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- Keep your bedroom dark, cool and quiet.
- Exercise daily.
- Maintain a regular schedule of sleep, work, physical activity, bedtime and waking.
- Limit daytime naps to 30 minutes.
- Avoid caffeine and excessive alcohol consumption.
- Avoid strenuous exercise or heavy meals for several hours before bedtime.
- Establish a regular relaxing bedtime routine.
- Practice a calming and meditative exercise, such as yoga, in the evening.
- Ensure adequate exposure to natural light (sunlight in the day and darkness at night)
- Consider using herbs or dietary supplements if needed (see Natural Products above)
- Work in partnership with your doctor to assess and monitor hormone imbalances; this may involve lab tests.
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While both conventional and complementary options are available, a 2009 review found that behavioral therapies maintain longer-term improvement in sleep quality compared to pharmaceuticals.
Conventional Approaches
In conventional medicine, insomnia and sleep disruption are often treated with sleep medications which may help temporarily but don’t address the underlying cause, can be habit-forming and may even increase risks of death from a variety of causes including overdose, infections, cancer, depression and suicide, hypnotic-withdrawal insomnia, and automobile crashes, falls, and other accidents.
Eating Well
A pilot randomized study of a fatigue-reduction diet rich in fruit, vegetables, whole grains and omega-3 fatty acid-rich foods improved sleep and fatigue in women with breast cancer compared to a control group receiving general health information.
Reducing Hot Flashes as a Barrier to Sleep
A 2009 review concluded that “acupuncture does not appear to be more effective than sham acupuncture for treatment of vasomotor symptoms (hot flashes) in postmenopausal women in general.” However, the following evidence has come forth since that review regarding acupuncture and hot flashes:
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- A study in 2015 found that electroacupuncture (EA) with breast cancer patients may be more effective in reducing hot flashes than the prescription drug gabapentin, and with fewer side effects. EA was also shown comparable to gabapentin for improving sleep quality in women experiencing hot flashes.
- Early phase studies suggest that acupuncture may relieve hot flashes in prostate cancer patients.
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Natural Products
Mind-Body Approaches
A 2009 review found that behavioral therapies maintain longer-term improvement in sleep quality compared to pharmaceuticals.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) for eight weeks was effective in treating moderate to severe insomnia and more effective than acupuncture for those with mild symptoms of insomnia. Both therapies also improved quality of life. Although both treatments produced meaningful and durable improvements, CBT-I was more effective and should be the first line of therapy..
- Two elements of Cognitive Behavioral Stress Management (CBSM)—relaxation training and cognitive restructuring—target sleep and fatigue. A randomized control trial of CBSM in women undergoing primary treatment for breast cancer demonstrated greater improvement in sleep quality and fatigue than those in a control group.
- Qigong, a component of traditional Chinese medicine, has reduced stress levels with improved sleep quality, activity levels, immune response and balance in older adults.
- Sleep Training Education Program: Both STEP‐1 (a single sleep education session) and STEP‐2 (a three‐session, group cognitive behavioral treatment) improved Insomnia Severity Index (ISI) scores, with substantial remission of insomnia among cancer survivors in a small study. This therapy can be administered by non sleep-specialists, making it accessible to more patients.
Manipulative and Body-based Methods
- Acupuncture was effective in treating moderate to severe insomnia and also improved quality of life.
- Massage, whether with or without aromatherapy, was associated with better sleep In a randomized control trial of people with advanced cancer in a hospice setting.
Diets & Metabolic Therapies
- A small study of people with metabolic syndrome with a baseline 14-hour or more eating window each day switched to a consistent self-selected 10-hour window, with 14 straight hours of fasting each day. Outcomes included improved restful sleep.
Addressing Inflammation
Michael Irwin, MD, of the UCLA Department of Psychiatry and Biobehavioral Sciences prefers not to use anti-inflammatory drugs to reduce inflammation in cancer patients due to multiple side effects. He has researched several mind-body approaches and found these are useful in improving or reversing insomnia and subsequently improving inflammatory markers:
Other symptoms such as depression and fatigue also improved.
Access
Many of the strategies for improving sleep are available through books, websites, group classes or private lessons. If you decide to use diet and supplements to help with your sleep, consulting with a healthcare professional who is experienced in prescribing diets and supplements for cancer patients—such as an integrative oncology physician, a naturopathic oncologist, an oncology dietitian or clinical nutritionist—could be helpful.
Cautions
Mind-body approaches to helping with insomnia are generally considered safe.
If you decide to take natural products to assist with sleep, consult with your pharmacist or healthcare provider to see if any contraindications, side effects or drug-herb or herb-herb interactions arise. Let your cancer care team know if you are taking any natural products such as herbs or supplements.
Integrative Programs, Protocols and Medical Systems
- Integrative programs and protocols
- Alschuler & Gazella complementary approaches
- Block integrative cancer care program
- Cohen & Jefferies Mix of Six anticancer practices
- Geffen Seven Levels of Healing
- MacDonald breast cancer program
- Traditional systems
From BCCT advisor Ted Schettler, MD, MPH, March 4, 2019: Lavender oil (as with some other essential oils) has estrogenic properties at some concentrations. It might be wise to avoid skin application of lavender oil in the setting of an estrogen positive breast cancer diagnosis.
Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update on June 30, 2020.
- Hrushesky WJ, Grutsch J et al. Circadian clock manipulation for cancer prevention and control and the relief of cancer symptoms. Integrative Cancer Therapies. 2009 Dec;8(4):387-97; Grutsch JF, Wood PA et al. Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer. Journal of Circadian Rhythms. 2011 May 18;9:4.
- Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
- Leproult R, Colecchia EF, L'Hermite-Balériaux M, Van Cauter E. Transition from dim to bright light in the morning induces an immediate elevation of cortisol levels. Journal of Clinical Endocrinology and Metabolism. 2001 Jan;86(1):151-7; Nesbitt AD. Delayed sleep-wake phase disorder. Journal of Thoracic Disease. 2018 Jan;10(Suppl 1):S103-S111.
- Wu LM, Amidi A et al. The effect of systematic light exposure on sleep in a mixed group of fatigued cancer survivors. Journal of Clinical Sleep Medicine. 2018 Jan 15;14(1):31-39.
- Warille AA, Altun G et al. Skeptical approaches concerning the effect of exposure to electromagnetic fields on brain hormones and enzyme activities. Journal of Microscopy and Ultrastructure. 2017 Oct-Dec;5(4):177-184.
- Lewczuk B, Redlarski G et al. Influence of electric, magnetic, and electromagnetic fields on the circadian system: current stage of knowledge. BioMed Research International. 2014;2014:169459.
- Halgamuge MN. Critical time delay of the pineal melatonin rhythm in humans due to weak electromagnetic exposure. Indian Journal of Biochemistry & Biophysics. 2013 Aug;50(4):259-65.
- Bush B, Hudson T. The role of cortisol in sleep. Natural Medicine Journal. 2010 Jun;2(6).
- Walker L, Hepp N. Psychosocial Environment. Collaborative on Health and the Environment. September 2016. Viewed January 16, 2018.
- Parent ME, El-Zein M, Rousseau M-C, Pintos J, Siemiatycki J. Night work and the risk of cancer among men. American Journal of Epidemiology. 2012 Nov 1;176(9):751-9; Bhatti1 P, Cushing-Haugen1 KL et al. Nightshift work and risk of ovarian cancer. Occupational and Environmental Medicine. 2013 Apr;70(4):231-7; Madigan MP, Ziegler RG, Benichou J, Byrne C, Hoover RN. Proportion of breast cancer cases in the United States explained by well-established risk factors. Journal of the Nationall Cancer Institute. 1995 Nov;87:1681-5; He C, Anand ST, Ebell MH, Vena JE, Robb SW. Circadian disrupting exposures and breast cancer risk: a meta-analysis. International Archives of Occupational and Environmental Health. 2015 Jul;88: 533-47.
- Irwin MR. Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Current Psychiatry Reports. 2013;15(11):10.1007/s11920-013-0404-1.
- Fernandez-Mendoza J, He F, Vgontzas AN, Liao D, Bixler EO. Interplay of objective sleep duration and cardiovascular and cerebrovascular diseases on cause-specific mortality. Journal of the American Heart Association. 2019 Oct 15;8(20):e013043.
- Winters N, Higgins Kelley J. The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies. Vermont: Chelsea Green Publishing. 2017. p. 252.
- Randall M. The physiology of stress: cortisol and the hypothalamic-pituitary-adrenal axis. Dartmouth Undergraduate Journal of Science. 2010 Fall. February 3, 2011. Viewed January 17, 2018.
- Ryu TY, Park J, Scherer PE. Hyperglycemia as a risk factor for cancer progression. Diabetes & Metabolism Journal. 2014 Oct;38(5):330-6.
- Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. p. 411; Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncology. 2010 Dec; 6(12):1863-1881; Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clinical Science (London, England). 1999 May;96(5):513-23.
- Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. Journal of the National Cancer Institute. 2000;92(12):994-1000; Andersen BL, Farrar WB et al. Stress and immune responses after surgical treatment for regional breast cancer. Journal of the National Cancer Institute. 1998 Jan 7;90(1):30-6.
- Berger AM, Farr L. The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncology Nursing Forum 1999; 26(10):1663-71; Block K. Life Over Cancer. New York: Bantam Dell. 2009. pp. 412-414.
- Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. p. 412, interpreting results from Mormont MC, Waterhouse J et al. Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clinical Cancer Research. 2000 Aug;6(8):3038-45.
- Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. pp. 412-414.
- Irwin M. Mindful Awareness Practices to Promote Sleep Health: Inflammatory Mechanisms. Keynote Presentation: Society for Integrative Oncology Conference, 2016, Miami, Florida.
- Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. pp. 412-414; Schernhammer ES, Hankinson SE. Urinary melatonin levels and postmenopausal breast cancer risk in the Nurses' Health Study cohort. Cancer Epidemiology, Biomarkers & Prevention. 2009 Jan;18(1):74-9; Lissoni P, Tancini G et al. Melatonin increase as predictor for tumor objective response to chemotherapy in advanced cancer patients. Tumori. 1988 Jun 30;74(3):339-45; Bubenik GA, Blask DE et al. Prospects of the clinical utilization of melatonin. Biological Signals & Receptors. 1998;7(4):195-219.
- Eriguchi M, Levi F et al. Chronotherapy for cancer. Biomedicine and Pharmacotherapy. 2003; 57 Suppl 1:92s-95s.
- Hoyt MA, Bower JE, Irwin MR, Weierich MR, Stanton AL. Sleep quality and depressive symptoms after prostate cancer: the mechanistic role of cortisol. Behavioral Neuroscience. 2016;130(3):351-356.
- Durko L, Malecka-Panas E et al. Lifestyle modifications and colorectal cancer. Current Colorectal Cancer Reports. 2014;10:45-54.
- Derry MM, Raina K, Agarwal C, Agarwal R. Identifying molecular targets of lifestyle modifications in colon cancer prevention. Frontiers in Oncology. 2013 May 14;3:119.
- Zhao H, Yin JY et al. Sleep duration and cancer risk: a systematic review and meta-analysis of prospective studies. Asian Pacific Journal of Cancer Prevention. 2013;14(12):7509-15.
- Steele SR, Chang GJ et al. Practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. Diseases of the Colon and Rectum. 2015 Aug;58(8):713-25.
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
- Howard M. The sleep-loss epidemic: understanding and managing sleep disorders. INR Seminar presentation, Roanoke Virginia. May 8, 2018.
- American Academy of Sleep Medicine. When to consult a sleep doctor: guidelines for insomnia, apnea, and other disorders. February 29, 2016. Viewed May 17, 2018.
- Breus MJ. Sleep RX. WebMD. Viewed May 14, 2018.
- Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009; National Sleep Foundation. Sleep Hygiene. Viewed May 14, 2018.
- Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. pp. 423-427.
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Research. 2016;5:918.
- Zick SM, Colacino J et al. Fatigue reduction diet in breast cancer survivors: a pilot randomized clinical trial. Breast Cancer Research and Treatment. 2017 Jan;161(2):299-310.
- Deng GE, Frenkel M et al. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. Journal of the Society for Integrative Oncology. 2009 Summer;7(3):85-120.
- Walker EM, Rodriguez AI, Kohn B, et al. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. Journal of Clinical Oncology. Feb 1 2010;28(4):634-640.
- Mao JJ, Bowman MA, Xie SX, et al. Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: a randomized placebo-controlled trial. Journal of Clinical Oncology. Aug 24 2015.
- Garland SN, Xie SX et al. Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial. Menopause. 2017 May;24(5):517-523.
- Ashamalla H, Jiang ML et al. Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy. International Journal of Radiation Oncology, Biology, Physics. 2011 Apr 1;79(5):1358-1363; Beer TM, Benavides M et al. Acupuncture for hot flashes in patients with prostate cancer. Urology. Nov 2010;76(5):1182-1188; Capodice JL, Cheetham P, Benson MC, McKiernan JM, Katz AE. Acupuncture for the treatment of hot flashes in men with advanced prostate cancer. International Journal of Clinical Medicine. 2011;2(1):51-55.
- Innominato PF, Lim AS et al. The effect of melatonin on sleep and quality of life in patients with advanced breast cancer. Supportive Care in Cancer. 2016 Mar;24(3):1097-105.
- Rao TP, Ozeki M1, Juneja LR. In search of a safe natural sleep aid. Journal of the American College pf Nutrition. 2015;34(5):436-47.
- Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for sleep: a systematic review and meta-analysis. American Journal of Medicine. 2006 Dec;119(12):1005-12.
- Lillehei AS, Halcon LL. A systematic review of the effect of inhaled essential oils on sleep. Journal of Alternative and Complementary Medicine. 2014 Jun;20(6):441-51; Kasper S, Gastpar M et al. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment of 'subsyndromal' anxiety disorder: a randomized, double-blind, placebo controlled trial. International Clin Psychopharmacol. 2010 Sep;25(5):277-87.
- Manni R, Toscano G, Terzaghi M. Therapeutic symptomatic strategies in the parasomnias. Current Treatment Options in Neurology. 2018 Jun 5;20(7):26.
- Abrams DI. The therapeutic effects of cannabis and cannabinoids: an update from the National Academies of Sciences, Engineering and Medicine report. European Journal of Internal Medicine. 2018 Mar;49:7-11.
- Yurcheshen M, Seehuus M, Pigeon W. Updates on nutraceutical sleep therapeutics and investigational research. Evidence-based Complementary and Alternative Medicine. 2015;2015:105256.
- Riemann D, Baglioni C et al. European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research. 2017 Dec;26(6):675-700; Villet S, Vacher V et al. Open-label observational study of the homeopathic medicine Passiflora Compose for anxiety and sleep disorders. Homeopathy. 2016 Feb;105(1):84-91.
- Mao JJ, Seluzicki C. Sleeping well after cancer: patient-centered research for treatment of insomnia. The ASCO Post. May 25, 2020. Viewed June 17, 2020; Garland SN, Xie SX et al. Acupuncture versus Cognitive Behavioral Therapy for Insomnia in cancer survivors: a randomized clinical trial. Journal of the National Cancer Institute. 2019;111(12):1323-1331..
- Vargas S, Antoni MH et al. Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida. International Journal of Behavioral Medicine. 2014 Dec;21(6):971-81. doi: 10.1007/s12529-013-9374-2.
- Yang Y, Verkuilen J, Rosengren KS, et al. Effects of a taiji and qigong intervention on the antibody response to influenza vaccine in older adults. American Journal of Chinese Medicine. 2007;35(4):597-607; Yang Y, Verkuilen JV, Rosengren KS, et al. Effect of combined taiji and qigong training on balance mechanisms: a randomized controlled trial of older adults. Medical Science Monitor. Aug 2007;13(8):CR339-348; Jahnke RA, Larkey LK, Rogers C. Dissemination and benefits of a replicable tai chi and qigong program for older adults. Geriatric Nursing. Jul-Aug 2010;31(4):272-280.
- Zhou ES, Michaud AL, Recklitis CJ. Developing efficient and effective behavioral treatment for insomnia in cancer survivors: results of a stepped care trial. Cancer. 2019 Sep 24.
- Davenport L. Insomnia in cancer patients: interventions that may help. Medscape Medical News. May 18, 2018. Viewed May 31, 2018; Mao JJ, Xie S et al. The effect of acupuncture versus cognitive behavior therapy on insomnia in cancer survivors: a randomized clinical trial. 2018 ASCO Meeting Abstract. Journal of Clinical Oncology. 36, 2018 (suppl; abstr 10001).
- Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliative Medicine. 2004 Mar;18(2):87-92.
- Wilkinson MJ, Manoogian ENC et al. Ten-hour time-restricted eating reduces weight, blood pressure, and atherogenic lipids in patients with metabolic syndrome. Cell Metabolism. 2020;31(1):92–104.e5.
- Irwin M. Mindful Awareness Practices to Promote Sleep Health: Inflammatory Mechanisms. Keynote Presentation: Society for Integrative Oncology Conference, 2016, Miami, Florida; Irwin MR, Olmstead R et al. Tai chi chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: a randomized, partially blinded, noninferiority trial. Journal of Clinical Oncology. 2017 Aug 10;35(23):2656-2665; Irwin MR, Olmstead R et al. Tai chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: a randomized controlled trial. Journal of the National Cancer Institute. Monographs. 2014 Nov;2014(50):295-301.
- Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
- Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.
- Cohen L, Jefferies A. Anticancer Living. New York: Viking. 2018.
- Geffen J. The Journey Through Cancer: An Oncologist's Seven-Level Program for Healing and Transforming the Whole Person. New York, New York: Three Rivers Press. 2006.
- MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. 2016.
- Simões BM, Kohler B et al. Estrogenicity of essential oils is not required to relieve symptoms of urogenital atrophy in breast cancer survivors. Therapeutic Advances in Medical Oncology. 2018 Apr 2;10:1758835918766189; Henley DV, Lipson N, Korach KS, Bloch CA. Prepubertal gynecomastia linked to lavender and tea tree oils. New England Journal of Medicine. 2007 Feb 1;356(5):479-85; Diaz A, Luque L, Badar Z, Kornic S, Danon M. Prepubertal gynecomastia and chronic lavender exposure: report of three cases. Journal of Pediatric Endocrinology & Metabolism. 2016 Jan;29(1):103-7; Politano VT, McGinty D et al. Uterotrophic assay of percutaneous lavender oil in immature female rats. International Journal of Toxicology. 2013 Mar-Apr;32(2):123-9; Shinohara K, Doi H, Kumagai C, Sawano E, Tarumi W. Effects of essential oil exposure on salivary estrogen concentration in perimenopausal women. Neuroendocrinology Letters. 2017 Jan;37(8):567-572; Henley DV, Korach KS. Physiological effects and mechanisms of action of endocrine disrupting chemicals that alter estrogen signaling. Hormones (Athens). 2010 Jul-Sep;9(3):191-205.
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