Women diagnosed with breast cancer experience a high prevalence of sleep disruption during treatment and survivorship. Sleep disruption encompasses a wide range of sleep disorders (eg, insomnia, restless legs syndrome, sleep apnea) in patients with breast cancer. Although numerous sleep disorders occur in women with breast cancer, insomnia is one of the most prevalent. Insomnia involves difficulty falling asleep or staying asleep, waking up earlier than intended, or having unrestored sleep. For clinical diagnosis, these difficulties are typically associated with daytime impairment, such as fatigue or excessive sleepiness at least 3 times a week for 30 minutes or more for at least 1 month. Nearly 80% of women undergoing chemotherapy for breast cancer will experience insomnia symptoms, and approximately half of those patients will meet full clinical criteria for insomnia.1 Before surgery, 69% of women with nonmetastatic breast cancer reported having insomnia symptoms, and although these rates declined over time, 42% of women were still experiencing insomnia symptoms at 18 months after surgery.2 In studies of women with metastatic breast cancer, 63% have reported experiencing insomnia symptoms.3,4 Insomnia also occurs in patients undergoing radiation treatment, but at lower rates than in those undergoing chemotherapy.
This article focuses on insomnia, and uses the terms sleep disruption and insomnia interchangeably as they are used in the literature. The responsible mechanisms of sleep disruption associated with breast cancer are addressed, in addition to treatment-related and behavioral factors implicated in the development of sleep disturbance. Finally, this article discusses sleep disturbance and its associated side effects in breast cancer, followed by evidence-based interventions that improve sleep among individuals with breast cancer.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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