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
Sleep and Cancer Treatment
Sleep and Cancer Outcomes
Sleep and Quality of Life
Quality sleep is most likely beneficial across a wide range of cancers, even though research to date may focus on only a few cancer types. Restful sleep, like several other lifestyle-related practices, generally involves very little risk, may improve quality of life and possibly improve cancer outcomes, and many practitioners are comfortable recommending this for patients.
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.26
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:31
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.33
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.34
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.35
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.”36 However, the following evidence has come forth since that review regarding acupuncture and hot flashes:
- L-theanine (Suntheanin)42
- Valerian (About Herbs)43
- Lavender (About Herbs) (noting caution with estrogen-sensitive cancers; see the Commentary below)44
- 5-HTP (Medline Plus)45
- Medical cannabis and cannabinoids46
- Chamomile (About Herbs) (limited evidence)47
- Homeopathic remedies (British Homeopathic Association) (limited evidence)48
A 2009 review found that behavioral therapies maintain longer-term improvement in sleep quality compared to pharmaceuticals.
- 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.49
- 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.50
- Qigong, a component of traditional Chinese medicine, has reduced stress levels with improved sleep quality, activity levels, immune response and balance in older adults.51
- 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.52 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.53
- 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.54
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.61 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 October 20, 2019.
- I-Heart Radio:
- Lonestar Medical Group Patient Education webpage: Insomnia
- NCI: Sleep Problems and Cancer Treatment
- Finding a sleep specialist:
- National Heart, Lung and Blood Institute: Innsomnia.
- Medscape: OTC Insomnia Supplements: The Latest Evidence
- Matt Walker: Sleeping Enough to Be Truly Awake
- helpsyhealth.com: Helpsy Health
- Andrew Weil Center for Integrative Medicine: CanHEAL
- Integrative Cancer Review
- Martin L. Rossman, MD: Fighting Cancer from Within
- Lise Alschuler and Karolyn A. Gazella: iThrive Plan
- Barbara MacDonald, ND, LAc: The Breast Cancer Companion: A Complementary Care Manual: Third Edition
- September 2018 Issue of the Journal of Alternative and Complementary Medicine
- Wayne Jonas, MD: Your Healing Journey: A Patient’s Guide to Integrative Breast Cancer Care
- American Society of Clinical Oncology: Cancer.Net
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Lorenzo Cohen and Alison Jefferies: Anticancer Living: Transform Your Life and Health with the Mix of Six
- Jeremy R. Geffen, MD, FACP: The Seven Levels of Healing®: Celebrating Life and Spirit on the Journey through Cancer
- Martin L. Rossman, MD: The Healing Mind