Cancer of the lymphatic system, or lymphoma, is an immune system disease that attacks the white blood cells, known as lymphocytes, to produce blood cancer. Different lymphomas develop when something goes wrong during the maturation of white blood cells, resulting in the uncontrolled proliferation of particular lymphocyte cells: B-cells, T-cells or natural killer (NK) cells that occur at different stages of their maturation. Lymphoma accounts for around 5% of all malignancies. The survival rate for people with lymphoma accounts for 72%.¹

The development of lymphocytes manifests as an abnormal process which leads to their uncontrolled multiplication in lymphoma cells. Hodgkin lymphoma, together with non-Hodgkin lymphoma, accounts for the main types of this cancer. Lymphoma is the most common blood cancer in the UK, with doctors diagnosing more than 14000 cases each year.² 

Sleep disturbances in lymphoma patients

The majority of people with cancer, including those with lymphoma, face sleeping difficulties. Sleep functions as an essential component to increase overall health for someone receiving treatment for, or living with, chronic blood cancer. The relationship between lymphoma and sleep must be understood because quality sleep directly affects patients' health, recovery process and the outcome of their therapy.³

During various stages of their illness, most patients face sleep problems which disrupt their regular sleeping patterns. The main sleep-related problems among lymphoma patients consist of:

Physical symptoms

• Night sweats: They interrupt sleep by creating heat and discomfort in patients. Episodes with high intensity lead patients to soak their clothes and bedding. The condition makes it difficult to achieve quality sleep⁴
• Restless legs syndrome: Some medications, or the illness itself, may trigger uncomfortable leg sensations that interfere with sleep⁵
• Itching and discomfort: People with Hodgkin lymphoma often experience persistent itching that causes serious discomfort, thus preventing them from enjoying peaceful rest⁶
• Pain or swollen lymph nodes: Enlargement of lymph nodes generates pain or pressure sensations that can affect sleep when lying in bed⁶

Psychological symptoms

Beyond the physical impact, lymphoma often causes emotional distress:

• Anxiety and depression: A cancer diagnosis may create emotional pressure that can lead to the development of anxiety and depression, which independently affect sleep patterns. A research study used matched samples of patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) and non-cancer controls to determine depression and anxiety prevalence rates. Depression led to a diagnosis in 24.0% of HL cases as well as 22.3% of NHL cases, while anxiety required diagnosis in 6.7% of HL patients and 5.3% of NHL patients within 10 years. The research indicates that both Hodgkin lymphoma and non-Hodgkin lymphoma patients can have elevated depression risks, yet NHL was specifically linked to elevated anxiety risks⁷
• Insomnia: Patients experience challenges when falling asleep and maintaining restful sleep. Sleep disturbances occur at a rate between 30% to 75% in cancer patients shortly after diagnosis or medical treatment. This prevalence remains twice as high as in the general population. Numerous investigations have shown that cancer patients report insomnia symptoms, which range between 30% and 50% in their studies. Research on the impact of cancer on sleep mainly uses survey questionnaires and is limited due to the lack of sufficient objective sleep monitoring systems⁸
• Excessive daytime sleepiness: Daytime sleepiness and fatigue persist when individuals have slept an adequate amount at night. The main sign of central hypersomnolence disorders appears as excessive daytime sleepiness. Multiple Sleep Latency Testing (MSLT) helps to evaluate this condition. MSLT act as a universal diagnostic instrument for measuring EDS intensity. The research analysed 16 cancer patients, and most of them were women at a median age of 49 years, and 31% were currently undergoing active medical treatment. Daytime fatigue appeared in 94% of patients while daily naps developed in 81% of them, and 69% suffered from excessive daytime sleepiness according to MSLT, which identified central hypersomnolence disorders in 5 patients⁹ 

How sleep affects lymphoma patients

Sleep is not just a passive activity; it's essential for overall well-being, especially in lymphoma patients.

• Immune system support: Sleep plays the main role in supporting the immune system and maintaining human health. The function of the immune system depends on good quality sleep, while immunity defends against cancer development. Studies have highlighted an increase in tumour markers in individuals who experience inadequate sleep or sleep disorders. Conducting research into the relationship between sleep, immunity, and cancer may lead to better disease management and health results¹⁰
• Healing and recovery: The human body carries out its maintenance processes while people rest at night. When sleep decreases, it impedes the healing process of potential cancer treatments and produces lower energy levels in the body. According to the energy conservation theory, sleep minimises energy use when the human body's activity is low, since metabolic rates decline during sleep. According to the restorative theory, sleep enables your body to conduct repair work and tissue growth. According to the brain plasticity theory, sleep supports neural reorganisation and learning processes, together with brain growth in children and infants¹¹
• Mood and quality of life: Lack of sleep can increase fatigue and emotional struggles, which decrease quality of life. Not getting enough sleep can create feelings of brain fog, low energy and a refreshed feeling, which may obstruct your performance in tasks such as academic work and driving duties. Sleep health should be assessed through sleepy feelings that emerge during inactive periods. The typical indicators of sleepiness occur when reading, watching TV or during meetings or vehicle rides¹²

Ways to improve sleep in lymphoma patients

Improving sleep can be approached in several ways:

Medical support

• Managing pain and symptoms: Patients can experience reduced nighttime bother when symptoms are alleviated
• Adjusting medications: Medication timing or type adjustments sometimes minimise drug-related sleep disturbance side effects
• Cognitive-behavioural therapy (CBT) for insomnia: Therapy without drugs stands as a proven medical solution for persistent sleeping disorders¹³

Lifestyle adjustments

• Maintaining a regular sleep schedule: The body maintains its internal regulatory system better when people establish regular sleeping and waking patterns
• Creating a restful environment: A dark, cool atmosphere inside a quiet bedroom can lead to improved quality of sleep
• Limiting screen time and caffeine: Avoiding screens and stimulants in the evening can improve sleep quality¹⁴
• Relaxation techniques: Gentle yoga, meditation and deep breathing teach the body to achieve calmness before sleep and lead to better sleep
• Through guided imagery or music therapy: The practice of listening to harmonious sounds, as well as creating peaceful images in your mind, helps reduce stress and bring about relaxation to aid with sleep

When to seek help

• Everyone should seek medical attention if their sleep issues persist, since these problems disrupt their routine and medical procedures
• Patients should get medical help when their sleep problems include continuous insomnia along with loud snoring, airway interruptions during sleep and severe tiredness during the day
• A doctor consultation is necessary when sleep-related problems keep occurring because an expert diagnosis and treatment plan need to be created

Summary

Sleep problems have a fundamental connection with lymphoma development. Physical symptoms, emotional stress, and adverse effects from treatment lead to sleep disruptions. The absence of adequate quality sleep results in destructive consequences for the healing process, immune system, and emotional health. 

All lymphoma treatment plans need to include sleep issue recognition and appropriate treatment strategies. Combining medical care with healthy practices and emotional support will help lymphoma patients achieve better sleep quality, leading to enhanced life quality. Keep seeking help from professionals for persistent sleep problems since recuperation depends on restful sleep.