Abstract 5041: The effect of YOCAS©® Yoga on prescription sleep medication and over-the-counter sleep medication usage in cancer survivors with impaired sleep quality
Authors: Peppone Luke J. , Janelsins Michelle , Friedberg Jonathan , Tejani Mohamed , Kamen Charles , Flannery Marie , Peoples Anita , Atkins James , Melnik Marianne , Mustian Karen 
Published: May 2015

Abstract
Background: Impaired sleep quality (ISQ) is highly prevalent among cancer survivors; 30-90% of cancer survivors report some form of ISQ following treatment. Cancer survivors with ISQ are often provided with sleep medications, which fall into two classes: prescription sleep medications (PSM) or over-the-counter sleep medications (OSM). The most common PSM are non-benzodiazepine hypnotics (NBH), benzodiazepines (BENZO), and tricyclic antidepressants (TCA). PSM have an uncertain efficacy, carry a risk of dependency, and may cause deleterious side effects. OSM (usually diphenhydramine and doxylamine) are believed to be safer, but the user can develop tolerance and often report a “groggy” feeling the next day. The aim of this secondary data analysis is to examine the effect of YOCAS©® Yoga for ISQ in cancer survivors on PSM and OSM usage. We also examined the baseline association between PSM, sleep quality, and side effects.
Methods: We previously conducted a RCT among 410 cancer survivors suffering from moderate to severe ISQ between 2 and 24 months after treatment. The YOCAS©® program consisted of breathing exercises, 16 Gentle Hatha and Restorative yoga postures, and meditation. Participants attended two 75-minute sessions per week for four weeks. At baseline, participants listed all current prescription sleep medications while also completing questionnaires on sleep quality and side effects commonly experienced by cancer survivors. ANCOVA models were used to calculate the difference between groups while controlling for age, gender, race, and baseline values (where appropriate).
Results: Previously published results showed YOCAS©® Yoga significantly improved ISQ compared to the control group. At baseline, 26% and 13% of participants reported using PSM and OSM, respectively. PSM users had significantly worse sleep quality (PSQI score: PSM=10.5 vs. No PSM=8.6; p&lt;0.001) and insomnia scores (ISI score: PSM=14.7 vs. No PSM=13.3; p&lt;0.01) than non-PSM users at baseline. PSM users reported higher levels of fatigue (Multidimensional Fatigue Inventory: PSM=28.9 vs. No PSM=21.2; p&lt;0.01) and memory problems (0-10 scale: PSM=3.7 vs. No-PSM=2.8; p&lt;0.01). Yoga participants significantly reduced the weekly quantity of NBH (NBH: Yoga = -0.85 vs. Control = 0.26; p=0.047) and there was a significant trend for a reduction in the weekly quantity of OSM use in yoga participants compared to the control participants (OSM: Yoga = -1.46 vs. Control = -0.41; p=0.092).
Conclusion: PSM use was associated with ISQ along with side effects such as fatigue and memory problems at baseline. YOCAS©® yoga significantly reduced the use of NBH, which is currently the most used PSM. There was also a trend towards the reduction of OSM use with yoga. Clinicians may consider prescribing alternative therapies for ISQ such as YOCAS©® yoga, which improve ISQ and reduce the dependency on certain sleep medications.
Citation Format: Luke J. Peppone, Michelle Janelsins, Jonathan Friedberg, Mohamed Tejani, Charles Kamen, Marie Flannery, Anita Peoples, James Atkins, Marianne Melnik, Karen Mustian. The effect of YOCAS©® Yoga on prescription sleep medication and over-the-counter sleep medication usage in cancer survivors with impaired sleep quality. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5041. doi:10.1158/1538-7445.AM2014-5041