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Improve Sleep Energy Post Myeloma Chemotherapy
Would you like to improve sleep energy post myeloma chemotherapy? MM patients who have undergone dexamethasone as well as other chemotherapy treatments know that dex screws up their sleep and their energy. While some MM patients used the energy bestowed on them by dexamethasone, no one wants to feel the kind of fatigue that a good night’s sleep doesn’t improve.
The video below gives a good, basic explanation of the body’s circadian rhythm.
Everything You Need To Know About The Circadian Rhythm
The solution? If chemotherapy and dexamethasone change your circadian rhythm, then you can readjust your body clock.
Below is an evidence-informed and patient-friendly framework integrating chronobiology, symptom management, and recovery support.
🌗 GOALS AFTER MYELOMA CHEMOTHERAPY
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Re-establish stable sleep–wake and hormone cycles (melatonin, cortisol).
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Reduce steroid-induced insomnia, anxiety, and appetite disruption.
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Improve fatigue, cognition, and immune repair during remission or maintenance.
🕰️ 1. Manage Dexamethasone Timing and Effects
Problem: Dexamethasone strongly suppresses nighttime melatonin and elevates cortisol — causing alertness and sleep loss.
Solutions
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Take dexamethasone early (before 9 a.m.) to minimize nighttime stimulation.
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Avoid caffeine or green tea on Dex days.
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Plan physical activity late morning to use the steroid energy “boost.”
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Use calming rituals (music, warm bath, gentle yoga, magnesium tea) at night after Dex days.
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Optional: Low-dose melatonin (0.3–1 mg) or magnesium glycinate 200–400 mg at bedtime on Dex days may help shorten sleep latency.
☀️ 2. Morning Anchoring (Light + Activity)
Why: Myeloma patients often have delayed circadian phase and flattened cortisol rhythm.
Actions
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Within 30 min of waking:
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Get 15–30 min bright natural light or use a 10,000-lux light box.
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Eat breakfast with protein (e.g., eggs, Greek yogurt, nuts).
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Do light movement (walk, stretching, tai chi).
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These cues synchronize central (brain) and peripheral (immune, bone marrow) clocks.
🌿 3. Chrononutrition & Metabolic Rhythm
Why: Chemotherapy and steroids disturb glucose and insulin cycles.
Guidelines
| Time | Nutrition Focus | Purpose |
|---|---|---|
| Morning | Protein + complex carbs (oats, eggs, berries) | Cortisol alignment, energy |
| Midday | Balanced meal with fiber, antioxidants (leafy greens, lentils, olive oil) | Gut & immune rhythm |
| Evening | Lighter meal; include tryptophan-rich foods (turkey, oats, banana) | Boost serotonin–melatonin pathway |
| Avoid | Large late-night meals, alcohol | Prevent delayed melatonin rise |
🌙 4. Evening Wind-Down Routine
Goal: Encourage melatonin secretion and body cooling.
1–2 h before bed:
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Dim lights and reduce screen exposure (use red-orange lighting or blue-blocking glasses).
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Meditation / slow breathing / guided imagery — helps normalize heart-rate variability disrupted by chemo stress.
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Bedroom environment:
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Temperature 65–68 °F
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Dark, quiet (eye mask if needed)
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Mild lavender or chamomile scent
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🧘 5. Mind–Body Synchronizers
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Gentle exercise (yoga, qigong, walking) in the morning or early afternoon.
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Shown in trials to improve fatigue and circadian amplitude in hematologic cancers.
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Cognitive-behavioral therapy for insomnia (CBT-I) — gold-standard for post-chemo sleep recovery.
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Mindfulness or gratitude journaling at night reduces cognitive hyperarousal from steroids and treatment anxiety.
💊 6. Optional Supportive Nutraceuticals
| Supplement | Typical Timing | Evidence/Note |
|---|---|---|
| Melatonin 0.3–1 mg | 1 h before bed | Improves sleep quality, antioxidant effect in myeloma cells (preclinical) |
| Magnesium glycinate or threonate | Evening | Muscle relaxation, improved deep sleep |
| L-theanine (100–200 mg) | Early evening | Reduces Dex-related anxiety |
| Ashwagandha extract (300 mg) | Morning | May help normalize cortisol rhythm; use only with oncologist approval |
🔬 7. Chronotherapy Principles for Future Cycles
If further treatment cycles occur:
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Ask your oncologist about chronomodulated infusion timing (day vs night administration).
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Avoid nighttime steroids or other circadian-disrupting meds if possible.
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Track sleep with a wearable or app; patterns can reveal when additional light therapy or schedule adjustments are needed.
🧭 Example “Post-Dex Day” Schedule
| Time | Routine | Purpose |
|---|---|---|
| 7 a.m. | Wake, take dexamethasone, get sunlight, protein breakfast | Anchor circadian clock |
| 10 a.m. | Light exercise / chores | Use steroid-induced energy |
| 1 p.m. | Balanced lunch | Maintain metabolic rhythm |
| 4 p.m. | Hydrate, short rest (20 min nap max) | Prevent fatigue crash |
| 6:30 p.m. | Light dinner, limit screens | Begin wind-down |
| 8:30 p.m. | Warm shower, dim lights, calm breathing | Lower cortisol |
| 9:30 p.m. | Optional melatonin + magnesium | Trigger sleep onset |
| 10 p.m. | Bedtime | Maintain regular rhythm |
I am a long-term MM survivor. Living with and studying myeloma since my diagnosis in 1994 has taught me that MM patients and survivors need both conventional and evidence-based non-conventional therapies to manage their MM. While conventional oncology is central to our blood cancer, it is only a piece of the puzzle.
If you’d like to learn more about MM, email me at David.PeopleBeatingCancer@gmail.com.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Effect of regular and irregular stimulation cycles of dexamethasone on circadian clock in NIH3T3 cells
ABSTRACT
Animal studies have shown that irregular light-dark cycles cause circadian desynchronization, while few studies have addressed the effect of regular/irregular stimulation cycles of signaling hormones on the cellular clock in vitro.
Here, we examined how cellular clocks respond to regular and irregular stimulation cycles of dexamethasone, using NIH3T3 cells transfected with the Bmal1 promoter-driven luciferase (Bmal1-Luc) reporter gene. Cyclic stimulation with dexamethasone at different time intervals (18–28 h, 3 times regularly) revealed that Bmal1-Luc bioluminescence rhythms can be entrained to 22 and 24 h cycles during the stimulation period, but not to other cycles.
The rhythm entrained for 24 h cycles persisted for at least one day after the last stimulation. Irregular dexamethasone treatment (16, 24, and 16 h, sequentially; short-term jet lag protocol) resulted in an overall upregulation and phase shifts of the temporal expression of several clock genes and cell cycle genes, including c-Myc and p53.
Regular dexamethasone stimulation three times with 24 h cycles also caused upregulation of Per1 and Per2 expression, but not c-Myc and p53 expression.
In conclusion, our study identified the entrainable range of the circadian clock in NIH3T3 cells to the dexamethasone stimulation cycle and demonstrated that irregular dexamethasone treatment could disturb the expression of cell cycle genes.”
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