10 Tips for Better Sleep With Polycythemia Vera

Polycythemia Vera and Insomnia: 10 Tips for Better Sleep

Polycythemia Vera and Insomnia: 10 Tips for Better Sleep
Everyday Health
Sleep is very important for physical and mental well-being. But disrupted sleep is a common problem in polycythemia vera (PV), a rare blood cancer in which your bone marrow makes too many red blood cells.

Many PV symptoms can make it hard to sleep. So can the stress and anxiety that often come with a diagnosis.

“Patients living with PV often struggle with sleep due to severe nighttime symptoms, including heavy night sweats, intense skin itching, painful sensations, and restless legs,” says Mohamad Khasawneh, MD, a hematologist and medical oncologist with Loyola Medicine in Tinley Park, Illinois.

Addressing sleep issues may take a multipronged approach that involves treatment of the underlying disease and lifestyle measures.

1. Create a Relaxing Environment

Make the bedroom a calming space. “Focus on establishing a relaxing bedroom environment that is cool and dark,” says Dr. Khasawneh. Use a fan or turn down the temperature, and consider blackout curtains if too much light comes through your windows. Make sure your bed is comfortable: Replace your mattress if it doesn’t give your body the support it needs.

2. Practice Relaxation Techniques

It helps to calm and clear your mind before bedtime with activities such as deep breathing, meditation, or journaling. “Developing a calming pre-bedtime routine and addressing physical discomfort right before sleeping can help you fall asleep easier and stay asleep longer,” says Khasawneh.

3. Avoid Blue Light

The type of light that comes from electronic devices can affect your sleep. Studies show that it can disrupt your natural sleep cycle or circadian rhythms, and also suppress the production of melatonin, a hormone that regulates sleep.

“If you have trouble falling asleep, turn off electronic devices at least 30 to 60 minutes before bedtime and avoid any exposure to bright lights,” says Jennifer Martin, PhD, a clinical sleep psychologist based in Miami and a spokesperson for the American Academy of Sleep Medicine. “When awake at night, avoid electronics, keep your phone out of reach, and use dim light if you need to get up during the night.”

4. Stick to a Routine

A consistent schedule is one of the most important sleep-promoting strategies. “This is especially important in the morning,” says Dr. Martin. “Getting up at the same time each morning encourages strong circadian rhythms, and can help with solid sleep.”

Try to keep both your bedtime and waking time the same every day, including weekends. But if you have trouble falling asleep, it’s better not to stay in bed tossing and turning. Get up and do something relaxing like reading or listening to music, then return to bed when you feel sleepy.

5. Keep Naps to a Minimum

Although fatigue is common in PV, sleeping during the day can lead to nighttime sleep problems. A short nap (20-30 minutes) is okay, but long naps can contribute to insomnia, says Martin. If you’re going to take a nap, try to do it early in the day, ideally before 3 p.m.

6. Avoid Heavy Meals, Alcohol, and Caffeine Near Bedtime

You don’t want to go to bed hungry, but eating too close to bedtime can be disruptive to sleep. One study found that nighttime awakenings increased by about 40 percent when a meal was eaten within three hours of bedtime.

Stimulants such as nicotine and caffeine can also keep you awake and alert when you’d like to go to bed, and can take hours to wear off. Drinking alcohol before bed can also disrupt your sleep, even though it may make you sleepy initially.

7. Manage Night Sweats

“Night sweats are a symptom patients with PV might experience,” says Martin. “This is due to the body producing excess levels of cytokines, a type of protein that causes inflammation, which leads to excessive sweat.”

You may find relief by practicing good sleep hygiene and consulting with your healthcare provider about the best management options for your specific situation. “Keeping the room cool is especially important,” says Martin. “Keep an extra set of pajamas nearby in case they are needed.”

8. Keep Itching Under Control

Itching is a common symptom of PV, especially itching that is triggered by contact with water. It can be challenging to manage, and in some people, itching can become severe enough to interfere with sleep. Treatment may include lifestyle measures, over-the-counter drugs, and prescription medicines.

If itching is triggered by water, avoid bathing in the evening before you go to sleep. Other measures include taking shorter baths or showers, using cooler water, moisturizing your skin immediately after bathing, and using anti-itch creams or oral antihistamines.

Treating the underlying disease is often the most effective strategy to relieve itching, and the medications or other treatments your doctor prescribes to control PV may also soothe your skin and help you sleep. In some cases, antidepressants such as selective serotonin reuptake inhibitors are prescribed for PV-related itching.

9. Control Pain

Many people with PV experience pain and discomfort at one time or another, and in various ways. “Physical PV symptoms such as numbness, tingling, burning, or weakness in the hands, feet, arms, or legs, and painful swelling of joints can make it difficult to settle in for a good night of sleep,” says Martin.

Pain-management strategies depend on the type and cause of pain. The first step is to discuss the situation with your healthcare team and get the okay before you take any medications or supplements.

Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are available over the counter and are usually effective for mild to moderate pain. If your pain is more severe, your doctor may prescribe an opioid. It’s important to take this type of medication as directed. Anti-seizure drugs like gabapentin can help with nerve pain.

Aside from medications, there are other interventions that can be used for both pain and to help you sleep, including acupuncture, hypnosis, meditation, relaxation techniques, music therapy, yoga, and massage therapy.

10. Get Screened

It’s possible that some of your sleep disruptions may be related to an underlying sleep disorder, such as insomnia. If you have symptoms like trouble falling asleep at night, trouble staying asleep, waking up earlier than you want in the morning, or feeling tired during the day, talk to your doctor about treatment options. “This can include optimizing PV symptom management or directly addressing insomnia symptoms with cognitive-behavioral therapy approaches,” says Martin.

Restless legs syndrome, a disorder that causes uncomfortable feelings in your legs and gives you the urge to move them, is more common among people with PV than in the general population.

 Because the symptoms mainly occur at night, they can disturb your sleep. PV can also cause numbness and tingling in your arms and legs, but a key sign of restless legs syndrome is that symptoms improve when you move.

By depriving your body of oxygen, obstructive sleep apnea (OSA) can signal your bone marrow to make too many red blood cells, a condition called secondary polycythemia.

 It’s different from PV, but can cause similar symptoms. Get tested for OSA if you snore loudly when you sleep, stop breathing momentarily during the night, or feel excessively sleepy during the daytime.

Resources We Trust

EDITORIAL SOURCES
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Daniel Landau, MD

Medical Reviewer

Daniel Landau, MD, is a distinguished board-certified hematologist-oncologist with a career that has spanned two eminent institutions: the Orlando Health Cancer Institute and the M...

Roxanne Nelson

Roxanne Nelson, RN

Author

Roxanne Nelson is a registered nurse (RN) and a medical and health writer. Her work has been published by a range of outlets for both healthcare professionals and the general publi...