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by hopeful February 18, 2019

Sleep Problems During Cancer Treatment: How to Beat Insomnia

It seems like the cruelest joke to be exhausted and unable to sleep. But sleep problems are extremely common for people during cancer treatment. Insomnia (difficulty falling or staying asleep) can be caused by a number of factors, from a tumor’s location to medication side effects to anxiety and depression.
 
“A lot of people think feeling fatigued is just a normal part of cancer treatment and don’t seek help,” said Kathleen Kelly, B.S.N., B.S., cancer information resource nurse in the Department of Supportive Care Medicine at City of Hope. “But you shouldn’t ignore sleep problems. Getting deep, restful, uninterrupted sleep helps your body rebuild itself — something you need more than ever when you have cancer.”
 

How cancer affects sleep

Cancer can affect your ability to get good sleep in a variety of ways:
 
The cancer itself
Symptoms of cancer, such as pain, can make it difficult to sleep, and tumors can affect your ability to breathe comfortably. A tumor in the respiratory area can cause shortness of breath, and head and neck cancers can lead to obstructive sleep apnea (when you periodically stop breathing because airflow is blocked).
 
Side effects
Fatigue is a common side effect of cancer treatments including chemotherapy, radiation therapy, immunotherapy and surgery. But daytime naps can disrupt your evening sleep. Some medications can also disrupt your normal sleep-wake cycle.
 
Additionally, some side effects of treatment may make it hard to get comfortable enough to fall or stay asleep, such as:
  • Nausea and vomiting
  • Diarrhea
  • Night sweats
  • Pain
 
Emotional turmoil
A cancer diagnosis can be incredibly stressful. Dwelling on worries and fears at night can keep you from being able to wind down enough to doze off. Some people with cancer also have anxiety and depression, which can cause insomnia as well.
 
Impact of insomnia
Chronic insomnia negatively impacts your mood, exacerbates pain and makes you feel tired all the time. Some studies also suggest that it can affect your immune function.
 
Insomnia makes it difficult for you to think clearly, said Alla Sverdlik, M.D., M.P.H., a psychiatrist in the Department of Supportive Care Medicine at City of Hope. “This is a time when you have to make a lot of important decisions. Impaired sleep certainly affects your decision-making capabilities and your ability to absorb information. It can also impact how well you stick to your care plan — you might not feel up to making appointments and getting treatment if you’re exhausted.”
 
Get better sleep
A healthy amount of sleep is seven to nine hours a night for adults. You may need more than that during cancer treatment though, as your body works to heal. Try these proven strategies for getting better rest:
 
Consult with your doctor
Your doctor can help you troubleshoot sleeping problems by treating symptoms or side effects, or discovering and treating an underlying condition unrelated to cancer (like restless legs syndrome or a thyroid condition). Additionally, your doctor can determine if a certain medication is causing sleep disruption or if you need the support of a mental health professional to address anxiety or depression.
 
Develop a sleep routine
Create a nighttime ritual that replaces stimulating activities such as watching TV or being on the computer. Choose soothing options like reading, meditating or taking a bath one or two hours before bedtime.
 
“Your mind and body will start to recognize your routine as a trigger for ‘it’s time to rest’ and respond once it’s a habit,” said Sverdlik. For more ideas on how to relax and form healthy sleep habits, see these tips for what to do when you’re not getting enough sleep.
 
Limit napping
It’s best to avoid napping altogether because it can disrupt your sleep-wake cycle, making it difficult to fall asleep in the evening, said Sverdlik. But if you must, limit it to one nap that’s 30 minutes or less. 
 
 Exercise every day
“A significant therapy for treating fatigue is exercise,” said Kelly. “Although it feels like the last thing you want to do when you’re tired, it actually peps you up and helps you sleep better at night.”
 
As you go through treatment, you might find there are days and times you tend to have more energy, said Kelly. Make note of the pattern and exercise at those peak-energy times. Try walking at least once a day with a caregiver, family member or hospital nurse (as long as you don’t have balance problems or anything else that would make it unsafe). Or, ask your doctor about a seeing a physical therapist who can develop a safe exercise program for you.
 
Get a dose of sunlight
Light is what tells your brain when it’s time to sleep and when it’s time to wake up. To get your sleep-wake cycle back on track, sleep in a darkened room and expose yourself to bright sunlight first thing in the morning. You can stand by a window or go outside.
 
Talk about your feelings
A lot can be weighing on your heart and mind during cancer treatment. Instead of bottling up those feelings and thinking about your concerns all night, it’s important to talk to a supportive person about them. You can start with a friend or family member, but it might be easier to open up to a chaplain, social worker, psychologist or psychiatrist.
 
Besides the physical and mental benefits of better rest, Kelly said getting a good night’s sleep also makes you happier. “Treating fatigue helps you better connect with and enjoy your life and the people in it.”
 
Learn more about how City of Hope provides emotional, social and spiritual support for patients during cancer treatment. 
 

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