Hi grgskye,  I am very sorry to hear about your stage 4 diagnosis.  It is no wonder you have little energy, radiotherapy can be very debilitating and tiring.  You need to rest and try and recover.  If you have cancer in your spine this can cause pain in arms and legs and shoulders etc.  Different vertebrae control different parts of your body so these pains could be from your bone mets.  The hot flushes are horrible and caused by the letrozole.  I have stage 4 breast cancer with bone mets in pelvis, hips, spine, ribs and skull.  I had breast cancer 12 years ago with lumpectomy, chemo, radio and then tamoxifen.  Have you told your oncologist about pain in your shoulder, neck and arms.  I had pain in my arms when I lifted them and had radio on the biggest tumor on spine.  This helped me a lot with pain.  I am on Ribociclib, Exemastane and denosumab injections and Adcal.  I was diagnosed with secondary cancer in September 2024 and in the beginning I found it difficult to sleep.  I got zopiclone from the doctor and took half a tablet when I needed to.  It cannot be used long term though.  I also have shoulder pain and have bought an orthopedic mattress and an ergonomic side sleeping pillow.  I don't know what to say about the hot flushes but mine seem to be getting less.  I do have a silk pillowcase which is very cooling to sleep on.  I am here most days if you want to chat.  Big hugs.

Lee x