Sleep Disruption

What is sleep disruption? What may contribute to sleep disruption?

What is sleep disruption?

Sleep disruption, also called insomnia, is the inability to fall asleep in a reasonable amount of time, or to return to sleep on awakening during the night, or to achieve restful sleep.

What are the signs or symptoms of sleep disruption?

Sleep disruption is marked by these symptoms:

Difficulty falling asleep

Early awakening

Nighttime waking frequently and/or with an inability to get back to sleep for an hour or more

Not feeling refreshed in the morning

What may contribute to sleep disruption?

Many factors can interfere with the quality of sleep: “These include unresolved stress, a noisy bedroom environment, too much light in the bedroom, a bedroom that is too warm, hormonal issues such as hot flashes, too much alcohol, insufficient protein in the evening meal and side effects of medications.”¹Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.

Medical conditions

Many medical conditions can contribute to sleep disruption, including pain and anxiety.²Azizoddin DR, Soens MA et al. Perioperative sleep disturbance following mastectomy: a longitudinal investigation of the relationship to pain, opioid use, treatment, and psychosocial symptoms. Journal of Clinical Oncology. 2021 Oct 1;39(28_suppl:192.

“Comorbidities that can contribute to sleep problems include alcohol and substance abuse disorder, obesity, cardiac dysfunction, endocrine dysfunction, respiratory disorders, anemia, neurologic disorders (including chemotherapy-induced peripheral neuropathy), pain, fatigue, and emotional distress.”³Sanft T, Day A et al. NCCN Guidelines® Insights: Survivorship, Version 1.2023. Journal of the National Comprehensive Cancer Network. 2023 Aug;21(8):792-803.

Medications and therapies

“Some medications, both prescription and over-the-counter, can contribute to sleep issues. For instance, pain medication, antiemetics, antihistamines, antidepressants, and antipsychotics can all contribute to sleep disturbance.”⁴Sanft T, Day A et al. NCCN Guidelines® Insights: Survivorship, Version 1.2023. Journal of the National Comprehensive Cancer Network. 2023 Aug;21(8):792-803. Check the inserts with any prescription medications you use or ask your pharmacist if you have concerns.

Therapies that we have reviewed that may contribute to sleep disruption:

• Insomnia is a common side effect of nonsteroidal anti-inflammatory drugs (NSAIDs ›
• Difficulty sleeping, nightmares and vivid dreams during the first week of use are reported side effects of low-dose naltrexone ›
• Insomnia is listed as a side effect of reishi mushrooms ›

Lifestyle and behavior

Insomnia is often related to lifestyle choices and situations that take us away from our natural rhythms and that promote inactivity:

Overeating, eating foods that interfere with sleep promotion, or eating late in the evening or at night

Consuming food or beverages with caffeine, including energy drinks

Overwork or nighttime work

Chronic unmanaged stress

Staying up late and “screening”—looking at television, computer and/or cell phone screens for long hours, especially late in the evening

Opioid use

Alcohol use

Environment

Some environmental exposures are thought to contribute to sleep disruption. Research is still sparse, but blue light from electronics and bright light shortly before bedtime may disrupt sleep.

Light

Blue light, which is emitted from screens on electronics such as cell phones, tablets, computers, televisions, and other devices, may disrupt sleep when people are exposed in the evening and/or after bedtime:

• Better balance of hormones related to sleep (melatonin) and wakefulness (cortisol) among people exposed to bright or blue-enriched light during the day and not in the evening (modest evidence)
• Improved sleep efficiencythe ratio of total sleep time to time in bed among fatigued people with cancer exposed to bright white light in the morning (preliminary evidence)
• Some worse indicators of sleep quality among children and adults using electronic devices near bedtime or after going to bed, but no negative effects for adults using electronic devices for 2 hours at night following exposure to bright light for 6.5 hours earlier in the day (preliminary evidence)

Electromagnetic fields

Some people suggest that electromagnetic fields from electrical wiring, wi-fi or phone signals, or other sources may disrupt sleep. Evidence to date does not support a link:

• Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of effects from extremely low frequency electromagnetic fields (ELF-EMFs)—produced by power lines, electrical wiring, and electrical equipment—on hormone levels related to sleep
• Shorter time to fall asleep with exposure to signals used in mobile radio and two-way transceivers (TETRA)―used primarily in emergency communications systems―or in mobile communications systems (GSM900 EMF) (preliminary evidence)
• Insufficient (conflicting) evidence of effects on sleep from exposure to wi-fi or cellular signals

Risk factors for sleep disruption

These conditions are related to sleep disruption in adults:⁵Smagula SF, Stone KL, Fabio A, Cauley JA. Risk factors for sleep disturbances in older adults: evidence from prospective studies. Sleep Medicine Reviews. 2016 Feb;25:21-30; CJung HK, Choung RS, Talley NJ. Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications. Journal of Neurogastroenterology and Motility. 2010 Jan;16(1):22-9. Okuyama M, Takaishi O et al. Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scandinavian Journal of Gastroenterology. 2017 Jan;52(1):44-49; Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. International Journal of Obesity (London). 2010 Mar;34(3):407-19; Amiri S, Behnezhad S. Obesity and anxiety symptoms: a systematic review and meta-analysis. Neuropsychiatrie. 2019 Jun;33(2):72-89. English.

Some of these relationships with sleep disruption work both ways. For example, physical illness may precede and increase the risk of sleep disruption, but sleep disruption may also precede and increase the risk of physical illness. The same may be true for depressed mood, low marital quality, inflammation, and other conditions. 

The increased incidence of depression, inflammation, and illness among people with cancer may also be a factor in why people with cancer report insomnia at twice the rate as the general population.⁶Irwin MR. Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Current Psychiatry Reports. 2013;15(11):10.1007/s11920-013-0404-1.

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