Insomnia and fatigue with metastatic breast cancer
While insomnia and fatigue can affect people with any stage of breast cancer, these side effects can be very challenging for those with stage IV disease. Even on a quiet day you may feel tired, weak, or so exhausted you can’t function as you might like.
In early-stage breast cancer, it can take up to a year for energy levels to return to normal. But your experience with metastatic disease may make these issues more long-lasting. That doesn’t mean your fatigue is permanent, but it does make it very important to talk with your providers so they can help you find ways to cope.
Many different things can cause fatigue and insomnia when you are living with stage IV breast cancer. These include
- medicines used to treat metastatic disease, including many common hormonal and targeted therapies
- chemotherapy medicines that cause anemia, which can make you feel tired
- pain and discomfort from treatment side effects, such as hot flashes and neuropathy, nerve damage that causes tingling and numbness in your hands and feet
- the emotional stress of living with uncertainty — worrying about what’s going to happen can keep you up at night and drag you down in the daytime
- anxiety and depression caused by stress or medicines
If you have insomnia or fatigue for more than a month, talk with your healthcare provider. In addition to identifying the cause, your providers can prescribe medicines or refer you to other health specialists who can help with nonmedical treatment options. These include:
- Exercise. Research has shown that people involved in an exercise program have an improved quality of life. You will likely be referred to a physical therapist or occupational therapist to help tailor an exercise plan suited to your needs.
- Good nutrition. A visit to a dietitian can help ensure you are getting the right nutrients.
- Massage, yoga, meditation, a meditation program called mindfulness-based stress reduction (MBSR), and cognitive behavioral therapy. In cognitive behavioral therapy, a trained healthcare provider helps you think about how you feel, and why you do certain behaviors and how to change them — which can lower the stress that causes fatigue and poor sleep.
If you have fatigue along with other side effects, or fatigue becomes so disruptive that you cannot live well in your day-to-day life, you may consider changing treatment. It may also be possible to change the dose or schedule. It’s possible the medicine could work as well. Talk with your providers about how they will monitor the impact of any changes to your treatment.
Sometimes people don’t want to report side effects because they are worried if the dose or timing of the medicine changes, the treatment will not be as effective. But most treatments have recommendations built-in to lower the dose or change the timing of the medicine if symptoms are of concern. Studies show that even if the dose is lowered or changed, the treatment will still be effective against the cancer. If the dose or change would not be effective, your healthcare providers would then change you to a different treatment.
Although one goal of your treatment is to keep the cancer under control for as long as possible, a second, equally important goal is to allow you to live a good life. Remember, your needs are an important part of your treatment plan. Open communication with your providers is very important. You and your providers will decide together whether continuing with a certain treatment is right for you.