Weekly blog: Let's talk about sleep

03 May 2022

By Tim Baker

Long-time readers of this column (stretching back, oh, what is it now, three weeks?) may recall that my own cancer self-care mantra is a simple one: Remember to take your M.E.D.S – Meditation, Exercise, Diet, Sleep. And that ticking each of these boxes each day, alongside conventional therapies, helps us withstand the rigours of cancer treatment and enhance quality of life.

So, let’s look at the S: Sleep. Research suggests good quality sleep is one of the most important determinants of good health, and poor sleep can contribute to chronic disease, hypertension and other poor health outcomes.

Which, raises the obvious question: How do we sleep well? Particularly when living with a cancer diagnosis, the rollercoaster ride of test results, the debilitating impacts of treatment and the gnawing anxiety that can sabotage our slumber at 3 am?

All the previous pillars of my self-care mantra can contribute to good sleep. A daily routine of meditation before bed can prime us for a restful slumber, assist in the production of melatonin which prepares the body for sleep, and allows our cycling worries and anxieties to be tamed. A healthy diet, avoiding excess sugar, caffeine and alcohol can also assist with sleep. As does regular exercise. I never sleep better than after a good work-out.

But even so, sound sleep can still elude me. I’ve come to recognise the tell-tale signs when my nervous system is feeling a bit ragged, and I might need to be more pro-active with my good sleep regime. Key among them is one I’m not particularly good at – getting off all electronic devices and screens at least half an hour before bed, preferably an hour, and banishing them from the bedroom. I was a bit slow on the uptake of the concept of good “sleep hygiene” – an odd term that I suspected meant washing one’s sheets more than once a month.

What it actually refers to is carefully attending to the factors that promote good sleep – being in a regular routine, making your bedroom a sanctuary where sleep is the primary function, avoiding overeating in the evenings or consuming caffeine late in the day. And perhaps most importantly of all, avoiding the dreaded blue light of mobile phones, computer screens and TV leading up to bedtime. Building healthy sleep habits means observing routines or rituals that signal to your body that the time for sleep is approaching. Dimming lights. Allowing the mind and body to settle and come to rest after the exertions of the day, through a practice like meditation or a guided relaxation. Perhaps a chamomile tea. Some gentle stretching.

The Barefoot Investor, that best-selling financial guru, doesn’t generally offer a great deal of lifestyle advice or advocate splurging on consumer products. But one thing he does recommend is investing in a really good pillow. We spend about a third of our lives asleep, if we are in fact getting adequate sleep, so it makes sense to treat ourselves to the accoutrements that might foster good quality sleep.

It’s worth asking yourself, how do you wake up in the morning? Do you feel rested and refreshed and ready to take on the day? Or do you crawl out of bed tired and restless, lacking energy and vitality? If you tend towards the latter, it’s a fair bet you’d benefit from attending to your pre-sleep routine and finding what might assist you in greeting the dawn with greater joie de vivre.

Worrying about not sleeping well, cruelly, can also sabotage your sleep. Try looking forward to bedtime as a welcome reward for navigating another day. There’s a certain point in the evening, an hour or two after dinner, when I start thinking about my bed, imagining sinking into its soft, supportive contours, anticipating the welcome release from the day’s trials and challenges. What a miracle it is to simply lay down exhausted and wake up refreshed.

This precious goal is complicated for men with prostate cancer by the likelihood of multiple trips to the bathroom during the night. Even so, there are strategies to assist. Try not to turn lights on when you wake, if you can safely navigate your way to the bathroom in near darkness or have a subdued night light. Get your business done and head straight back to bed. Resist the temptation of detours to the kitchen or TV if you feel restless.

Lying awake in bed even when sleep eludes you can still be deeply restful if you treat it as a kind of prone meditation, focusing on the breath, letting go of tension in the physical body and the mind, scanning the body from head to toe and back again, simply enjoying the quiet of the night and a sense of relaxation. My meditation practice has assisted greatly with this – I simply refuse to worry about not sleeping and savour the sensation of rest even when lying awake in the wee hours (excuse the pun).

If you feel you’ve had inadequate sleep during the night, try napping, as chronic overtiredness can actually make it harder to sleep soundly. Many cultures observe a siesta in the middle of the day, typically after lunch, before resuming work or other daily activities. It’s only in modern western societies that we’ve decided we can charge through the entire day without a significant break.

Taking a melatonin supplement may assist with sleep and there are even several studies which suggest an anti-cancer benefit. Low levels of melatonin have been associated with an increased risk of prostate cancer and it’s been suggested melatonin levels could serve as a biomarker for prostate cancer risk.

A 2020 study, Melatonin impedes prostate cancer metastasis by suppressing MMP-13 expression, found: “Men with higher urinary levels of the sleep hormone melatonin are much less likely to develop advanced prostate cancer compared with men with lower levels of melatonin. Melatonin has shown anticancer activity in experimental investigations.”

Such investigations are far from conclusive, and no one is suggesting melatonin on its own is a cure for cancer or can replace conventional therapies. But it might be worth speaking to your doctor about the role melatonin could play in assisting with sleep, and any potential anti-cancer benefit would be a bonus.

A couple of years ago, dogged by nights of broken sleep, I signed up for a clinical trial called the Quest Initiative run by the University of Sydney examining the benefits of medical cannabis for people with chronic illness. As part of this trial, I was referred to a specialist cannabis doctor and prescribed both a CBD (non-psycho-active) oil and a THC oil (the psycho-active stuff), predominantly for sleep. It has made a dramatic difference to my sleep.

Without the oil I might wake three or four times a night for a trip to the loo. With oil, I might wake once or twice and occasionally sleep through the night, and when I do wake I quickly and easily get back to sleep. While the trial is now closed, it is becoming increasingly simple and easy to access medicinal cannabis safely and legally through a qualified cannabis doctor.

If you don’t enjoy that slightly disorienting “stony” feeling, you can simply take it right before bed and drift off into a deep slumber before the full effects kick in. And taking a CBD oil along with the THC can also mitigate that stoned sensation. But be warned, there is no legal limit for cannabis in your bloodstream when driving, even when you have accessed it legally, and it can stay in your system for days. So, if you are using medicinal cannabis, you shouldn’t technically be driving.

References

^{Wang, S. W., Tai, H. C., Tang, C. H., Lin, L. W., Lin, T. H., Chang, A. C., Chen, P. C., Chen, Y. H., Wang, P. C., Lai, Y. W., & Chen, S. S. (2021). Melatonin impedes prostate cancer metastasis by suppressing MMP-13 expression. Journal of cellular physiology, 236(5), 3979–3990. https://doi.org/10.1002/jcp.30150}

PCFA encourages men to consult with their GP or a PCFA specialist nurse for information and advice about treatments and complementary therapies before trying anything new.

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