Occasionally having trouble sleeping is normal for most people. Everyday stress, heartburn, or too much caffeine or alcohol all can make it hard to fall asleep.
Insomnia is different. If you frequently can't fall asleep, can't stay asleep, or don't get enough sleep to be rested, you may have insomnia. Insomnia can affect your mood and energy levels, cause fatigue, and make it hard to think and concentrate.
The stress of a breast cancer diagnosis and treatment, as well as some of the treatments themselves, and certain pain medicines can cause insomnia.
Cognitive behavioral therapy, a specific type of talk therapy where you talk with a counselor in a structured way, is considered the best treatment for insomnia.
A study has found that tai chi, an exercise that combines slow movements with meditation and breathing techniques, is just as effective as cognitive behavioral therapy in easing insomnia in women who have been treated for breast cancer.
The research was published online on May 10, 2017 by the Journal of Clinical Oncology. Read the abstract of “Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial.”
Breastcancer.org Professional Advisory Board Member Patricia Ganz, M.D., professor in the schools of medicine and public health at UCLA and director of the Division of Cancer Prevention and Control Research at the Jonsson Comprehensive Cancer Center, is one of the study’s authors.
Developed in China in the 12th century, tai chi started as a martial art. Today, many people practice tai chi for health purposes. Many practitioners believe there is a vital energy flowing throughout the body, called qi (pronounced “chee”) and that tai chi helps keep the flow of qi moving and unblocked.
During a tai chi session, you move through a series of movements, called a form or a routine. As you perform the movements, you pay attention to your breathing, focusing on breathing from your diaphragm, the big muscle in your stomach. At the same time, you maintain a relaxed concentration on the area just below your navel, which is where the qi is believed to begin.
"While cognitive behavioral therapy treats insomnia, it's too expensive for some people and there is a shortage of trained professionals in the field," said Michael Irwin, M.D., the study's lead author and professor of psychiatry and director of the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience and Human Behavior at UCLA. "Because of those limitations, we need community-based interventions like tai chi," he continued. "Free or low-cost tai chi classes are often offered at libraries, community centers or outdoors in parks. Do-it-yourselfers can find instructional videos on YouTube and smartphone apps."
The study included 90 women ages 42 to 83 years who had been treated for breast cancer between April 2008 and July 2012. All the women had insomnia and had completed any surgery, radiation, and chemotherapy at least 6 months before the study started. The researchers also evaluated the women for symptoms of fatigue and depression, which often accompany insomnia.
Other characteristics of the women:
- 10 women were treated with surgery only
- 28 women were treated with surgery and radiation
- 11 women were treated with surgery and chemotherapy
- 28 women were treated with surgery, radiation, and chemotherapy
- 28 women were continuing to take hormonal therapy medicine
The researchers randomly split the women in two insomnia treatment groups:
- 45 women participated in a tai chi program
- 45 women received cognitive behavioral therapy
The cognitive behavioral therapy program was conducted in groups of 7 to 10 women in weekly 2-hour sessions for 3 months.
The tai chi program was done in groups of 7 to 10 women in weekly 2-hour sessions for 3 months. The women did a Westernized type of tai chi called tai chi chih.
At 3 months, 6 months, and 12 months after the tai chi or cognitive behavioral therapy ended, the researchers evaluated the women’s sleep quality to see if the insomnia symptoms had eased. The researchers also evaluated symptoms of fatigue and depression to see if they also had eased.
A year after either tai chi or cognitive behavioral therapy ended, nearly half the women in each treatment group had substantial improvement in insomnia symptoms:
- 46.7% of women in the tai chi group had marked improvement in insomnia
- 43.7% of women in the cognitive behavioral therapy group had marked improvement in insomnia
So tai chi worked just as well as cognitive behavioral therapy to ease insomnia in breast cancer survivors.
"Breast cancer survivors often don't just come to physicians with insomnia," Irwin concluded. "They have insomnia, fatigue and depression. And this intervention, tai chi, impacted all those outcomes in a similar way, with benefits that were as robust as [cognitive behavioral therapy], the gold standard treatment for insomnia."
If you’re having ongoing sleeping problems, it’s a good idea to talk to your doctor. As this study shows, there are treatments that can help -- you don’t have to suffer.
Besides tai chi and cognitive behavioral therapy, there are other steps you can take to try and get the best sleep possible, including:
- avoiding alcohol
- cutting down on caffeine
- using blackout curtains
- going to bed and getting up at the same time every day
For more information on managing insomnia, visit the Breastcancer.org Treatments for Sleep Problems page. For more information on tai chi, including what to expect during a tai chi session, visit our Tai Chi page.