Sleep Disruption in Breast Cancer Patients and Survivors

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Sleep disruption is prevalent in patients and survivors of breast cancer. Most patients undergoing chemotherapy will experience transient sleep disruption, and nearly 60% will have chronic sleep problems. Numerous factors contribute to sleep disruption in women diagnosed with breast cancer. Sleep disruption is a consequence of several biological alterations, including circadian disruption and immune and metabolic deregulations. These systems also play significant roles in the control and progression of breast cancer. Sleep disruption is associated with many side effects and psychiatric and medical comorbidities. This article discusses the relationship between stress and posttraumatic stress disorder, depression and fatigue, and how sleep disturbance might be the cause or consequence of these disorders. Current evidence for management of sleep disturbance in breast cancer and high chronic use of hypnotic medication in this population is also discussed. Finally, the differences in management of sleep disturbance during acute cancer care and during the survivorship phase are discussed. More research is needed on accurate and timely assessment of sleep disturbance associated with breast cancer, and additional tailored approaches for the management of sleep problems in breast cancer should be developed.

Correspondence: Oxana Palesh, PhD, MPH, 401 Quarry Road, Office 2318, Stanford, CA 94305-5718. E-mail: opalesh@stanford.edu
  • 1.

    PaleshOGRoscoeJAMustianKM. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol2010;28:292298.

    • Search Google Scholar
    • Export Citation
  • 2.

    SavardJIversHVillaJ. Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol2011;29:35803586.

  • 3.

    PaleshOGCollieKBatiuchokD. A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol2007;75:3744.

    • Search Google Scholar
    • Export Citation
  • 4.

    KoopmanCNourianiBEricksonV. Sleep disturbances in women with metastatic breast cancer. Breast J2002;8:362370.

  • 5.

    BergerAMWielgusKHertzogM. Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy. Support Care Cancer2010;18:105114.

    • Search Google Scholar
    • Export Citation
  • 6.

    SavardJLiuLNatarajanL. Breast cancer patients have progressively impaired sleep-wake activity rhythms during chemotherapy. Sleep2009;32:11551160.

    • Search Google Scholar
    • Export Citation
  • 7.

    SephtonSESapolskyRMKraemerHCSpiegelD. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst2000;92:9941000.

    • Search Google Scholar
    • Export Citation
  • 8.

    KondratovaAAKondratovRV. The circadian clock and pathology of the ageing brain. Nat Rev Neurosci2012;13:325335.

  • 9.

    GarauletMMadridJA. Chronobiological aspects of nutrition, metabolic syndrome and obesity. Adv Drug Deliv Rev2010;62:967978.

  • 10.

    CochraneARobertsonIHCooganAN. Association between circadian rhythms, sleep and cognitive impairment in healthy older adults: an actigraphic study. J Neural Transm2012;119:12331239.

    • Search Google Scholar
    • Export Citation
  • 11.

    InnominatoPFLeviFABjarnasonGA. Chronotherapy and the molecular clock: clinical implications in oncology. Adv Drug Deliv Rev2010;62:9791001.

    • Search Google Scholar
    • Export Citation
  • 12.

    DantzerR. Cytokine-induced sickness behavior: mechanisms and implications. Ann N Y Acad Sci2001;933:222234.

  • 13.

    KruegerJMTakahashiSKapasL. Cytokines in sleep regulation. Adv Neuroimmunol1995;5:171188.

  • 14.

    OppMRBornJIrwinMR. Sleep and the immune system. In: AderR ed. Psychoneuroimmunology. Vol. 4New York, NY: Academic Press; 2007:579618.

    • Search Google Scholar
    • Export Citation
  • 15.

    CapuronLMillerAH. Immune system to brain signaling: neuropsychopharmacological implications. Pharmacol Ther2011;130:226238.

  • 16.

    RichTInnominatoPFBoernerJ. Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer. Clin Cancer Res2005;11:17571764.

    • Search Google Scholar
    • Export Citation
  • 17.

    MillsPJParkerBDimsdaleJE. The relationship between fatigue and quality of life and inflammation during anthracycline-based chemotherapy in breast cancer. Biol Psychol2005;69:8596.

    • Search Google Scholar
    • Export Citation
  • 18.

    SchubertCHongSNatarajanL. The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review. Brain Behav Immun2007;21:413427.

    • Search Google Scholar
    • Export Citation
  • 19.

    OppMR. Cytokines and sleep. Sleep Med Rev2005;9:355364.

  • 20.

    LiuLMillsPJRisslingM. Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy. Brain Behav Immun2012;26:706713.

    • Search Google Scholar
    • Export Citation
  • 21.

    WellenKEHotamisligilGS. Obesity-induced inflammatory changes in adipose tissue. J Clin Invest2003;112:17851788.

  • 22.

    PanossianLAVeaseySC. Daytime sleepiness in obesity: mechanisms beyond obstructive sleep apnea—a review. Sleep2012;35:605615.

  • 23.

    LucassenEARotherKICizzaG. Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci2012;1264:110134.

    • Search Google Scholar
    • Export Citation
  • 24.

    BergerAMGerberLHMayerDK. Cancer-related fatigue: implications for breast cancer survivors. Cancer2012;118(8 Suppl):22612269.

  • 25.

    GerberLHStoutNMcGarveyC. Factors predicting clinically significant fatigue in women following treatment for primary breast cancer. Support Care Cancer2011;19:15811591.

    • Search Google Scholar
    • Export Citation
  • 26.

    SpielmanAJCarusoLSGlovinskyPB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am1987;10:541553.

  • 27.

    MorinC. Insomnia: Psychological Assessment and Management. New York: Guilford Press; 1993.

  • 28.

    HunterMSGrunfeldEAMittalS. Menopausal symptoms in women with breast cancer: prevalence and treatment preferences. Psychooncology2004;13:769778.

    • Search Google Scholar
    • Export Citation
  • 29.

    CarpenterJSJohnsonDWagnerLAndrykowskiM. Hot flashes and related outcomes in breast cancer survivors and matched comparison women. Oncol Nurs Forum2002;29:E1625.

    • Search Google Scholar
    • Export Citation
  • 30.

    KravitzHMGanzPABrombergerJ. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause2003;10:1928.

    • Search Google Scholar
    • Export Citation
  • 31.

    ColagiuriBChristensenSJensenAB. Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery. J Pain Symptom Manage2011;42:710720.

    • Search Google Scholar
    • Export Citation
  • 32.

    AkechiTOkuyamaTAkizukiN. Associated and predictive factors of sleep disturbance in advanced cancer patients. Psychooncology2007;16:888894.

    • Search Google Scholar
    • Export Citation
  • 33.

    LorizioWWuAHBeattieMS. Clinical and biomarker predictors of side effects from tamoxifen. Breast Cancer Res Treat2012;132:11071118.

  • 34.

    SavardJIversH. The initiation of chemotherapy, but not radiation therapy, coincides with increased insomnia. Psychooncology2012;21:3738.

    • Search Google Scholar
    • Export Citation
  • 35.

    PaleshOPepponeLInnominatoPF. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nat Sci Sleep2012;4:151162.

    • Search Google Scholar
    • Export Citation
  • 36.

    PaleshOKoopmanC. Breast cancer: post-traumatic stress disorder-prevalent and persistent. Nat Rev Clin Oncol2013;10:252254.

  • 37.

    Vin-RavivNHillyerGCHershmanDL. Racial disparities in posttraumatic stress after diagnosis of localized breast cancer: the BQUAL study. J Natl Cancer Inst2013;105:563572.

    • Search Google Scholar
    • Export Citation
  • 38.

    GrandnerMAHaleLJacksonN. Perceived racial discrimination as an independent predictor of sleep disturbance and daytime fatigue. Behav Sleep Med2012;10:235249.

    • Search Google Scholar
    • Export Citation
  • 39.

    ThomasKSBardwellWAAncoli-IsraelSDimsdaleJE. The toll of ethnic discrimination on sleep architecture and fatigue. Health Psychol2006;25:635642.

    • Search Google Scholar
    • Export Citation
  • 40.

    TomfohrLPungMAEdwardsKMDimsdaleJE. Racial differences in sleep architecture: the role of ethnic discrimination. Biol Psychol2012;89:3438.

    • Search Google Scholar
    • Export Citation
  • 41.

    OtteJLCarpenterJSRussellKM. Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manage2010;39:535547.

    • Search Google Scholar
    • Export Citation
  • 42.

    BeattyDLHallMHKamarckTA. Unfair treatment is associated with poor sleep in African American and Caucasian adults: Pittsburgh SleepSCORE project. Health Psychol2011;30:351359.

    • Search Google Scholar
    • Export Citation
  • 43.

    PaleshOGMustianKMPepponeLJ. Impact of paroxetine on sleep problems in 426 cancer patients receiving chemotherapy: a trial from the University of Rochester Cancer Center Community Clinical Oncology Program. Sleep Med2012;13:11841190.

    • Search Google Scholar
    • Export Citation
  • 44.

    BowerJE. Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol2008;26:768777.

  • 45.

    ReichMLesurAPerdrizet-ChevallierC. Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat2008;110:917.

    • Search Google Scholar
    • Export Citation
  • 46.

    VargasSWohlgemuthWKAntoniMH. Sleep dysfunction and psychosocial adaptation among women undergoing treatment for non-metastatic breast cancer. Psychooncology2010;19:669673.

    • Search Google Scholar
    • Export Citation
  • 47.

    Ancoli-IsraelSLiuLMarlerMR. Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer2006;14:201209.

    • Search Google Scholar
    • Export Citation
  • 48.

    BergerAMFarrLAKuhnBR. Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manage2007;33:398409.

    • Search Google Scholar
    • Export Citation
  • 49.

    PhillipsKMJimHSDonovanKA. Characteristics and correlates of sleep disturbances in cancer patients. Support Care Cancer2012;20:357365.

    • Search Google Scholar
    • Export Citation
  • 50.

    BergerAMKuhnBRFarrLA. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. J Clin Oncol2009;27:60336040.

    • Search Google Scholar
    • Export Citation
  • 51.

    FiorentinoLAncoli-IsraelS. Sleep dysfunction in patients with cancer. Curr Treat Options Neurol2007;9:337346.

  • 52.

    ParkerKPBliwiseDLRibeiroM. Sleep/wake patterns of individuals with advanced cancer measured by ambulatory polysomnography. J Clin Oncol2008;26:24642472.

    • Search Google Scholar
    • Export Citation
  • 53.

    SilberfarbPMHauriPJOxmanTESchnurrP. Assessment of sleep in patients with lung cancer and breast cancer. J Clin Oncol1993;11:9971004.

    • Search Google Scholar
    • Export Citation
  • 54.

    RoscoeJAPerlisMLPigeonWR. Few changes observed in polysomnographic-assessed sleep before and after completion of chemotherapy. J Psychosom Res2011;71:423428.

    • Search Google Scholar
    • Export Citation
  • 55.

    PaleshOAldridge-GerryAZeitzerJ. Actigraphy measured sleep disruption as a predictor of survival among women with advanced breast cancer [abstract]. J Clin Oncol2013;31(Suppl):Abstract 9532.

    • Search Google Scholar
    • Export Citation
  • 56.

    MorgenthalerTKramerMAlessiC. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep2006;29:14151419.

    • Search Google Scholar
    • Export Citation
  • 57.

    SavardJSimardSIversHMorinCM. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: sleep and psychological effects. J Clin Oncol2005;23:60836096.

    • Search Google Scholar
    • Export Citation
  • 58.

    EspieCAFlemingLCassidyJ. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol2008;26:46514658.

    • Search Google Scholar
    • Export Citation
  • 59.

    BergerAMKuhnBRFarrLA. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psychooncology2009;18:634646.

    • Search Google Scholar
    • Export Citation
  • 60.

    BarsevickABeckSLDudleyWN. Efficacy of an intervention for fatigue and sleep disturbance during cancer chemotherapy. J Pain Symptom Manage2010;40:200216.

    • Search Google Scholar
    • Export Citation
  • 61.

    CostantiniCAle-AliAHelstenT. Sleep aid prescribing practices during neoadjuvant or adjuvant chemotherapy for breast cancer. J Palliat Med2011;14:563566.

    • Search Google Scholar
    • Export Citation
  • 62.

    CasaultLSavardJIversH. Utilization of hypnotic medication in the context of cancer: predictors and frequency of use. Support Care Cancer2012;20:12031210.

    • Search Google Scholar
    • Export Citation
  • 63.

    RiechelmannRPTannockIFWangL. Potential drug interactions and duplicate prescriptions among cancer patients. J Natl Cancer Inst2007;99:592600.

    • Search Google Scholar
    • Export Citation
  • 64.

    JacobsenPBMassieMJKinneDWHollandJC. Hypnotic efficacy and safety of triazolam administered during the postoperative period. Gen Hosp Psychiatry1994;16:419425.

    • Search Google Scholar
    • Export Citation
  • 65.

    HansenMVMadsenMTHagemanI. The effect of MELatOnin on Depression, anxietY, cognitive function and sleep disturbances in patients with breast cancer. The MELODY trial: protocol for a randomised, placebo-controlled, double-blinded trial. BMJ Open2012;2:e000647.

    • Search Google Scholar
    • Export Citation
  • 66.

    MockVDowKHMearesCJ. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum1997;24:9911000.

    • Search Google Scholar
    • Export Citation
  • 67.

    Van SomerenEJLijzengaCMirmiranMSwaabDF. Long-term fitness training improves the circadian rest-activity rhythm in healthy elderly males. J Biol Rhythms1997;12:146156.

    • Search Google Scholar
    • Export Citation
  • 68.

    NormanJFVon EssenSGFuchsRHMcElligottM. Exercise training effect on obstructive sleep apnea syndrome. Sleep Res Online2000;3:121129.

  • 69.

    TanakaHTairaKArakawaM. Effects of short nap and exercise on elderly people having difficulty in sleeping. Psychiatry Clin Neurosci2001;55:173174.

    • Search Google Scholar
    • Export Citation
  • 70.

    KingACOmanRFBrassingtonGS. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA1997;277:3237.

    • Search Google Scholar
    • Export Citation
  • 71.

    TworogerSSYasuiYVitielloMV. Effects of a yearlong moderate-intensity exercise and a stretching intervention on sleep quality in postmenopausal women. Sleep2003;26:830836.

    • Search Google Scholar
    • Export Citation
  • 72.

    HumpelNIversonDC. Sleep quality, fatigue and physical activity following a cancer diagnosis. Eur J Cancer Care (Engl)2010;19:761768.

    • Search Google Scholar
    • Export Citation
  • 73.

    Young-McCaughanSMaysMZArzolaSM. Research and commentary: change in exercise tolerance, activity and sleep patterns, and quality of life in patients with cancer participating in a structured exercise program. Oncol Nurs Forum2003;30:441454; discussion 441-454.

    • Search Google Scholar
    • Export Citation
  • 74.

    Ancoli-IsraelSMoorePJJonesV. The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care (Engl)2001;10:245255.

    • Search Google Scholar
    • Export Citation
  • 75.

    NeikrugABRisslingMTrofimenkoV. Bright light therapy protects women from circadian rhythm desynchronization during chemotherapy for breast cancer. Behav Sleep Med2012;10:202216.

    • Search Google Scholar
    • Export Citation
  • 76.

    MustianMSprodLPepponeL. Effect of YOCAS yoga on circadian rhythm, anxiety, and mood: a URCC CCOP randomized, controlled clinical trial among 410 cancer survivors [abstract]. J Clin Oncol2011;29(Suppl):Abstract 9034.

    • Search Google Scholar
    • Export Citation
  • 77.

    MustianKMSprodLKJanelsinsM. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol2013;10;31:32333241.

    • Search Google Scholar
    • Export Citation
  • 78.

    DenlingerCSCarlsonRWAreM. NCCN Clinical Practice Guidelines in Oncology: Survivorship. Version 12013. Available at: NCCN.org. Accessed November 14 2013.

    • Search Google Scholar
    • Export Citation
  • 79.

    Ortiz-TudelaEMartinez-NicolasACamposM. A new integrated variable based on thermometry, actimetry and body position (TAP) to evaluate circadian system status in humans. PLoS Comput Biol2010;6:e1000996.

    • Search Google Scholar
    • Export Citation
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