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Common to be tired, but can't sleep?

Page last modified on: August 19, 2008
Question from Allison: I'm so exhausted from dealing with all the emotional ups and downs with my disease. I'm wondering how much of this overtiredness is not physical at all. Will I ever feel stronger? I barely sleep since I've been home from my surgery. I'm tired, but never tired enough to just sleep soundly. Is this common?
Answers —Lillian Nail, Ph.D., R.N.: It's not unusual for people to tell us that the experience of a recent diagnosis of cancer and starting treatment is emotionally draining and that they have difficulty sleeping. The emotional landscape tends to level out over time for most people. But not for everyone, and the problem sleeping as we have addressed in earlier questions can have many, many different causes, which deserve to be investigated.
Russell Portenoy, M.D.: That's an extremely good question. In patients who don't have cancer, physicians usually rely on a combination of symptoms and signs to make a diagnosis of depression. Some of these symptoms and signs are physical, such as poor appetite and weight loss, In patients with cancer, some of these symptoms and signs, including fatigue, are no longer reliable because they may be caused by the disease, by the treatment for the disease or by other factors related to the illness. For this reason, doctors usually rely on the emotional content to make a diagnosis of depression in patients with cancer. A physician might ask a patient whether they feel hopeless or helpless or have despair. A physician might inquire about the ability to experience joy. If the emotions are persistently negative, then a diagnosis of depression is suggested. Nowadays, with many treatments for depression available and relatively safe, many physicians are quick to make a diagnosis of depression and quick to offer treatment in the hope that this will improve the fatigue, the mood and the overall quality of life.
Lillian Nail, Ph.D., R.N.: One of the problems that some women have experienced is people saying to them, you are not tired, you are just depressed. This is a serious problem because it ignores the impact of fatigue and depression. It is important to have both of those problems evaluated and both of them are potentially treatable.

On Wednesday, March 21, 2001, our Ask-the-Expert Online Conference was called Ease Fatigue, Boost Energy. Lillian Nail, Ph.D., R.N., Russel Portenoy, M.D., and Marisa Weiss, M.D. answered your questions about ways to manage fatigue and increase energy levels.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Lillian Nail, Ph.D., R.N.Lillian Nail, Ph.D., R.N., is the Dr. May Rawlinson Distinguished Professor and a senior scientist at the Oregon Health Sciences University School of Nursing in Portland.

Russell Portenoy, M.D.Russell Portenoy, M.D., is a neurologist and chairman of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York.

Marisa Weiss, M.D. is a radiation oncologist specializing in breast cancer and the founder, president, and guiding force behind Breastcancer.org.

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