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Insomnia and Skin Cancer Anxiety, Part 2: Solutions

Last week, we reviewed the sources of anxiety and insomnia in people with skin cancer. It’s important to identify these problems early when managing one’s overall health while treating skin cancer for two reasons: untreated insomnia and anxiety may actually exacerbate your illness, and both conditions have multiple options for treatment. Below you’ll find an outline of solutions to consider if you’re living with skin cancer.

When you don’t treat your anxiety

Anxiety and distress, when left untreated, may lead to extended periods of any chronic illness.1 However, chronic ongoing stress, by itself, has been shown to have a role in the emergence and progression of certain skin cancers. It can also lead to delayed tumor regression, altered immune-system responses, and lower protective immunity.2 People diagnosed with later stage skin cancer may also experience added stress while dealing with more aggressive treatments.2

When you don’t treat your insomnia

It’s a vicious cycle: Lost sleep at night leads to daytime naps, which then interfere with circadian rhythms, disrupting the sleep-wake cycle, leading to more insomnia.3

If you don’t treat insomnia, you risk exacerbating any health condition you may be living with, including cancer. Insomnia also has distinct links to mood dysregulation which may also lead to amped up worries and stress.

How to find the sleep you need

Good sleep hygiene

  • Put away your handheld devices at bedtime
  • Avoid alcohol at bedtime and caffeine after lunch
  • Have a sleep-conducive bedroom that is dark, comfortably cool, and as quiet as possible
  • Reset disrupted circadian rhythms with morning exercise

Relaxation techniques

These complementary approaches are shown to have relaxing benefits:

  • Meditation and yoga
  • Progressive muscle relaxation
  • Other forms of relaxation: massage, soft music, mild stretching, yogic breathing, warm baths

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I specifically targets insomnia using the same behavior modifying techniques of CBT (see below) while focusing on the context of the sleep-wake cycle.

Sleep medications

A host of medications can treat insomnia4:

  • Benzodiazepines, like Xanax or Ativan
  • Nonbenzodiazepine hypnotics, like Ambien or Lunesta
  • Tricyclic Antidepressants, like Amitryptiline
  • Specialty medications including melatonin
  • Antihistamines, like Benadryl

However, the extended use of pharmaceuticals to treat insomnia can cause dependence. Non-pharmacological approaches are encouraged as the first line against insomnia, especially within the context of cancer.5

Of special interest is melatonin, which is used to enhance chronotherapeutic treatments for cancer patients. Melatonin is a key circadian rhythm substance manufactured by the brain which can also be taken orally.4

Anxiety therapies

Medications

Drugs known as “anxiolytics” can help.2 The Anxiety and Depression Association of America (ADAA) describes 4 classes of anti-anxiety drugs6:

  • Selective Serotonin Reuptake Inhibitors (SSRIs), like Paxil and Lexapro
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), like Effexor
  • Benzodiazepines
  • Tricyclic Antidepressants

Cognitive Behavioral Therapy (CBT)

As with insomnia, CBT techniques can be extremely helpful for modifying anxious behavior.
CBT is a short-term approach that involves a variety of therapies which identify behaviors and thinking patterns that can lead to or fuel an anxiety response.

Problem-solving is the focus of CBT. Its goal is to teach those with anxiety how to change their thinking patterns and beliefs so that they may have more productive and emotionally healthy responses to their problems.

Self-care

The following practices are cited by the ADAA6 as helpful for anxiety:

  • Meditation
  • Regular exercise
  • Yoga and yogic breathing
  • Priority reset: managing time and energy more efficiently, asking for help
  • Music or other art therapy
  • Support groups

Integrative approaches

The emerging field of psychodermato-oncology may be part of a skin cancer team in the near future. Psychodermatologists can provide therapies to address the psychological impacts of skin cancer—anxiety, depression, distress, and guilt—as well as help patients manage stress and improve quality of life during both treatment and remission.2

  1. (Chapter 8) Psychological Aspects of Critically Ill Cancer.” Hatipoğlu Z, Bolukbası and Ozcengiz D. Mechanical Ventilation in Critically Ill Cancer Patients, 2018; Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-319-49256-8_8
  2. “(Chapter 15) Nonmelanoma Skin Cancer.” Kumar AB, Al‐Qubaisy Y and França K. Advances in Integrative Dermatology, 2019 Jan 25; John Wiley & Sons. https://onlinelibrary.wiley.com/doi/10.1002/9781119476009.ch15
  3. “Anxiety and Sleep.” Psycom, 2019 Apr 11. Accessed on the Internet on May 7, 2019: https://www.psycom.net/anxiety-and-sleep/
  4. “Pharmacological Treatment of Insomnia.” Lie JD, Tu KN, Shen DD, and Wong BM. Pharmacy and Therapeutics: a peer-reviewed journal for formulary management, 2015 Nov;40(11), 759–771. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634348/
  5. “Insomnia in the Context of Cancer: A Review of a Neglected Problem.” Josée Savard J and Morin CM. Journal of Clinical Oncology, 2001;19:3, 895-908.
  6. “Sleep Disorders.” The Anxiety and Depression Association of America. Accessed on the Internet on May 7, 2019: https://adaa.org/understanding-anxiety/related-illnesses/sleep-disorders

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