Treatments for Sleep Disturbances
There are a limited array of medications and natural treatments for sleep disturbance. Often a combination of supplements and herbs works effectively but often will need modification over time and they require a number of days for optimum effectiveness.
Pharmaceuticals have potential side effects and tolerance issues, but do have a place in treatment, for short-term usage when an immediate intervention is required.
Importantly, the physical and emotional effects of cancer also need recognition and treatment to attempt to diminish their impact and influence on sleep disturbances.
Table of Contents:
Proactive Sleep Hygiene
These are important, as making small changes can add another layer to help improve sleep parameters.
Set times for going to sleep and waking to establish a rhythm.
The bed is for sleep, not watching TV, or using technology while in bed.
Hours before bed, avoid eating, reduce late-day caffeine and avoid alcohol.
If unable to sleep, after 20-30 minutes get up and sit and listen to relaxing music or meditate and then try again.
Keep the bedroom cool, and dark and have a comfortable mattress.
Try to wind down 30 minutes prior to sleep time and avoid stimulating music or shows.
If you must work on a computer in the early evening, put up an orange screen which is easy to download. The normal screen is bluescreen which reduces melatonin stimulation.
If you must nap, keep them short, set a timer, and in the early afternoon
If you have a sleep app, evaluate for snoring or stopping breathing or low oxygen levels, below 90% saturation, as indicators of possible sleep apnea.
Utilizing natural supplements and herbs can offer assistance with sleep disruption.
GABA, gamma-aminobutyric acid acts as an inhibitory neurotransmitter in the central nervous system which means it can diminish brain excitability and one benefit is to improve sleep initiation by decreasing wakefulness and promoting non-rapid eye movement (NREM) sleep.
Often it is used in combination with L-Theanine, a component of green tea, and acts in a non-sedating way to improve overall relaxation, and in sleep situations, it also increases NREM sleep.
Melatonin (N-acetyl-5- methoxy tryptamine) is used in sleep disruption and a recent review, six studies were reviewed in cancer patients and four demonstrated improved quality of sleep and insomnia but the other two showed no improvement in sleep quality but did improve sleep efficiency.
It also should be noted that melatonin effects include:
As an antioxidant, scavenging free radicals
Promotes apoptosis through P53 tumor suppressor gene
Anti Inflammatory
Anti-angiogenic
Offers benefits when used with cisplatin
There is a potential issue with melatonin. In animal studies it stimulates the bone marrow, so it is prudent to avoid it with blood cancers.
Pharmaceuticals
Zolpidem and benzodiazepines, or Valium and Xanax, also act to inhibit GABA receptors and improve sleep. However, they are designed for short-term use as their effectiveness diminishes over time due to the body becoming accustomed to the drug. These drugs can also result in tolerance, or the need for higher doses which can result in dependence and addiction with rebound or worsening of sleep when taken away, if used long term.
The Chinese Medicine Approach to Sleep Disruption
In Western medicine, understanding the pathophysiology, or how disease affects the functions of the body can be complex and the jargon difficult. The same is true of Chinese medicine, with different definitions of Western concepts and disease symptoms and terms that are unfamiliar.
The following explanation of Insomnia in Chinese medicine can help understand some basic concepts. The formulas listed below are based on symptoms and can be effective if used in this manner. It is wise however to discuss your decision with an experienced practitioner to make sure your pattern is correct and to review potential adverse effects especially if treatment is ongoing.
Yin is considered the foundation of structural components within the body and generates Blood which provides nourishment to the body by its flow inside the blood vessels and acupuncture channels and outside the vessels in the form of body fluids that moisten tissues and joints.
Yang is considered the foundation of the energetic activity within the body and is the source of Qi, the vitality of the body, the energy that encompasses the functionality of each organ and cell within the body.
The Chinese model of sleep disturbances is considered to be the domain of the Heart, Liver and Kidney.
Heart -The Shen is considered the mind and rooted firmly in the body through the Heart, which is composed of the Yin and Blood. It is considered our essence, or consciousness, self-awareness along with memory and creativity.
Liver-The Hun is considered the ethereal soul and is firmly rooted in the Liver, through the Blood. It is most similar to the soul in the Western world, responsible for intuition and inspiration and surviving the body after death.
The kidney is the root energy source and essence of the body and the basis of growth and development throughout life.
These are primary systems, but since the organ systems are mutually interactive ,they too are affected by their imbalance.
Sleep disturbances are considered to be the result of the Shen(mind) or Hun (soul) not being anchored in their respective organs as the result of diminished Blood, Yin or both, and the organ that is affected.
For simplicity
Difficulty falling asleep
Is the result of Kidney Yin deficiency with the consequence of being unable to generate blood. The body’s circadian rhythm at night moves from activity, Yang, to rest and recovery, Yin. Cancer and treatments disrupt this rhythm by weakening the source of Kidney energy, the bank account or reserves of the body, which prevents Initiating rest.
Staying Asleep
This implies being able to go to sleep, but with waking throughout the night. This is due to Liver Blood weakness causing a form of night stimulation.
Chinese medicine stresses balance between Yin and Yang. When they are equal they counterbalance each other. If the fluids and/or structural components derived from Yin are damaged by cancer and treatment, night waking is the presentation. With decreased Yin/Blood, the Yang is unchanged but now becomes more because the balance shifts, less Yin and relatively more Yang. Yang is heat and energy, and heat rises, moving upward causing problems.
Empirical Formulas Based on Symptoms
Suan Zao Ren Tang (Zizyphus Combination): Strengthens the Liver Blood and restrains the overactive Yang which causes symptoms of insomnia during the night, weakness, exhaustion, restlessness, agitation, night sweats, palpitations, and nervous exhaustion.
Er Xian Tang (Two Immortals): Tonifies Kidney energy ,with insomnia, hot flashes, sweating nervousness, fatigue, depression irritability and palpitations. It is believed to have estrogen-like properties and should be avoided in estrogen-sensitive cancers.
Tian Wang Bu Xin Dan (Ginseng and Zizphus): Can be used as supportive treatment for anemia with symptoms of insomnia, palpitations, night sweats and emotional lability. It should be avoided if there are significant digestive problems.
Zhi Zi Shi Tang(Gardenia and Soja Combination): Which is effective for insomnia, irritability associated with fever from an infection
Gui Zhi Jia Long Gu Mi Li Tang (Cinnamon and Dragon Bone): Is indicated for insomnia with nervous exhaustion and palpitations
Wen Dan Tang (Bamboo and Hoelen): Insomnia with nervousness, depression, anorexia and stomach distress.
Gui Pi Tang (Ginseng and Longan): A common formula for insomnia with anemia, fatigue, decreased vitality, and Importantly gastrointestinal weakness.
References
Kim S, Jo K, Hong KB, Han SH, Suh HJ. GABA and l-theanine mixture decreases sleep latency and improves NREM sleep. Pharm Biol. 2019 Dec;57(1):65-73. doi: 10.1080/13880209.2018.1557698. PMID: 30707852; PMCID: PMC6366437.
Jafari-Koulaee A, Bagheri-Nesami M. The effect of melatonin on sleep quality and insomnia in patients with cancer: a systematic review study. Sleep Med. 2021 Jun;82:96-103. doi: 10.1016/j.sleep.2021.03.040. Epub 2021 Apr 25. PMID: 33910162.
Zare H, Shafabakhsh R, Reiter RJ, Asemi Z. Melatonin is a potential inhibitor of ovarian cancer: molecular aspects. J Ovarian Res. 2019 Mar 26;12(1):26. doi: 10.1186/s13048-019-0502-8. PMID: 30914056; PMCID: PMC6434863.