Woman suffering from insomnia

You might think that after surviving breast cancer, sleep would come easily but many survivors suffer from insomnia. Researchers at the University of Colorado Denver College of Nursing are trying to help women REST through a study with the same name.

Insomnia is a common problem throughout the course of breast cancer, frequently persisting long after primary treatment is completed, which affects women with all stages of breast cancer. Insomnia can be caused by the cancer itself, treatment (long and short term side effects), lifestyle changes or a combination of factors.Evidence suggests that insomnia has a profound impact on daily functioning and quality of life in cancer patients, immune functioning and may even have implications for tumor progression. Women with breast cancer experience approximately twice the risk of insomnia compared to the general population. Medications are often effective in managing acute insomnia during cancer treatment; however, medications have long-term limitations, and do not address the underlying mechanisms of chronic insomnia.

Enter Ellyn Matthews, assistant professor of Nursing at the UC Denver College of Nursing. She is the principal investigator for the REST study (Research Evaluation Sleep Therapy), which examines a cognitive behavioral intervention for insomnia in women after breast cancer treatment. Virginia Borges, MD, and Anthony Elias, MD, with the University of Colorado Cancer Center are co-investigators on this study. According to Matthews, the purpose of the study is to examine the effects of cognitive-behavioral treatment for insomnia (CBTI) on sleep, quality of life and daily functioning in individuals with breast cancer after treatment.  “Very few studies examine the insomnia women with breast cancer may experience in the survivor stage—or the effect cognitive-behavioral treatment on functional outcomes,” said Matthews. “CBTI is most effective when insomnia is chronic, particularly after treatment demands are removed.”

Insomnia can take many different forms: difficulty falling asleep or staying asleep, waking up too early or waking up feeling exhausted.  Matthews began the three year study in July 2008 with a National Institute of Nursing Research (NINR) grant. She hopes to enroll 60 participants who have finished their primary breast cancer treatment (chemo, radiation, surgery) and are one month to thirty six months after treatment—she currently has 20 survivors enrolled. As an oncology nurse for more than 30 years, Dr. Matthews knows that sleep problems are common amongst breast cancer survivors. Insomnia affects the memory, how women go through treatment, how they feel, their mood, their performance, etc. She believes that chronic insomnia can be helped through cognitive-behavioral treatment in four parts: stimulus control; scheduling of sleep; sleep hygiene tips; and addressing thoughts which keep one awake.

The six study therapy sessions last six weeks, but the total participation in the study is six months. Participants complete pencil and paper surveys on four occasions: baseline, end of the therapy sessions, and at three and six months. The first three sessions are in person, the second two are via phone to go over the sleep diaries and the last session is in person to discuss scheduling, stimulation control and thoughts.

Gabrielle, an Aurora artist, is a REST study participant. Gabrielle was diagnosed in 2004 and went through two surgeries and 18 months of chemo and radiation which finished in Feb. 2007. She is on medication for five years now to repress the estrogen. “The REST study is helping me tremendously,” said Gabrielle.


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