Introduction

Bowel cancer (also known as colorectal cancer) affects the large bowel, which includes the colon and the rectum. In this article, we will explore how bowel cancer links to sleep, which is known to be significant to an individual’s overall well-being. Hopefully, after reading this article, you are encouraged to apply the practices that will aid your overall health, irrespective of your current health condition. 

The relationship between bowel cancer and sleep

Poor sleep or a lack of sleep can harm many aspects of health. This is due to a dysregulation in immune system functioning, leading to chronic diseases such as: 

• Hypertension (high blood pressure)
• Type 2 diabetes 
• Cardiovascular diseases (such as coronary heart disease, stroke and peripheral arterial disease)

Research has also found a possible connection between sleep disorders and colorectal cancer risk.¹

Other lifestyle factors may be at play such as: 

• Levels of physical activity
• Stress
• Smoking
• Drinking alcohol
• Obesity

In this article, we will focus on the impact of sleep on bowel cancer.

Psychological conditions such as anxiety and depression are common among people living with cancer and can impact sleep quality. But what if somebody without bowel cancer is sleeping poorly? What are the potential consequences of poor sleep on bowel cancer? Could this increase the chances of them developing bowel cancer?

We know that poor sleep can affect cancer progression due to several factors:¹

• Increased inflammation
  • Inflammation is known to be associated with the development of cancer²
• Disruption to the circadian rhythm (the body’s internal 24-hour clock)
  • This occurs commonly among sleep problems and is linked to the development of bowel cancer and its potential progression³

Sleep disorders and bowel cancer

Around 50% of colorectal cancer patients experience insomnia, with 35.6% of patients experiencing clinically significant insomnia.⁴ This may be due to the psychological and physiological symptoms of bowel cancer including: 

• Anxiety 
• Depression
• Hot flushes
• Diarrhoea 

Managing sleep problems in bowel cancer patients

Now that a link between bowel cancer and sleep has been established, we’ll look at the numerous practices and methods that can aid sleep. 

Non-pharmacological interventions 

These are healthcare interventions that don’t rely on medications. These include: 

• Positive sleep habits (sleep hygiene)
  • ‘Sleep hygiene’ relates to a healthy sleep environment, a regular sleep schedule and the avoidance of caffeine, nicotine and alcohol close to bedtime⁵
• Cognitive-behavioral therapy (CBT)
  • CBT can re-regulate thought and behavioural patterns that may be disturbing one’s sleep⁵ 
  • However, it is important to keep in mind that this practice requires a qualified therapist which can be both costly and time-consuming 
• Relaxation techniques
  • These are fantastic intervention techniques as they are free and very efficient 
  • They include meditation, peaceful music, breathing exercises and progressive muscle relaxation
• Mindfulness practices
  • Mindfulness practices can include journaling, keeping a sleep diary, meditation and walking 
  • They can aid your sleep and contribute positively to all facets of your wellbeing, making them a great option

Should these non-pharmacological practices not work, you can move on to the pharmacological (i.e. medication) treatment options. It’s worth noting that these two treatment options can be used together.

Pharmacological treatment

Prescription sleep medications are a common intervention for those suffering from sleep issues, this includes the use of: 

• Sedative-hypnotics (e.g. zolpidem and eszopiclone) 
• Melatonin agonists (ramelteon)⁵ 

Whilst these medications are effective in treating insomnia, it is important to note they tend to come with side effects such as drowsiness, nausea and dependence issues. It is therefore necessary to consult your physician regarding any pharmaceutical intervention you begin as the misuse of these medications can be detrimental to your well-being.

Healthcare professionals

Healthcare professionals can assess sleep in cancer patients through the use of patient-reported outcome measures (PROMs).⁶ 

PROMS include the use of sleep diaries and questionnaires. The sleep diary collates relevant information such as the time taken to fall asleep, bedtime hour, time of waking and frequency of sleep disturbances.⁶ 

Another tool used to assess sleep quality is the Pittsburgh Sleep Quality Index (PSQI). This comprises multiple facets of sleep, including sleep latency, duration, efficacy and quality.⁶ It is assessed numerically using the score range 0-21, with a higher score suggesting a poorer sleep quality. 

Either method of screening can be effective and can be used as a way to improve sleep due to the vast amount of data they provide on the components that lead to both poor and good-quality sleep.

Sleep specialists are key in this process as they can successfully diagnose and treat sleep disorders in bowel cancer patients. They can accurately treat and diagnose sleep disorders such as insomnia and sleep apnoea. In addition to sleep specialists, oncologists and psychologists are also required for the effective management of sleep disorders in cancer patients.⁶ 

In conclusion, the diagnosis and treatment of sleep disorders in bowel cancer patients require a multidisciplinary approach rather than just one type of healthcare professional.

Future research

Further research is required to fully understand the underlying mechanisms that link sleep disorders to bowel cancer. Potential areas of exploration include inflammation, circadian dysregulation and metabolic alterations.⁷ 

Targeted interventions for sleep disorders in bowel cancer patients may be useful. These interventions are specifically designed for bowel cancer patients such as CBT.⁷ It may prove useful for further studies to test the efficacy of non-pharmacological interventions such as CBT, mindfulness and fitness regimes, emphasising how they could cater to the needs of bowel cancer patients.⁷ 

These prospective studies would allow us to explore the interactions between sleep disorders and bowel cancer, enabling effective and proper treatments to be developed in the future. 

Summary

• Bowel cancer and sleep disturbances have a direct relationship — both affecting each other, with insomnia being common among bowel cancer patients, potentially caused by physical and psychological factors 
• Insomnia can significantly increase inflammation and circadian dysregulation and also cause metabolic issues, all of which can lead to bowel cancer 
• There is utility in non-pharmacological treatments such as relaxation techniques, CBT and meditation, all of which promote new behavioural and psychological patterns that may promote better sleep. Ensuring good sleep hygiene – which involves consistent practices that promote regular and deep sleep – is also important 
• Pharmacological treatments have much more potential to be harmful due to side effects, however, pharmacological intervention may be necessary and, if done safely and under the guidance of a physician, can prove to be a beneficial treatment 
• For successful screening, diagnosis and treatment of sleep disorders in bowel cancer patients, a multidisciplinary approach is beneficial, since the relationship between bowel cancer and sleep is complex and multidimensional 
• By recognising and addressing sleep disturbances, healthcare professionals from many different fields can significantly improve the quality of life, treatment outcomes, and overall well-being of patients living with bowel cancer
• Sleep issues in bowel cancer patients must be addressed as they can diminish a patient’s quality of life and well-being, making the symptoms of bowel cancer worse