Sex differences in location of initial diagnosis and discharge destination among medicare fee-for-service beneficiaries with post-stroke aphasia.

Breast cancer remains the most frequently diagnosed malignancy in women worldwide, and continued improvements in survival have increased the importance of symptom control, functional recovery, and quality of life during the perioperative and survivorship phases. Among the symptoms that affect postoperative recovery, sleep disturbance is common yet often underrecognized after breast cancer surgery. In this setting, poor sleep is associated with pain, fatigue, anxiety, depressive symptoms, impaired daytime functioning, and delayed recovery, and it may contribute to a broader symptom cluster that further compromises wellbeing during early survivorship (). Postoperative sleep disturbance (PSD) after breast cancer surgery is clinically heterogeneous. In some patients, insomnia is characterized predominantly by nocturnal hyperarousal and difficulty initiating sleep, whereas in others, sleep disruption appears to be more closely linked to postoperative pain, circadian misalignment, medication effects, emotional distress, or mixed symptom presentations (; ). This heterogeneity has important implications for treatment selection, because optimal management depends not only on the presence of sleep symptoms, but also on the underlying clinical phenotype and the broader perioperative context in which sleep disruption occurs. Pharmacologic treatment remains a common clinical strategy for acute or clinically significant postoperative insomnia, particularly when symptoms are functionally impairing or closely intertwined with pain and distress. However, pharmacologic management in women with breast cancer requires particular caution. The potential benefits of hypnotics, melatonergic agents, gabapentinoids, and related agents must be weighed against cumulative sedative burden, respiratory risk with concurrent opioid use, cognitive adverse effects, and breast cancer-specific considerations such as endocrine therapy context and clinically relevant drug-drug interactions. At the same time, behavioral and circadian-oriented interventions may enhance durability of benefit and support de-escalation of sedative medications when appropriate.