By Michael Breus, PhD, ABSM
New research suggests that regular practice of yoga can lead to significant improvements in sleep for people who have undergone cancer treatment. For patients with cancer, sleep problems are common. Research indicates that people coping with cancer are at significantly higher risk for sleep disorders than the general population. Lack of sleep contributes to fatigue, and can increase the risk of developing depression for people coping with cancer. Poor sleep and disrupted circadian rhythms are also associated with hormone dysregulation and immune system dysfunction. Among people with cancer, disrupted sleep can occur as a result of a number of factors, including physical pain or discomfort that interferes with falling asleep or staying asleep, side effects from medications and treatments, as well as stress and anxiety. And once triggered, problems with sleep are often difficult to reverse: disrupted sleep patterns that develop during cancer treatment can persist long after treatment has concluded.
Finding ways to help people coping with cancer to sleep better is an important goal of sleep research and clinical treatment. While short-term use of sleep medication may be useful, it’s critical to identify strategies for improving sleep that don’t rely on long-term use of sleep medicines.
Researchers investigated the effectiveness of yoga to improve sleep as part of a post-treatment care program and found that the mind-body exercise brought significant improvements to sleep quality and sleep efficiency. Yoga also helped to reduce patients’ reliance on prescription sleep medication. The study included 410 patients with cancer, all of whom had undergone one or more types of treatment—including surgery, radiation and chemotherapy—within the past 24 months. Most of the participants (96%) were women, with an average age of 54, and 75% of participants had breast cancer. All were suffering from at least moderate levels of sleep problems. Researchers divided the participants into 2 groups, both of which followed the same standard post-treatment care plan. In addition, one group also participated in a 4-week yoga program, consisting of 2 75-minute sessions each week. The yoga regimen included physical postures as well as meditation, breathing and relaxation exercises. At the beginning and the end of the 4-week study period, researchers measured sleep for both groups using questionnaires and wrist sensors worn during the night. They found both groups had improved their sleep during the 4-week period. However, the yoga group experienced significantly greater improvements to sleep compared to the non-yoga group:
- Using a scale of sleep quality with a range of 21-0, with lower numbers representing fewer sleep problems, the group that practiced yoga demonstrated more significant boost to sleep quality. The yoga group saw their average sleep quality score improve from 9.2 at the beginning of the study to 7.2 at the end. The non-yoga group’s average score improved to a lesser degree, from 9.0 to 7.9.
- Yoga practitioners also improved their sleep efficiency—the amount of time spent actually sleeping relative to the total amount of time in bed—to a greater degree than the non-yoga group.
- The yoga group experienced more significant improvements to daytime tiredness than the non-yoga group.
- The yoga group reduced their use of sleep medication by 21% per week during the course of the study. The non-yoga group, on the other hand, increased their sleep medication use by 5% per week.
This last finding is especially encouraging, that the group practicing yoga improved their sleep while also reducing their reliance on sleep medication. We know from the CDC’s first-ever investigation of prescription sleep medication that reliance on prescription sleep aids is alarmingly high, with 4% of the adult population of the U.S. taking medication to sleep. Long-term use of sleep medication is not the best method of improving sleep for anyone. For cancer patients–who may already be taking one or more other medications–effective, non-chemical treatments for sleep problems are particularly welcome and important. To date, we’ve not seen a great deal of research attention paid to the potential benefits of yoga for patients with cancer. But there are other studies that suggest that yoga and other types of gentle, mind-body exercises can help improve sleep among cancer patients:
- With a group of lymphoma patients, researchers examined the effects on sleep of Tibetan yoga, a form that incorporates breathing, visualization, mindfulness and physical postures. After 3 months, patients who did yoga reported significant decreases in sleep disturbances, increased sleep duration, and less reliance on sleep medication, compared to a group that did not participate in the yoga regimen.
- A group of patients with a variety of cancers experienced improvements to sleep and decreases to levels of stress and fatigue after an 8-week program of mindfulness-based stress reduction (MBSR). MBSR includes meditation practices designed to address both physical and psychological difficulties.
- A review of research into mind-body therapies for cancer patients found that several forms of mind-body treatment had positive effects on sleep, as well as on pain and fatigue.
These latest results provide important additional evidence that yoga and mind-body practices can play a constructive role in treating sleep problems among cancer patients. I am a proponent of yoga and mind-body exercise as a treatment for sleep problems, and as part of a healthy-sleep routine. I hope we’ll see additional research explore the possible benefits of these practices for people living with cancer.
Michael J. Breus, PhD
The Sleep Doctor®