Sleep Apnea and Breast Cancer: Is There A Connection?

There’s been a lot of press coverage recently about the new mammography screening recommendations for breast cancer. The United States Preventive Service Task Force recently recommended that women begin routine mammography screening at age 50, rather than 40. This is an important issue for me as my aunt died from metastatic breast cancer in her early 40s. 


One thing that I see over and over again is how obstructive sleep apnea can affect every aspect of your health, from your mood, to diabetes, to heart disease. You may think that cancer and sleep apnea are totally separate conditions, but with the human body, everything is ultimately connected in one way or another. This lead me ask the question: Do sleep apnea and cancer have a common origin?


In my practice, anytime I see a patient with a history of breast cancer, I almost consistently see the following: cold hands or feet, unrefreshing sleep, an inability to sleep on their backs, and a severely snoring parent, typically with cardiovascular disease. What’s remarkable is that when I examine their airways with a fiberoptic camera, the space behind the tongue is usually very narrow, especially when they lie flat on their backs. This anatomy leads to repeated obstructions and arousals, especially when sleeping on their backs and in deep sleep, when muscles relax the most. For this reason, these women prefer not to sleep on their backs.


In my book, Sleep, Interrupted, I describe a process where due to poor breathing and inefficient sleep, a physiologic stress state is created, which leads to lack of proper blood flow to certain parts of the body that are considered unimportant when you’re in a fight or running from a tiger. These areas include the digestive system, reproductive organs, your hands and feet, and your skin, amongst others. 


During periods of stress (whether internal/physiologic or external/emotional), there can be severe blood flow restriction to any of these body areas. As an example of how dramatic this can be, there’s a description of a man who was severely injured during battle, and most of his abdominal wall was missing, with his bowels clearly visible. While he was recovering in bed, his doctors noticed that whenever he was angry or in pain, his bowels were dark and dusky, whereas when he was happy, his bowels looked pink and healthy. Similarly, there can be dramatic fluctuations in blood flow to the breasts depending on the woman’s mood and stress-inducing states.


One common finding in both cancer and sleep apnea research fields is that hypoxia (lack or oxygen) in tissues can lead to production of signals that tell the body to bring in more blood and nutrients. As a result, a number of inflammatory mediators are released, including the well-known vascular endothelial growth factor (VEGF). VEGF promotes local growth of blood vessels in oxygen-poor areas. Imagine if this process happened all the time, with slow but gradual growth of local tissues, with activation of genes and proteins that promote more inflammation and more cell reproduction. 


We know that chronic overstimulation of any tissue can lead to cell replication that can go out of control. Chronic overstimulation of breast tissue can initially lead to localized benign growths or cysts, and some of these can end up transforming into malignancies. Perhaps some women with certain genes may be more susceptible to this transformation. This same process can also be described for prostate cancer.


Most younger breast cancer survivors probably won’t have obstructive sleep apnea if tested. But what they most likely will have is upper airway resistance syndrome, which results in multiple microscopic obstructions and arousals that prevents deep, efficient sleep. This can cause the nervous system to become hypersensitive, with increased physiologic states of stress. As they gain weight later on in life, many will progress into formal sleep apnea. 


Studies show that breast cancer survival is poorer in obese patients. Similar findings are also found with prostate cancer. This is possibly explained by the fact that the more obese you are, the more likely you’ll have obstructive sleep apnea. Having obstructive sleep apnea significantly increases your risk of dying in general.


Granted, what I’m describing here is a very different perspective in explaining breast cancer, and is sure to be controversial in some people’s minds. However, rather than trying to explain breast cancer from a molecular, genetic, or organ level, wouldn’t you agree that it’s much more satisfying when you can explain this illness from a whole-person perspective? As much as Western medicine tries to deny it by fragmenting care to different specialties, we know intuitively that whether it’s the breast, the heart, the mind or the prostate gland, everything is ultimately connected.


What’s your opinion on this important issue? Please enter your comments in the box below.


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11 thoughts on “Sleep Apnea and Breast Cancer: Is There A Connection?

  1. This topic is very interesting to me. Are you familiar with thermography to detect physiological changes in breast tissue, particularly increased vascularization? Angiogenesis is an exciting area of cancer research, as cancer cells need a good blood supply in order to grow.

    Thermography is painless, non-invasive, and has no radiation exposure. One sits in in a temperature regulated room for a few minutes in front of a small fan that blows a cool breeze on the skin before taking the image. However, it is important to find thermography facilities that use high resolution cameras, trained technicians, and most important, have an experienced and certified reader of the images. Not all thermography services are adequate for breast cancer screening, however, they may be adequate for investigation of occult pain and inflammation from injuries and other illnesses.

    Thermography images heat patterns, which can detect areas of abnormal breast inflammation (breast cancer is a disease of inflammation). High resolution thermography in black and white can also show the vascularization of the breasts. Periodic thermography exams can detect physiological changes over time, long before mammography can detect anatomical changes like lumps.

    To me, the question isn’t about choosing thermography instead of mammography, but how best to use these two tools which detect different changes at different stages. Obviously the earlier one can detect troublesome changes in breast tissue and correct the conditions that promote development of cancer, the better, especially if it doesn’t require radiation or cause pain from heavy compression (which can actually damage and spread delicate breast cancer cells).

    Therein lies the rub, what does one do with information the suggests abnormal breast tissue activity? The changes may indicate precancerous conditions (which *might* become cancer tumors in several years) or they may not ever become cancer.

    Currently, conventional medicine doesn’t know what to do with abnormal breast changes detected very early by thermography; we don’t really have an effective protocol for maintaining healthy breast tissue or reversing conditions that promote cancer (except for the ineffective ACS diet and lifestyle recommendations that actually can induce or increase inflammation). We must wait until a mammogram can detect a small lump to start treatment (which is often invasive, upsetting, costly, and toxic).

  2. Hi, as a medical secretary, with what I think must have been long-time OSA (though not overwt. at all til after 50) who also had very dense and cystic breasts when I was younger (now 65), I am a bit concerned about your thoughts, as while you might well be on an interesting track, I SO wish all the studies I see re OSA pts would specify their findings in terms of people with “treated” OSA and those not on Cpap.

    It’s disturbing to not have the designation made because all those (women, in this case) pts are going to worry unnecessarily if they’re on Cpap and their physiology changes as a result of it, whereas if your study took into account the difference they might be able to at least not be frightened, though of course should still be checked routinely for cancer as anyone else should.

  3. The question I got is the use of oxygen and a 5%  carbon dioxide mix that I just read about, (whether it was true or not, not sure), as a therapy for sleep apnea, possibly promoting the conditions for cancer to form.  From my understanding there was a guy who won a noble peace prize showing that cancer can be formed thru oxygen deficiency….?

  4. This seems to tie in with the idea that cancer is more prevalent among those who are awake at night or out of phase in sleep.

    I think that an underused therapy for sleep troubles are breathe-right (or other brand) nasal strips that open up the nose – I can sleep on my back using them, but not without using them. Since I’ve discovered them, I am much more well-rested and energetic. I think that the least invasive, common-sense techniques might be helpful to people.

  5. Many people with sleep-breathing problems have nasal congestion, and having flimsy nostrils is also very common. Breathing better through your nose is an absolute must for optimal health. However, the nose is not usually the only area of potential narrowing—you’ll also see narrowing behind the soft palate and especially behind the tongue. This is why when you perform nasal surgery to help you to breathe better, it only “cures” obstructive sleep apnea in about 10% of patients. People will various degrees of success, so it’s worth giving it a try. Sometimes, nasal dilator strips are not strong enough. There are other options including Nozovent, Brez, Sinus Cones, and Breathewitheez.

  6. While I believe that sleep apnea can cause diabetes, heart disease and stroke I do not believe it is connected to breast cancer. Quite a few have died in their sleep in my family from sleep apnea but no one has ever had breast cancer. I believe everything has a genetic connection. I think breast cancer has become very political and is way overdone like AIDS was a few years ago. I am very tired of it. It has a too big vocal lobby and that is it. I wish that chemical sensitivity could be recognized in this way but its all just political and not enough money is involved.

  7. i just been told that i have sleep apnea so you tell me i may have cancer i just had open heart surgery in 2008 and i am over weight and whatis osa can you please explain this to me i have pain in my knees all time now is this because of my weight i am afriad of hearing about different things but i know my health is good to find out.

  8. I haven’t read other comments but I would like to say that maybe I agree with your theory. I had BC in July 2010. Before I was diagnosed, for like 2 years, I was so miserable, running to doctors telling them that I felt paralyzed. They checked my motor skills, mascular functions etc. and found nothing. Finally, I was checked by a neurologist who couldn’t find anything either, so she sent me for sleep apnea analysis. Sure enough I was given a CPAP. It made a lot of difference. At the same time I was using an over the counter, herbal hormone replacement therapy, so thought that the improvement was due to that. I did not use the CPAP much but contined to use the HRT. However, not much time passed when I was digosed with BC. During treatment I did not use the CPAP since I used a sleeping pill for anxiety and sleep. Now after everything is over, I am begining to feel that paralysis feeling again. I researched today and found your article. I am so worried now, that I have not used the CPAP since my treatment a year ago. I will start using it from tonight. I honestly feel that your theory is correct. I have thought about this often. While the doctor told me that I have a mild sleep apnea, I think it made the difference in my body, lack of oxygen caused the cancer in the breast. Thanks.

  9. This is a fascinating idea which explains many of my health problems. I am 58 and have survived Stage III breast cancer twice, when I was 31 and 39 years old. Later in life, about 8 yrs. ago, I was diagnosed with OSA. I have severe allergies and collapsed valves in my nose. I have also been diagnosed with fibromyalgia about 3 years ago, having become continually exhausted and experiencing severe muscle pain (as though I had been running and had reached the limits of my exertion) . Recently, I have often felt shortness of breath and as though I wasn’t getting enough air. Nothing was found to be wrong with my heart or lungs. I have problems with mobility (also with falling) and pain; also cold hands and feet that turn almost purple. When first diagnosed with fibromyalgia, I read an anecdotal account that the OTC drug Mucinex helped fibromyalgia patients. It did seem to help me, but I was told that there was no evidence to support its value in these cases. So I have taken it only halfheartedly since then. I have recently had an esophageal ulcer which healed only through allergy treatments, as well as nodules on my vocal cords. I have had inflammatory digestive problems throughout my life. Your thoughts have connected these ailments for me…I believe I need to focus on eliminating any obstacles to oxygenating my blood and various organ systems. (My father also snored and had severe allergies.) Thank you for thinking outside the box.

  10. This article has increased my anxiety. I did have severe sleep apnea – diagnosed about 7 years ago. I slept with a Cpap machine for about 5 years, till it became more intrusive than sleeping without it. Although nervous about stopping, I slept fine, having lost about 35lbs. at the time. I was, however, just diagnosed with breast cancer 5 days ago, and am in the process of finding out what treatment I need. I will mention this to the surgeon and see if there’s any connection. I am still overweight. I lost 25 more lbs. last year, but they returned. I’m hoping for the best outcome of all this, but your explanation makes sense, as no one in my family has ever had breast cancer. I just pray that the healing process works.

  11. I have sleep apnea, and, sometimes, I wake up with breast pain and inflammation. I had a hysterectomy/oophorectomy seven years ago, so it’s not due to monthly hormonal changes. It reminds me of how I used to feel before I started my periods. Sleep apnea definitely affects hormones, and that’s how I believe that it can cause breast cancer.