The pancreas is a leaf-shaped organ that plays two important roles: it makes enzymes that help the body in digestion, and produces hormones to maintain the balance of sugar levels. It is found in the abdomen, behind the stomach.1 The pancreas lies close to the major blood vessels that carry blood to the liver, intestines, kidneys and lower part of the body.
Pancreatic cancer is caused by the uncontrolled and abnormal growth of cells in the pancreas.1 Unfortunately, early diagnosis of this cancer is not common because it does not show symptoms at an early stage of the cancer. The most common type of pancreatic cancer found among patients is pancreatic ductal adenocarcinoma.1 The symptoms profoundly impact individuals' physical, emotional and mental health, leading to sleep problems. Some patients can identify and talk about how they feel and seek support, but for some others, it is not easy. This will have a detrimental impact on their mental and physical health. Let’s explore it here.
Pancreatic cancer and the quality of sleep are connected. The endocrine pancreas produces hormones, while the exocrine pancreas produces digestive enzymes. Disruption in either of these functions can lead to a cascade of health issues, many of which affect sleep.2
The main symptoms of pancreatic cancer are:2
Patients with pancreatic cancer face problems maintaining a healthy weight as the cancer uses more energy from the body. Eating becomes more difficult due to nausea, lack of appetite and vomiting caused by both the cancer itself and treatments like chemotherapy. Enzymes produced by the pancreas help the body convert food into energy. When the pancreas does not make digestive juices, energy consumption is affected, and the body’s overall energy level is reduced.1
As the tumour grows, it can press against surrounding organs and nerves, causing persistent abdominal pain.1 It will be difficult to fall asleep when patients experience severe pain. Pain can last for a few minutes to a few hours and also range from dull and aching to sharp and stabbing, making it hard to fall or stay asleep. Patients also experience nerve pain that is described as burning or stabbing pain like needles or pins, which may not always be easy to pinpoint. Patients experience pain in such a way that they are not able to tell where it originates from. When pancreatic cancer spreads and affects the organs like the liver or bowel, it can cause soft tissue or visceral pain that feels very deep.5
Pancreatic cancer can grow and block the passage of digested food from the stomach into the intestines. This can cause bloating, nausea, and further discomfort, all of which interfere with restful sleep. 1
Commonly, patients with pancreatic cancer feel mentally and physically drained, which is different from everyday tiredness. They have to endure pain, issues with digestion, hormonal balance and other things. It affects patients in so many different ways depending on individual circumstances. Fatigue might occur during the treatment, after the surgery or treatment. It might last for different periods.4 This exhaustion is not simply a lack of energy; it is a deep, lingering feeling of physical and mental depletion that greatly impacts sleep and daily functioning.
A pancreatic cancer diagnosis can cause anxiety, fear, uncertainty and stress among patients. Might be worried about the recovery, the treatments, side effects, symptoms and other things. This, in turn, affects their sleep. Patients may experience feelings of hopelessness and anxiety. They may also lose interest in their personal lives, feel worthless or guilty, and become depressed. It is crucial to assess the patient's mental stability. The care team should provide appropriate talking therapies and counselling sessions to foster optimism and strengthen the patient's mental health.7
Studies have shown that approximately 50% of patients with pancreatic cancer before the diagnosis experience anxiety.8
Another clinical research review explored the connection between depression and cancer of the pancreas; this might be due to changes in hormone or enzyme production that affect brain function and emotional well-being.9
Sleep and health are strongly associated. In pancreatic cancer, the combination of physical symptoms (such as jaundice, pain, and fatigue), psychological strains, and side effects from treatments can severely affect sleep quality.
A research study showed that pancreatic cancer patients reported sleep disturbances in the immediate postoperative period. The results also stated that the patients who underwent pancreatic surgery for pancreatic cancer suffered from sleep disturbance. Additionally, the study suggested that chemotherapy played a role in the severity of insomnia, as patients receiving chemotherapy suffered from more severe insomnia than the others. The routine screening for sleep disorders in postoperative cancer patients can alleviate some of the burden on their mental well-being and improve their quality of life.10
Painkillers can be recommended to reduce the pain for the patients. Depending upon the severity and type of pain, different forms of painkillers, such as tablets, liquids, patches, injections and capsules, may be prescribed. The goal is to make the patient as comfortable as possible, particularly at night.12
Patients with pancreatic cancer have often reported symptoms of anxiety and depression. This can trigger problems with good quality of sleep. As cancer progresses and affects the organs close to the pancreas, it can exacerbate pain, including nerve pain. The sleep disturbances impact mental health and fatigue, creating a vicious cycle. The reasons for sleep disturbance must be identified and communicated to the physicians. Identifying the cause of disturbed sleep allows doctors to intervene, whether through medications, pain management, counselling, or lifestyle adjustments. Regular physical activity, when possible, and a consistent sleep routine may also help improve rest and overall quality of life.
Several symptoms are impacting the quality of sleep, such as anxiety and pain. Treating the symptoms might improve the quality of sleep. For example, if the abdominal pain is making the patient wake up during sleep. Appropriate medications can be recommended to alleviate the pain. Research shows that physical activity helps people with cancer to make them feel better, gives them more energy, improves their appetite and helps with their mood. Other methods that can help improve sleep quality include maintaining a consistent sleep schedule (going to bed and waking up at the same time), ensuring a calm and quiet bedroom environment, and avoiding caffeine or tea for six hours before bedtime.11
Several studies have established the relationship between tiredness and fatigue in cancer patients. An increase in sleep quality reduces fatigue. When a patient with cancer is not sleeping well day after day, the body is not fully charged. During sleep, the body usually goes through a full reset; if this does not happen, the body loses the ability to function well in the daytime. Over time, this can reduce physical strength, affect mood, and interfere with treatment recovery.
Feeling tired is not fatigue. Tiredness is relieved by rest or sleep. Fatigue is a persistent lack of energy that does not go away with sleep. It’s common in people with cancer and can significantly affect the quality of life.
Engage in activities that make you happy. Try to eat healthy and get a good quality of sleep. Set some short-term goals to achieve and maintain discipline in pursuing them. Reconnecting with people who support each other is good. Engage in doable exercises. Complementary therapies such as acupuncture (needles are inserted under the skin in specific places), massage, relaxation therapies, and music therapies are also beneficial.12
