Dr. Weeks’ Comment: As part of a general assessment, a doctor is well-advised to ask, in detail, about a patients sleep – both quantity, quality and the degree of feeing refreshed, restored and rejuvenated in the morning. Sleep is the time of the day when we repair the wear and tear of the prior day – it is the parasympathetic restorative response to the sympathetic stress of the prior day – it is the anabolic phase which recovers us from the catabolic consequence of living our lives… and without a habit of deep restorative sleep, our health will deteriorate. The metaphor which is highly instructive is that during the day we burn our candle (at both ends!) so a good night’s sleep allows us to “rewax” our candle by morning. So, you are understanding that I am a HUGE fan of a good night’s sleep and now we read that if you have cancer, attaining a good night sleep can save your life. The problem is that all commonly prescribed sleep agents WORSEN sleep. How can that be? Well these agents do rendered you horizontal, unconscious and amnestic but they actually “disrupt sleep architecture”. So then worsen sleep and are actually dangerous… especially if you have cancer.
“…While data have been reported most extensively for fluoxetine and paroxetine, class effects of SSRI therapy appear to include increased sleep onset latency and/or an increased number of awakenings and arousals, leading to an overall decrease in sleep efficiency...”
Better sleep predicts longer survival time for women with advanced breast cancer
Results show that higher sleep efficiency was significantly associated with lower mortality over the ensuing six years, an effect that remained after adjusting for baseline prognostic factors such as age, estrogen receptor status and treatments received. Mean survival was 68.9 months for efficient sleepers compared with 33.2 months for participants with poor sleep efficiency. Further analysis found that a 10 percent increase in sleep efficiency reduced the estimated hazard of subsequent mortality by 32 percent. There was no association between sleep duration and survival.
“We were surprised by the magnitude of the relationship between sleep quality and overall survival even after we accounted for medical and psychological variables that typically predict survival,” said lead author Oxana Palesh, PhD, assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University and research director of the Stanford Cancer Survivorship. “Good sleep seems to have a strongly protective effect, even with advanced breast cancer.”
Study results are published in the May 1 issue of the journal Sleep.
The study involved 97 women with advanced breast cancer who had a mean age of 55 years. Objective sleep parameters were measured by wrist actigraphy for three consecutive days. Overall, participants spent about eight hours in bed at night but slept for only about 6.5 hours.
“This study emphasizes the importance of assessing sleep quality among women with breast cancer,” said American Academy of Sleep Medicine President Dr. M. Safwan Badr. “Healthy sleep is critical for physical health, quality of life and overall well-being.”
According to the authors, this is the first study to demonstrate the long-term detrimental effects of objectively quantified sleep on survival in women with advanced cancer. Although the mechanism of the relationship between sleep quality and advanced breast cancer survival is unclear, they suggested that sleep disruption may lead to diminished immune function or impaired hormonal stress responses that are more directly responsible for the decrease in survival.
The authors also noted that further research is needed to replicate this finding using a prospective, controlled, experimental design to determine whether improving sleep can improve survival.
“There are effective treatments for sleep disruption in the general population, and some of them have shown to be effective in cancer survivors as well,” said Palesh. “But much more research is needed to develop and test interventions that are adapted for cancer patients and survivors. These interventions might not only improve quality of life, but can potentially improve survival.”
- Oxana Palesh, Arianna Aldridge-Gerry, Jamie M. Zeitzer, Cheryl Koopman, Eric Neri, Janine Giese-Davis, Booil Jo, Helena Kraemer, Bita Nouriani, David Spiegel.Actigraphy-Measured Sleep Disruption as a Predictor of Survival among Women with Advanced Breast Cancer. SLEEP, 2014; DOI: 10.5665/sleep.3642