By Christina M. Seluzicki, MBE, Margaret Barton-Burke, PhD, RN, FAAN, and Jun J. Mao, MD, MSC
Nearly 60% of people with cancer experience insomnia; it can persist for years if not appropriately managed. Furthermore, patients with cancer who have insomnia are at increased risk for infections, anxiety, and depression, which can negatively affect quality of life.
Insomnia can occur at any point in the cancer trajectory: distress following diagnosis may initiate and prolong insomnia symptoms, and cancer treatments, including surgery, chemotherapy, radiotherapy, and hormonal therapy, have been associated with sleep disturbances.
Current treatment options for insomnia include pharmaceuticals and cognitive behavioral therapy (CBT-I). However, sedative medications frequently cause side effects such as continued sleep difficulty, performance problems, memory disturbances, driving accidents, and falls. Although CBT-I is a safe, non-drug approach, not all patients benefit from it because of lack of access, unwillingness to participate, or nonresponsiveness to the therapy.
Tai Chi for Insomnia
Tai chi is a form of mind-body therapy stemming from traditional Chinese medicine theory that combines a sequence of gentle body movements with meditation and breathing. Clinical trials in noncancer settings indicated that tai chi improves insomnia symptoms and sleep quality in healthy older adults with moderate sleep complaints. Findings from another study showed that long-term, rather than short-term, tai chi practice led to improvements in sleep in older adults with chronic insomnia.
In addition, a systematic review and meta-analysis of 11 studies involving 994 patients evaluated tai chi’s effects on sleep quality in healthy adults and those with chronic conditions. Data revealed that tai chi practice for 1.5–3 hours per week for 6–24 weeks significantly improved sleep quality, although the studies were heterogeneous and some lacked methodologic rigor.
Research in cancer populations indicates the potential effectiveness of tai chi for insomnia. A randomized, partially blinded, noninferiority study comparing tai chi to CBT-I in breast cancer survivors (N = 90) found that both treatments resulted in clinically meaningful insomnia improvements. Participants completed a two-month phase-in period followed by randomization to three months of tai chi practice or CBT-I, each delivered to groups of 7–10 patients in weekly 120-minute sessions. Tai chi was statistically noninferior to CBT-I at three months (p < 0.01), six months (p < 0.01), and 15 months (p = 0.02). Participants in both groups showed robust improvements in depressive symptoms and fatigue that are known to lead to insomnia.
A systematic review and meta-analysis of 22 studies assessed the effects of physical and mind-body exercises on sleep problems in patients with breast cancer (N = 2,107). Tai chi was reported useful in alleviating insomnia, and when combined with qigong, it improved sleep dysfunction and depression.
The mechanisms via which tai chi exerts its benefits have not been completely elucidated. In cancer and noncancer populations, it was found to reduce cellular inflammatory responses and expression of genes encoding proinflammatory mediators, both associated with sleep disturbance.
What Oncology Nurses Need to Know
ONS’s Putting Evidence Into Practice resources recommend CBT-I, exercise, and mindfulness-based stress reduction as useful interventions for sleep-wake disturbances.
As a mind-body practice that encompasses gentle exercise and meditation, tai chi is being investigated for its role in alleviating cancer-related insomnia. Available evidence, although limited, supports the practice for managing this important quality-of-life issue. As with other mind-body modalities, patients can experience increased benefits with regular practice.
Tai chi is considered safe, and it can be practiced by people of all ages because its movements are gentle and put little stress on the body. Because of ease of implementation, many hospitals, cancer centers, and community and senior centers offer tai chi typically taught by experienced instructors. Patients with musculoskeletal symptoms should consult with their physicians before practicing tai chi.