Sleep as Medicine
Did you know that March is Sleep Awareness Month? Sleeping well and long enough is crucial for well-being, especially for patients with prostate cancer and survivors. Sleep is so vital that we call it “medicine” that works in tandem with cancer treatment, healthy diet, regular exercise, and social support to improve treatment outcomes and survivorship.
Good sleep helps reduce inflammation in the body, stabilize mood, and improve day-to-day functioning. It can support your immune function and may even help treatment work better.
After treatment, quality sleep helps reduce inflammation and regulate hormones, which can potentially speed recovery and may even help reduce the chances of cancer recurrence, although the jury is still out. We do know that poor sleep is linked to an increased risk of developing prostate cancer, including high-grade disease, so sleeping as well as possible after treatment makes sense as a strategy to help keep cancer from coming back.
Poor sleep also can make it harder to recover from prostate cancer treatment, return to daily activities, stay emotionally regulated, and keep a good quality of life. For this reason, addressing sleep issues is a key part of providing comprehensive prostate cancer care and improving survivorship.
Spotlight on Sleep, Inflammation, and Immunity
Sleep affects inflammation and immunity, which in turn can impact cancer treatment and recovery. During sleep, especially deep sleep phases, the body naturally suppresses inflammation, repairs tissues, and produces anti-inflammatory cytokines (a type of signaling protein that helps keep inflammation in check).
Poor sleep disrupts this process, tipping the balance toward inflammation. Chronic inflammation leads to pain, swelling, and tissue damage that make it hard to tolerate a full course of treatment or exercise regularly to support recovery and overall health.
Optimizing immune system function is important during cancer treatment and relies heavily on adequate sleep. Immune cells tasked with finding and killing cancer cells work best when you are well-rested. Sleep deprivation compromises immune cell activity, which may help cancer cells avoid detection.
These are ongoing areas of study, but so far, data suggest that quality rest and sleep play a vital role in reducing inflammation, supporting immune function, and improving cancer outcomes.
Challenges: When Sleep Becomes Elusive
Unfortunately, sleep is often elusive for patients both during and after prostate cancer treatment. Understanding why can help you make changes that improve sleep.
One of the most common sleep disruptors is nocturia, or frequent nighttime urination. Nocturia stems from prostate enlargement as well as treatment side effects, especially the first few weeks after radiation therapy. Getting up often in the night breaks up sleep cycles and prevents deep, restorative sleep. Urine leakage after prostatectomy can also disrupt sleep and contribute to insomnia.
Pain and tenderness after surgery and radiation also are common and can impair sleep quality. The “fatigue paradox” of cancer treatment—feeling exhausted yet unable to sleep—creates another frustrating cycle that compounds sleep problems.
Many individuals with prostate cancer worry about treatment outcomes and face financial stress from medical bills and time off from work. Men may also feel a sense of shifting identity after a prostate cancer diagnosis, including changes in relationship dynamics and self-perception. All these stressors can trigger nighttime worries that disrupt sleep during cancer treatment—and sometimes for years afterward.
Solutions: Rebuilding Healthy Sleep
These challenges may sound daunting. But take heart— there are evidence-based ways to improve sleep during and after treatment for prostate cancer.
If nocturia or urine leakage are problems, try going to the bathroom just before bedtime and “frontloading” most of your fluids earlier in the day, so you feel less need to urinate at night. Pelvic floor exercises also can improve bladder control issues that affect sleep quality. A qualified physical therapist can recommend exercises for you. If these aren’t enough, talk to your oncology care team about other options.
Certain medications can help reduce hot flashes associated with hormone therapy, as can acupuncture. You may also wish to talk to your healthcare provider about adjusting the timing of any other medications you take that may impair sleep.
Aim for a sleep environment that’s cool, dark, and quiet, and only use your bed for sleep and intimacy. Try to get out into the sun in the morning and go to bed and get up at the same time each day to train your body’s clocks.
Relaxation techniques—such as paced breathing, or guided imagery focused on healing—may help calm ruminations before bedtime. Many men also benefit from joining prostate cancer support groups where they can share sleep challenges and solutions with others facing similar issues.
Cognitive behavioral therapy also can help improve sleep, as can sleep medications. These should always be discussed with a healthcare provider. If sleep problems persist, reach out to your oncology care team to ask about these and other solutions.
A final tip: Rather than pressuring yourself to get “ideal” sleep—which paradoxically might make you worry more and sleep less—we suggest taking a realistic and stepwise approach. Sleep issues are very common during the prostate cancer journey and are no one’s “fault.” Sleeping even a little bit better can meaningfully improve your life and health—and may help you take more steps that help you sleep and feel even better over time.
