Ten years after cancer diagnosis, could I finally dispense with chemical sleeping aids?
Cancer is a terrible bedfellow. It tosses and turns, snorting and kicking and snatching more than its share of the covers. It never caresses or croons lullabies, but instead hisses innuendos into the wee hours, turning wakefulness into a wake. No wonder insomnia plagues cancer patients, often sending us to chemical aids. Ten years after diagnosis, could I finally dispense with them?
Back in 2008, long before the Food and Drug Administration issued warnings about Ambien, my oncologist prescribed it during standard interventions against late-stage ovarian cancer. A succession of infections, surgeries to cope with them, and umpteen rounds of antibiotics and chemotherapy, not to mention all-pervasive fear of my imminent mortality, kept me coming back to renew my prescription. Every month I appeared at the pharmacy, plunking down my driver’s license and credit card. Without the pills, I could no more sleep than elephants can fly.
As the years passed, after I gained level ground in a clinical trial that keeps the cancer at bay, I reduced the dosage from 10 milligrams to five. And then I started cutting the five-milligram pill in half. Had it become Dumbo’s feather, I wondered, less of a physiological fix, more of a magical confidence booster?
One member of my cancer support group, Traci, weaned herself from sleeping aids. Ornery about big pharma, she disliked the expense, the sense of being addicted, and the side effects. Not unlike cancer treatments, Ambien can produce memory loss, depression, nightmares, and confusion.
Seeking an alternative, another friend, Julia, swears by melatonin or marijuana extracts. A synthetic form of melatonin, a hormone produced by the brain, has been approved by the F.D.A. as a dietary supplement and some researchers believe it helps with the memory loss, depression, nightmares and confusion attending cancer treatment. Julia, a therapist, has patients who have been helped by marijuana-related sleep aids containing CBD or THC. CBD oils (cannabinoids extracted from hemp plants) do not produce the high of marijuana, while THC products (tetrahydrocannabinol from cannabis plants) do.
In our country, the legality of their use differs by state. CBD products are generally available, whereas the legality of THC as well as marijuana is evolving. That marijuana has been classified a Schedule 1 controlled substance by the Drug Enforcement Administration deters researchers from testing cannabinoids, according to the American Cancer Society.You have 2 free articles remaining.Subscribe to The Times
While Traci and Julia touted CBD or THC tinctures and vapes, salves and candies, I realized that I had no idea how they would interact with the experimental drug I take daily in my clinical trial. Also, many of these commodities are not well regulated in terms of exactly what is in them or what dosages should be. Nor is it clear how or whether they work. So I whittled down slivers of Ambien and stayed on course.
Then another member of my cancer support group, Dana, lent me her copy of “Why We Sleep: Unlocking the Power of Sleep and Dreams.” Its author, the neuroscientist Matthew Walker, argues that eight hours of sleeping lowers the risk of heart attacks, stroke, diabetes and cancer. What I saw in this list was a bleak subtext: The insomnia often produced by cancer treatment undermines the body’s ability to protect itself from cancer and other ills. Just as frightful, Dr. Walker wonders whether medication-induced sleep provides “the same restorative immune benefits” as natural sleep.
Cancer patients need strong immune systems to ward off recurrence, so maybe we shouldn’t be taking sleeping pills at all. Bowled over by Dr. Walker’s research, I studied the National Institutes of Health’s list of good “sleep hygiene” practices and read about cognitive behavior therapy for insomnia, or CBT-I, which provides techniques in meditation, image visualization and relaxation.