Multiple Myeloma (MM) is a cancer that originates in the plasma cells, a type of white blood cell housed within the bone marrow. Severe fatigue and sleep disturbance are frequent concerns for patients living with MM. Understanding the distinction between common tiredness and the profound exhaustion associated with MM is the first step toward effective management. This article explores why patients often feel the need to sleep a lot and what steps can be taken to restore vigor.
Fatigue and Excessive Sleepiness in Myeloma
The experience of excessive tiredness is a near-universal symptom for people living with MM, often presenting as cancer-related fatigue (CRF). CRF is far more severe than common tiredness and is characterized by an overwhelming, persistent sense of exhaustion that significantly interferes with daily functioning, regardless of physical activity.
While patients may feel compelled to sleep a lot, the rest obtained is frequently not restorative; the exhaustion does not lift even after a full night’s sleep or multiple naps. This non-restorative nature separates CRF from simple sleepiness. The fatigue can manifest as a lack of energy, difficulty concentrating, and a feeling of heaviness or slowness in movement.
The Underlying Causes of Low Energy
The low energy and fatigue in MM stem from a complex interplay of direct disease effects, complications, and treatment side effects. One primary cause is anemia, which occurs because cancerous plasma cells crowd out healthy blood-producing cells in the bone marrow. A reduced number of red blood cells means less oxygen is transported throughout the body, leading to weakness and weariness.
Myeloma proteins can also impair the kidneys, which filter waste and regulate body fluids. When the kidneys do not work correctly, waste substances accumulate in the bloodstream, contributing to exhaustion. Renal impairment also reduces the production of erythropoietin, a hormone necessary for red blood cell production, further exacerbating anemia.
The disease process itself triggers the release of inflammatory molecules known as cytokines, which disrupt normal energy pathways. These high levels of inflammation are directly linked to cancer-related fatigue (CRF). Furthermore, many treatments used to control MM, such as chemotherapy and other anti-myeloma agents, commonly cause fatigue as a side effect.
Practical Steps for Improving Rest and Vigor
Managing MM-related fatigue requires a multi-pronged approach focused on lifestyle adjustments and open communication with the oncology team. A practical strategy involves energy conservation, meaning pacing activities throughout the day and prioritizing tasks to match fluctuating energy levels. Patients should plan the most demanding activities for times when energy is highest.
Low-impact exercise, such as walking, is a known countermeasure for CRF, despite the initial feeling of exhaustion. Engaging in gentle, consistent physical activity helps build muscle strength, improve mood, and regulate sleep patterns. Any new routine should be approved by a physician.
Proper sleep hygiene is also important, including establishing a consistent bedtime routine and optimizing the sleep environment. Limiting long daytime naps to under an hour and avoiding them late in the afternoon can help ensure better sleep at night. Maintaining adequate hydration and eating a balanced diet provides the necessary fuel to sustain energy.
Patients should communicate the severity of their fatigue to their care team. Medical interventions, such as treating anemia with a blood transfusion or adjusting medication, may be necessary to target the underlying biological causes.