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Treating sleep problems may improve pain management in patients with cancer
Westchester, Ill. –A study in the April 15 issue of the Journal of Clinical Sleep Medicine suggests that sleep problems lead to increased pain and fatigue in cancer patients. The results indicate that interventions aimed at trouble sleeping would be expected to improve both pain and fatigue in this patient population.
Results show that more than half the sample reported having trouble sleeping, with 26 percent reporting moderate or severe trouble sleeping. Compared with patients who reported no trouble sleeping, patients with moderate to severe trouble sleeping reported significantly more fatigue, pain and depressed mood. Using structural equation modeling analysis to evaluate causal relations and directions of effect, the best-fitting model indicates that trouble sleeping led to increased ratings of pain.
According to the authors, the relationship between pain and sleep often has been assumed to be reciprocal. In the present study, however, a model of reciprocal causation could not be fit to the data, and models in which pain caused trouble sleeping did not fit as well as the model in which trouble sleeping caused pain.
“We believed we would find a bi-directional relationship between insomnia and pain, but instead found that trouble sleeping was more likely a cause, rather than a consequence, of pain in patients with cancer,” said lead author Edward J. Stepanski, chief operational officer at the Accelerated Community Oncology Research Network in Memphis, Tenn.
The study included demographic, clinical and patient-reported outcomes data from 11,445 cancer patients undergoing treatment at the West Clinic, a large community oncology practice in Memphis. Participants had an average age of 61.5 years, and 74 percent were female. Breast cancer was the most common form of cancer, and about 25 percent of study subjects had received chemotherapy in the last 30 days. Increases in depressed mood also led to increased ratings of pain.
Younger age and recent administration of chemotherapy were both associated with increased trouble sleeping. According to the authors, younger patients often receive more aggressive chemotherapy than older patients; therefore, younger patients may be exposed to more treatment-related toxicity.
Stepanski stated that several studies have shown that cognitive behavioral therapy (CBT) improves sleep in cancer patients who have insomnia. He believes that this type of intervention may decrease patients’ pain and fatigue by improving their sleep.
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More information is available from the AASM about sleep and breast cancer at http://www.sleepeducation.com/Article.aspx?id=1076 and about cognitive behavioral therapy at http://www.sleepeducation.com/Treatment.aspx?id=5.
The Journal of Clinical Sleep Medicine (JCSM) contains published papers related to the clinical practice of sleep medicine, including original manuscripts such as clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports. In addition, the JCSM publishes proceedings from conferences, workshops and symposia sponsored by the American Academy of Sleep Medicine or other organizations related to improving the practice of sleep medicine
For a copy of the study, “The Relation of Trouble Sleeping, Depressed Mood, Pain, and Fatigue in Patients with Cancer,” or to arrange an interview with an AASM spokesperson, please contact Kelly Wagner, AASM public relations coordinator, at (708) 492-0930, ext. 9331, or kwagner@aasmnet.org.
AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research. As the national accrediting body for sleep disorders centers and laboratories for sleep related breathing disorders, the AASM promotes the highest standards of patient care. The organization serves its members and advances the field of sleep health care by setting the clinical standards for the field of sleep medicine, advocating for recognition, diagnosis and treatment of sleep disorders, educating professionals dedicated to providing optimal sleep health care and fostering the development and application of scientific knowledge.
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If you are someone who regularly takes sleeping pills to get a good night’s sleep, here’s a question for you – have you ever considered trying natural cures for insomnia? If you haven’t, you should definitely consider trying them. There are some very good homeopathic remedies available to treat insomnia and you’ll be surprised to know that they are far more effective and safer than the sleeping pills you take.
First of all, you should know that insomnia is not as bad as you think. It is not a disease, but a symptom of a sleeping disorder. Usually, people do not get a good night’s sleep when their mind is preoccupied with something. It’s a psychological, rather than a physical problem. The leading causes of insomnia are anxiety, stress and depression. Physical exhaustion can be another reason, but this is usually only temporary. When your physical system heals itself and you are fully rested, your natural sleep rhythm will Read the rest of this entry »
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Vedic description of insomnia
The best description of the causes and treatment of insomnia comes from Vidura Niti a dialogue between Vidura and Dhritasashtra, said Dr KK Aggarwal President Heart Care Foundation of India and Director IMAAKN Sinha Institute. .
Vidura said: “Sleeplessness overtakes thief, a lustful person, him that has lost all his wealth, him that has failed to achieve success and him also that is weak and has been attacked by a strong person”.
He therefore described five basic reasons for insomnia and even in today’s science they are true. No new cause has been added in this list of stress induced insomnia.
The situations are:
1. A thief
2. A lustful person
3. A person who has lost all his wealth
4. A person who has failed to achieve success
5. A person who is weak and has been attacked by a strong person.
Ayurveda describes sleeplessness as an aggravation of vata & pitta dosha. The number one cause of the same is mental tension; suppressed feelings & acute bitterness. The above five situations again hold true to this effect.
Apart in allopathy other causes of insomnia mentioned are constipation; dyspepsia; excessive intake of tea, coffee & alcohol and environment Factors-excessive cold, heat or change of environment. They are in most of the situations the effect and not the cause of insomnia.
The treatment of insomnia involves either suppressing the emotions with drugs or root level eradication of stress with proper counseling.
Bhagwad Gita, Chanakya Nitiu and Vidu Noti are all the high level counseling books of ancient era and provide texts and sutras even true today. Bhagwad Gita was a counseling when Arjuna went in an acute anxiety state and was not being able to decide whether or not he should fight with his near ones. He said: my legs are trembling, my bows are leaving me, by body is shaking, what should I do”. The principles of Gita today are incorporated as the principles of Bhagwad Gita and they are minimal 18 counseling sessions, second and last session the longest, in the first session only listen, reassure the person repeatedly.
Chanakya again gave principles of how to manage conflicts and win over others by way of different principles. One of his main teachings was that money earned by unfair means can only last for eight years.
Here are some of the sutras of Vidura Niti
Do not inhabit a surrounding where you are not respected, cannot earn your livelihood, have no friends, or cannot acquire knowledge. (1.8)
Do not reveal what you have thought upon doing, but by wise counsel keep it secret, being determined to carry it into execution. (2.7)
Consider again and again the following: the right time, the right friends, the right place, the right means of income, the right ways of spending, and from whom you derive your power. (4.18)
A wise man should not reveal his loss of wealth, the vexation of his mind, the misconduct of his own wife, base words spoken by others, and disgrace that has befallen him. (7.1)
One of the answers to insomnia is learning meditation as described in Patanjali Yoga Sutra or Yoga Vashistha. It is based on the principle of concentrating on the present, which shifts the inner environment from sympathetic to para sympathetic mode. 20 minutes of meditation morning and evening provides the same biochemical benefit as gathered from 7 hours of deep sleep
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