Also known by these names
The Importance of Sleeping Well
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.1
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?
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.
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:
Health Effects of Poor Sleep Quality
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.8
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..9
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:10
- In women:
- In men:
Cancer patients also report insomnia at twice the rate as the general population.11
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.12
Cortisol, Sleep and Cancer
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.19
- 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.20
- 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.21
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.2223
- Colorectal cancer patients who had normal sleep-activity rhythms had a 50 percent higher five-year survival rate.24
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.25
A 2014 review concluded that maintaining a regular and adequate daily amount of sleep contributes to prevention of colorectal cancer.26 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.27
Long sleep duration, sleeping nine or more hours per night, is also associated with an increased risk of colorectal cancer.28
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.29
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.30
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
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:35
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.37
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.38
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.39
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.”40 However, the following evidence has come forth since that review regarding acupuncture and hot flashes:
- L-theanine (Suntheanin)46
- Valerian (About Herbs)47
- Lavender (About Herbs) (noting caution with estrogen-sensitive cancers; see the Commentary below)48
- 5-HTP (Medline Plus)49
- Medical cannabis and cannabinoids50
- Chamomile (About Herbs) (limited evidence)51
- Homeopathic remedies (British Homeopathic Association) (limited evidence)52
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..53
- 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.54
- Qigong, a component of traditional Chinese medicine, has reduced stress levels with improved sleep quality, activity levels, immune response and balance in older adults.55
- 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.56 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.57
- 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.58
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.59
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:
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.
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
|For more information about programs and protocols, see our Integrative Programs and Protocols page.|
- Integrative programs and protocols
- 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.66 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.