Untreated insomnia can become harmful
By DR. V. UPENDER RAO
Published February 7, 2005
Inability to fall asleep within half an hour of going to bed, maintaining sleep, and being unable to get back to sleep within half an hour after an interruption is one way to define insomnia.
Millions of people across the world complain of insomnia, but it is particularly prevalent in cancer patients. It is said that at least 50 percent of cancer patients suffer from insomnia, understandably, during treatments, but oddly it also happens long after all treatments are completed.
Untreated insomnia can lead to chronic sleep deprivation, irritability, cognitive disorders and depression. Although not confirmed beyond doubt, there is some evidence that it can lead to dysfunctional immune surveillance of the NK, or natural killer cells, and result in progression of breast cancer.
There are many causes of insomnia in the cancer patient including anxiety, depression, pain, fatigue, altered bowel and bladder function, and side effects of chemotherapy, radiation, hormones and immunotherapy. Because of the many problems that confront cancer patients, insomnia rarely gets mentioned as a complaint.
Because of the ever growing complexity of cancer treatment, oncologists typically spend very little time dealing with such less dramatic issues as insomnia, but it is one problem that, if left untreated, can lead to many other problems and severely affect the quality of life.
CBT, or cognitive behavioral therapy, is thought to be the best approach, combined with pharmacotherapy where needed. An in-house psychiatrist could tackle these and other emotional issues effectively, but it is generally impractical and unavailable in the community setting.
In our practice at the Cancer and Blood Disease Center, a clinical social worker will be seeing patients to identify those who need either CBT or pharmacotherapy to improve the quality of life.
In the coming columns I will address the specific causes of insomnia in cancer patients and also mention some aspects of cognitive behavioral therapy and pharmacotherapy.
--Dr. V. Upender Rao, MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto.