Insomnia, Dizziness, and Chest Tightness After Cancer Treatment

Insomnia, dizziness, and chest tightness?

Hello Doctor: My mother is currently 60 years old.
She was diagnosed with breast cancer last year and only completed her radiation and chemotherapy at the beginning of this year.
She is currently resting at home and undergoing hormone therapy (taking "Fulvestrant").
During her radiation and chemotherapy, she did not experience severe insomnia; at least she could sleep well with the help of Ulotar.
However, recently, despite taking Ulotar, she has been unable to sleep well, waking up at 4 AM after going to bed at 11 PM, and she cannot fall back asleep.
She feels fatigued every day and has other symptoms such as dizziness, headaches, tightness in her chest, and general discomfort.
Therefore, we took her to a psychosomatic clinic, where the doctor diagnosed her with depression and anxiety, prescribing 1.
Kinloft 50MG, 2.
Clonazepam 0.5MG, and 3.
Modafinil 2MG.
After taking these medications for three days, her condition has not improved; she still wakes up at 4 AM and cannot sleep.
I want to know if these symptoms are truly caused by anxiety and depression, as my mother claims she is not having any racing thoughts and does not feel anxious.
It is strange that she automatically wakes up at 4 AM and cannot go back to sleep.
The medications seem ineffective, and I am unsure what to do next.
These medications have a long duration of action, so it shouldn't cause her to wake up so early.
Could there be a neurological issue or a problem with her brain? Should we continue seeing a psychiatrist, or should we get a full-body check-up? Or should we check her brain? I am really worried...
I feel like I am developing anxiety myself.
= ="

Fa Yi, 20~29 year old female. Ask Date: 2011/09/16

Dr. Wu Fangcan reply Family Medicine

Hello, hormone medications can indeed affect mood and sleep.
The symptoms you described could potentially be related to anxiety or mild depression, but it is essential to rule out any physiological issues first.
It is recommended that your mother consult her oncologist regarding these symptoms or arrange for further examinations.
The effects of antidepressants typically take at least two weeks to manifest, and sleep medications may not completely resolve insomnia issues.
You may also consider returning to the psychiatric clinic for medication adjustments and learning relaxation techniques.
Wishing you a speedy recovery.

Reply Date: 2011/09/16

More Info

I'm sorry to hear about your mother's struggles after her cancer treatment. It's understandable to feel overwhelmed when facing such complex health issues, especially when they involve both physical and mental well-being. Let's break down the symptoms and possible causes, as well as the next steps you might consider.

Understanding the Symptoms
1. Insomnia: Your mother’s difficulty sleeping, particularly waking up at 4 AM and being unable to return to sleep, can be influenced by several factors. While medications like "悠樂丁" (likely a form of sedative or sleep aid) are intended to help with sleep, they may not always be effective for everyone, especially if there are underlying issues such as anxiety or depression. Additionally, hormonal changes due to cancer treatment can also disrupt sleep patterns.

2. Dizziness and Headaches: These symptoms can be multifactorial. They may stem from medication side effects, dehydration, or even anxiety. It's important to monitor these symptoms closely, as they can also indicate other underlying health issues.

3. Chest Tightness: This can be particularly concerning, as it may relate to anxiety, but it can also be a sign of other medical conditions. Given your mother's cancer history, it’s crucial to rule out any serious cardiac issues.

4. General Discomfort: Feeling unwell overall can be a common side effect of cancer treatments, including chemotherapy and hormonal therapies. These treatments can lead to fatigue, changes in mood, and physical discomfort.

Potential Causes
Given the context of your mother's recent cancer treatment, her symptoms could be attributed to:
- Psychological Factors: Even if your mother does not feel anxious or depressed, the stress of cancer treatment and recovery can manifest physically. It's not uncommon for patients to experience anxiety or depression without being fully aware of it.

- Medication Side Effects: The medications prescribed for anxiety and depression can have side effects that may contribute to insomnia, dizziness, and other symptoms. It’s essential to discuss these with her healthcare provider.

- Hormonal Changes: Hormonal therapies can significantly affect mood and sleep patterns. The medication "復乳納" (likely a form of hormone therapy) could be contributing to her symptoms.

Next Steps
1. Consult with Healthcare Providers: It’s crucial to maintain open communication with her oncologist and the prescribing physician. They can evaluate whether her current medications are appropriate or if adjustments are needed.

2. Consider a Comprehensive Evaluation: If her symptoms persist, a full medical evaluation may be warranted. This could include blood tests, imaging studies, or referrals to specialists such as a neurologist or cardiologist to rule out any serious conditions.

3. Mental Health Support: Continuing to see a psychiatrist or psychologist may be beneficial. They can provide therapy options that may help her cope with the emotional aspects of her cancer journey. Cognitive Behavioral Therapy (CBT) is particularly effective for insomnia and anxiety.

4. Lifestyle Modifications: Encourage her to adopt healthy sleep hygiene practices, such as maintaining a regular sleep schedule, creating a restful environment, and avoiding stimulants before bedtime. Gentle exercise, mindfulness, and relaxation techniques can also help alleviate anxiety and improve sleep quality.

5. Monitor Symptoms: Keep a detailed log of her symptoms, including when they occur, their severity, and any potential triggers. This information can be invaluable for her healthcare team in determining the best course of action.

Conclusion
Navigating the aftermath of cancer treatment can be challenging, both physically and emotionally. It’s essential to approach her symptoms holistically, considering both medical and psychological aspects. Encourage her to stay engaged with her healthcare team and advocate for her needs. Your support as a family member is also crucial during this time. Remember, it’s okay to seek help for yourself as well, as caring for someone with complex health issues can be emotionally taxing.

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