Participating in twice-weekly practice of Tibetan yoga may reduce sleep disturbances and improve sleep quality in breast cancer patients receiving chemotherapy, according to a study from researchers at The University of Texas MD Anderson Cancer Center.

The research, published in the journal Cancer, found that women who practiced Tibetan yoga at least 2 times a week reported less daytime disturbances, better sleep quality, and sleep efficiency over time, compared to those practicing less often and to women in an active control group receiving usual care.

Sleep disturbances and fatigue are two of the most frequent and debilitating side effects experienced by cancer patients undergoing chemotherapy, says lead author Lorenzo Cohen, PhD, professor of Palliative, Rehabilitation, and Integrative Medicine and director of the Integrative Medicine Program. Patients often describe poor sleep quality, insomnia, and excessive drowsiness.

“Previous research has established that yoga effectively reduces sleep disturbances for cancer patients, but have not included active control groups or long-term follow-up,” says Cohen in a release. “This study hoped to address previous study limitations.”

For the randomized study, 227 women with stage I-III breast cancer undergoing chemotherapy at MD Anderson Cancer Center were randomized to 1 of 3 groups: a Tibetan yoga program, a simple-stretching program, or a waitlist control group receiving usual care. Participants in the Tibetan yoga program and the stretching program attended 4 75-90 minute classes during their chemotherapy treatment.

Participants in the Tibetan yoga program were taught one-on-one by a trained instructor, with each class focusing on controlled breathing, visualization, meditation, and postures. Patients were encouraged to practice daily, at home outside of class.

Prior to starting the interventions, participants completed baseline questionnaires and wore an actigraphy watch, which monitors rest and activity cycles, 24 hours a day for 7 days to assess sleep quality. Follow-up assessments were conducted one week after the end of intervention and 3, 6, and 12 months later.

Sleep disturbances and fatigue were assessed using the self-reported Pittsburgh Sleep Quality Index and the Brief Fatigue inventory. Participants also wore actigraphs 24 hours a day for 7 days at each study time point to measure sleep.

There were no statistically significant group differences in total sleep disturbances or fatigue levels over time, but participants in the Tibetan yoga group reported fewer daily disturbances 1 week post-treatment than either of the other groups.

Additionally, long-term sleep benefits emerged over time for those who practiced Tibetan yoga at least 2 times a week. Compared to those who practiced less often, these patients reported fewer daily disturbances 3 months post-treatment, as well as better sleep quality and efficiency at 6 months post-treatment. These patients also reported fewer daily disturbances 3 months and better sleep efficiency 6 months relative to the usual care control group.

“While the effects of this intervention were modest, it is encouraging to see that the women who practiced yoga outside of class had improved sleep outcomes over time,” says Cohen.

The study and findings were limited by several factors, including a lack of blinded group assignments and challenges with recruiting patients undergoing chemotherapy, resulting in just a 56% participation rate.

Planned future research will focus on shorter in-class instruction and increasing patient engagement in yoga practice outside of the instructional classes.

In addition to Cohen, other MD Anderson authors include: Alejandro Chaoul PhD, Kathrin Milbury PhD, Amy Spelman PhD, Rosalinda Engle, Qi Wei, of Palliative, Rehabilitation, and Integrative Medicine; Karen Basen-Engquist PhD, Carol Harrison, of Behavioral Science; Ya-Chen Tina Shih PhD, of Health Services Research; Banu Arun MD, Vicente Valero MD, of Breast Medical Oncology; George Perkins MD, of Radiation Oncology; and Gildy Babiera MD, of Breast Surgical Oncology. Other authors on the study include: Martica Hall, PhD, of University of Pittsburgh and Tenzin Wangyal of Ligmincha Institute.

The research was supported by the NIH/NCI under award numbers R01CA105023, P30CA016672, K01AT007559 and the Richard E. Haynes Distinguished Professorship for Clinical Cancer Prevention at The University of Texas MD Anderson Cancer Center.