Sleep Quality in Multiple Myeloma: Characterization and Melatonin's Role

Introduction

Sleep disturbances are a common issue for cancer patients, significantly affecting their quality of life. However, the specific characteristics of sleep problems in individuals with multiple myeloma (MM) have been less thoroughly investigated. This observational study aimed to characterize sleep profiles in MM patients and assess the potential therapeutic effects of exogenous melatonin supplementation.

The Study in Detail

The study, titled "Sleep quality and sleepiness in adults with multiple myeloma. Is melatonin a potential treatment?" was conducted by Fiori M et al. and published in Physiological Reports (2026 Mar;14(5):e70805). The researchers utilized an observational design, comparing 46 multiple myeloma patients with 64 age-matched control individuals. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and daytime sleepiness was measured with the Epworth Sleepiness Scale (ESS).

Key findings include:

• Multiple myeloma patients exhibited significantly worse global sleep quality compared to the control group (global PSQI: U = 1126; p = 0.034).
• A substantial 75% of MM patients reported poor sleep quality or sleep disorders.
• Specific sleep impairments were identified in sleep latency (p = 0.011), sleep duration (p = 0.0013), and the use of sleep medication (p = 0.0056) among MM patients.
• Despite the observed poor sleep quality in MM patients, exogenous melatonin supplementation did not lead to an improvement in global sleep quality.
• Paradoxically, melatonin supplementation was associated with worsened PSQI scores in the control group.
• There was a dissociation between sleep quality and daytime sleepiness, as ESS scores showed no significant differences between groups (p = 0.58) or due to melatonin treatment.

Assessment

This study provides valuable initial insights into the prevalence and nature of sleep disturbances in multiple myeloma patients. Its strength lies in being one of the first systematic characterizations of sleep profiles in this specific patient population, highlighting poor sleep quality as a significant and common issue. The use of validated instruments like the PSQI and ESS contributes to the reliability of the findings regarding sleep quality and sleepiness.

However, the observational nature of the study means it cannot establish causality. The finding that melatonin did not improve global sleep quality in MM patients and even worsened PSQI scores in controls is noteworthy. This suggests that while melatonin might influence specific sleep parameters, its overall efficacy for improving global sleep quality in MM patients, or even in healthy individuals, may be limited or complex. The study also points to a potential disconnect between subjective sleep quality and objective daytime sleepiness, which warrants further investigation.

Practical Relevance

For individuals with multiple myeloma, these findings underscore the importance of addressing sleep disturbances as a component of comprehensive care. Since 75% of patients experienced poor sleep, clinicians should routinely inquire about sleep quality and consider interventions beyond melatonin if global sleep improvement is the goal. The study suggests that a blanket recommendation for melatonin might not be effective for improving overall sleep quality in this population, and in some cases, could even be counterproductive.

Instead, a more personalized and potentially multifaceted approach to managing sleep-wake disturbances, possibly involving standardized chronotherapy or other behavioral and pharmacological strategies, might be necessary. Patients experiencing sleep issues should discuss these with their healthcare providers to explore appropriate and effective management strategies.

Conclusion

This observational study systematically characterizes sleep disturbances in multiple myeloma patients, identifying poor sleep quality as a prevalent issue. While melatonin influenced certain sleep parameters, it did not significantly improve global sleep quality in patients and was associated with worse scores in controls. These findings highlight the need for further research into effective, standardized chronotherapy approaches for managing sleep-wake disturbances in individuals with multiple myeloma.