Sleep, Stress, and Fatigue

Central Washington University

E.A.S.E. Cancer Foundation

Tim Burnham Ph.D.

Interrelated

Stress

Sleep disturbance Fatigue

Stress

Stress is YOUR response to a situation

Stressor: good (eustress) or bad (distress)

ACTH, Adrenaline, Cortisol

Increase BP, HR, Breathing, sweat

Increase blood glucose, free fatty acids

Response is the same despite cause

Chronic Distress

Multifaceted, unpleasant physical and emotional

experience that may interfere with the ability to

cope effectively with cancer, it’s physical symptoms

and treatment

Continuum: common normal feelings of

vulnerability, sadness and fears to disabling

feelings: depression, anxiety, panic, social isolation

and spiritual crisis

Common Stressors

Worries about getting cancer again

Reduced stamina and mental sharpness

Finances and keeping affordable health

insurance

Relationships

Finding or keeping a job

Sharing your cancer experience with others

Stress and Health

Cancer survivors have high levels of physical and emotional stress

High levels of stress hormones ACTH, adrenaline, cortisol

Decrease immune function: antibody production and inhibit NK cell activity

May increase risk of cancer recurrence and infections

Other health issues

Increase blood pressure and cholesterol

Increase blood sugar

More likely to have unhealthy diet, smoke,

lack exercise

Increased risk of other diseases, in particular

cardiovascular disease

Signs that a person is stressed

Headaches

Loss of appetite or eating too much

Body aches and pains

Pounding heart

Grinding teeth

Tense muscles

Fatigue

Signs that someone is stressed

Mood swings

Difficulty concentrating or making decisions

Nightmares

Worrying

Forgetfulness

Sleep problems

Ways to decrease stress

Exercise

Improves mood

Decreases stress hormones

Improves immune function

Regulates energy balance and fat

distribution

Lowers estrogen

Ways to decrease stress

Breathing and relaxation techniques (guided imagery, progressive muscle relaxation, meditation)

Yoga or Tai Chi

Support groups

Write in a journal

Ask for help with daily activities

Learn to say no

Ways to decrease stress

Cancer Related Fatigue

Profound fatigue related to cancer or it’s

treatment

76-99% of cancer survivors have CRF

CFR can significantly decrease activities of

daily living, decrease quality of life including

socializing, the ability to enjoy life and

decreased emotional well being

Cancer Related Fatigue

Not limited to the time during treatment, can last for years

CRF greater than exercise induced fatigue, remains after rest, more severe and debilitating

Both physiological and psychological aspects

Cancer Related Fatigue

Psycho-social factors related to CRF:

sleep

mood disturbance

chronic stress

anxiety

pain

depression

cognitive disturbance

Cancer Related Fatigue: other causes

Cachexia: muscle wasting

Anemia: lack of hemoglobin

Chemotherapy, radiation

Decreased nutrition

Ways to Decrease Fatigue

Exercise decreases fatigue

Decreases depression

Improves muscle function

Counteracts anemia

Think of you personal energy stores as a

bank, deposits and withdrawals of energy

must be balanced over the day

Ways to Decrease Fatigue

Plan ahead and organize your work

Schedule rest breaks

Pace yourself

Practice proper body mechanics

Limit isometric work

Prioritize activities to save energy

Eat properly

Sleep

Importance of sleep and treatment of sleep

disturbances has only been studied recently

50% of cancer survivors have sleep

disturbances (9-12% in general population)

Negative relationship between sleep and

fatigue, the greater the sleep, the less fatigue

Ways to improve sleep

Exercise

Yoga

Avoid long afternoon naps

Go to bed only when sleepy

Avoid caffeine in the evenings

Progressive muscle relaxing

Breathing exercises

If you toss and turn get out of bed

Meditation

Relationship between Sleep, Stress and

Fatigue

Stress, fatigue and sleep disturbance are all

separate entities.

However, they are all related to each other.

Learning techniques to reduce stress and

fatigue and increase sleep and sleep quality

can improve quality of life.

Relationship between Sleep, Stress and

Fatigue

A simple goal of starting an exercise plan

can work wonders. Walking 15-20 minutes, 3

times a week, at an intensity that allows you

to maintain a conversation, would be a good

step towards increasing sleep, reducing

fatigue and managing stress.