By John M. de Castro, Ph.D.
“Sleep disturbance is a common problem for women with breast cancer, and can have a variety of causes, from stress and depression related to the treatment or diagnosis, to a side effect of some of the drugs and anti-nausea medications used in chemotherapy regimens. Yoga not only produced benefits in the short term, it also produced benefits in sleep quality three months and six months after treatment.” – Paul Raeburn
Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. But, surviving cancer carries with it a number of problems. Fatigue and insomnia are common symptoms in the aftermath of surviving breast cancer.
Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress, sleep disturbance, and anxiety and depression. Yoga practice is a form of mindfulness training that has been shown to be beneficial for cancer patients. In today’s Research News article “Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735004/ ), Chaoul and colleagues examine the ability of yoga practice to improve sleep in breast cancer patients.
They recruited patients with Stage 1 to 3 breast cancer scheduled to undergo chemotherapy. They were randomly assigned to usual care or to either receive a Tibetan Yoga Program or a stretching program. Participants met for 4, 75 to 90-minute, sessions during chemotherapy and 3 booster sessions over the next 6 months. The participants were also encouraged to practice at home. The Tibetan Yoga Program consisted of “1) mindfulness and focused attention through guided meditation with breathing and visualization; 2) an alternate nostril breathing practice and a breath retention exercise; 3) Tsa Lung movements; and 4) closing with a brief compassion-based meditation.” The participants were measured before and after the programs and 3, 6, and 12 months later for sleep quality, fatigue, and actigraph measured sleep patterns.
They found that all groups improved in sleep quality and fatigue over the 12-month measurement period. But the Tibetan Yoga group had significantly less daily sleep disturbances and fewer minutes awake before sleep onset. Hence, participation in the Tibetan Yoga Program had modest benefits for the quality of sleep for the patients. The Tibetan Yoga Program contains a number of different components including meditation, postures, and breathing exercises. It is impossible to determine in the current study which components or which combinations of components were necessary and sufficient for the benefits.
These results are encouraging but not clinically significant as the effects were very modest. But,
it should be kept in mind that yoga and meditation programs have been shown to improve a number of other impacts of breast cancer diagnosis and survival. So, the total impact of participation in yoga for breast cancer patients may be much greater than implied by the current results.
So, improve sleep in breast cancer patients undergoing chemotherapy with yoga.
“it is encouraging to see that the women who practiced yoga outside of class had improved sleep outcomes over time. Previous research has established that yoga effectively reduces sleep disturbances for cancer patients, but have not included active control groups or long-term follow-up.” – Lorenzo Cohen
CMCS – Center for Mindfulness and Contemplative Studies
This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch
Chaoul, A., Milbury, K., Spelman, A., Basen-Engquist, K., Hall, M. H., Wei, Q., Shih, Y. T., Arun, B., Valero, V., Perkins, G. H., Babiera, G. V., Wangyal, T., Engle, R., Harrison, C. A., Li, Y., … Cohen, L. (2017). Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy. Cancer, 124(1), 36-45.
This randomized trial examined the effects of a Tibetan yoga program (TYP) versus a stretching program (STP) and usual care (UC) on sleep and fatigue in women with breast cancer undergoing chemotherapy.
Women with stage I–III breast cancer undergoing chemotherapy were randomized to TYP (n=74), STP (n=68), or UC (n=85) groups. Participants in the TYP and STP groups participated in 4 sessions during chemotherapy, followed by three booster sessions over the subsequent 6 months, and encouraged to practice at home. Self-report measures of sleep disturbances (Pittsburgh Sleep Quality Index) fatigue (Brief Fatigue Inventory), and actigraphy were collected at baseline, 1-week post-treatment, and 3, 6 and 12 months.
There were no group differences in total sleep disturbances or fatigue levels over time. However, patients in TYP reported fewer daily disturbances 1-week post-treatment than STP (difference=−0.43, 95% CI: −0.82, −0.04, P=0.03) and UC (difference=−0.41, 95.5% CI: −0.77, −0.05, P=0.02). Group differences at the other time points were maintained for TYP versus STP. Actigraphy data revealed greater minutes awake after sleep onset for STP 1-week post treatment versus TYP (difference=15.36, 95% CI: 7.25,23.48, P=0.0003) and UC (difference=14.48, 95% CI: 7.09,21.87, P=0.0002). Patients in TYP who practiced at least two times a week during follow-up reported better PSQI and actigraphy outcomes at 3 and 6 months post-treatment than those who did not and better than those in UC.
Participating in TYP during chemotherapy resulted in modest short-term benefits in sleep quality, with long-term benefits emerging over time for those who practiced TYP at least two times a week.