This episode of Curbside Consult with Dr Lise Alschuler explores how physicians can help patients with breast cancer better manage the mental health challenges of the diagnosis. Our focus today is on treating insomnia.
Helping patients manage anxiety and depression which is often the underlying cause of insomnia is an area where natural medicine really does excel.
Causes of Insomnia
Cancer and its treatments cause circadian disruption, which contributes to fatigue. Also, estrogen receptor positive breast cancer patients experience hot flashes at night, which can aggravate the insomnia. Then there is an overlay of stress which makes everything worse.
Blood sugar levels
Women who have been through breast cancer treatments or are menopausal can have hypoglycemic episodes at night. Maintaining good blood sugar levels and getting out into the sunshine soon after waking can help reinstate the circadian rhythm and help with sleep quality.
For some women hot flashes are very disruptive and a cause of interrupted sleep. Hot or warm episodes that feel like an internal furnace, affect as many as 75% of menopausal women.
Black cohosh is an excellent starting point, along with Valerian. Use a combination of full spectrum black cohosh along with a standardized extract. The standardized extract really helps to concentrate the active glycosides but there's an entourage effect of the whole plant that's really important.
Black cohosh in some retrospective studies has been found to reduce the risk of breast cancer recurrence.
Other options for hot flashes include using Hesperidin and Vitamin E together.
There are several supplements that can help women with breast cancer, including Valerian, which improves sleep and has the added bonus of decreasing hot flashes.
Fresh valerian root tincture is the go-to but some women object to the strong taste and smell. If they're not game for that, go for a standardized extract of Valerian.
Melatonin has been shown to have different anticancer mechanisms including reduction in tumor growth and metastases, reduction in the side effects associated with chemotherapy and radiotherapy as well as decreasing drug resistance in cancer therapy.
Clinical trials revealed that melatonin is an effective adjuvant drug to all conventional therapies.
Melatonin, the master regulator of circadian health, is the best studied natural supplement in integrative oncology, and it has also been shown to reduce depression, improve sleep and help women tolerate their treatments better.
Melatonin is an important substance that improves sleep latency and quality, as well as having anti-seizure effects. It also has immuno-enhancing properties specifically with natural killer cells and cytotoxic T cells, which are the anti-cancer immune cells.
Melatonin has been shown in several studies to reduce the adverse toxicity from various chemotherapy and radiation treatments and even augment their efficacy. The dose that's pretty universally used is 20 mg.
Many people use cannabis to help them with their sleep. They use the edible form of cannabis at bedtime and describe that the benefit is pretty significant. It’s important to check the source of the cannabis as organic cannabis is recommended.
Some of the cannabis on the market is either full of pesticides or extracted with solvents that are seldom completely washed off.
“If you get some benefit but not quite enough, then you have to layer in additional therapies. Other times, if something you give doesn't work at all, just pull it and try something else. I think using a carousel of our options is important. Riding on that carousel are other options like Vitamin E, the old tried and true. Hesperidin and Vitamin E together can be very good for hot flash management.” Dr Lise Alschuler, ND FABNO
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