Tackling Insomnia Symptoms through Vestibular Stimulation in Patients with Breast Cancer: A Perspective Paper

Abstract

Insomnia symptoms are common among patients with breast cancer (BC; 20–70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from circadian rhythm alterations consistently reported in this pathology and known as carcinogenic factors, including lower melatonin levels, a flattened diurnal cortisol pattern, and lower rest-activity rhythm amplitude and robustness. Cognitive behavioral therapy and physical activity are the most commonly used non-pharmacological interventions to counter insomnia difficulties in patients with BC. However, their effects on sleep structure remain unclear. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms. Indeed, recent reports have shown that vestibular stimulation could resynchronize circadian rhythms and improve deep sleep in healthy volunteers. Moreover, vestibular dysfunction has been reported following chemotherapy. This perspective paper aims to support the evidence of using galvanic vestibular stimulation to resynchronize circadian rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival.

Visual analysis of the research frontiers, hotspots and trends of exercise therapy intervention in tumor-related sleep-wake disorders

“…Although moderate-intensity walking is effective in improving sleep in cancer patients ( 45 ), aerobic exercise combined with resistance exercise may be more clinically effective ( 46 ), and exercise therapy interventions are best tailored to the patient’s physical impairments at baseline, such as: loss of muscle strength, cardiopulmonary decline, or sleep disturbances, et al ( 48 ). In addition, insomnia is a predictor of cancer progression and quality of life, and vestibular stimulation is particularly appropriate for the treatment of its accompanying symptoms ( 49 ). Menopausal symptoms are the strongest predictors of menopausal symptoms in patients with gynecologic cancers, and assessment of menopausal symptoms and sleep quality during and after cancer treatment, timely intervention ( 51 ), reduction of exercise-induced discomfort, and control of insomnia can effectively improve their health-related quality of life ( 43 ).…”

Exploration of effects of galvanic vestibular stimulation on circadian rhythms and its associations with sleep and spatial memory in patients with breast cancer: The ICANSLEEP-2 protocol

“…Previous reports have demonstrated reductions in sleep quantity and quality among patients treated for BC [ 29 , 95 ], mostly using actigraphy but also PSG [ 96 , 97 ]. There is thus a need to tackle these difficulties using innovative approaches that are specifically designed to reduce RAR alterations [ 55 ].…”

“…While CBT is the standard treatment for insomnia-related difficulties [ 47 ], there is a need for a new approach that directly targets RAR and improves sleep structure. An innovative approach tested in several studies involves the vestibular system, on account of its inherent properties and the effects of its stimulation on RAR [ 55 ].…”

Melatonin, BAG-1 and cortisol circadian interactions in tumor pathogenesis and patterned immune responses

“…Preclinical data shows chronic sleep disruption to suppress the antitumor immune response [ 12 ], as well as to modulate tumor progression in breast cancer patients [ 13 ]. The circadian disruption in breast cancer patients includes suppression of the night-time melatonin production by the pineal gland and alterations in the cortisol awakening response (CAR) [ 13 , 14 ]. Alterations in the circadian rhythm are also strongly associated with mood, fatigue, and cognition as well as with treatment outcomes [ 15 ].…”