Sleep Routine During Cancer Treatment

Sleep is the side effect people apologize for raising. It sounds minor next to a tumor. It is not minor, it is extremely common, and it has a real treatment that most people are never offered.

The National Cancer Institute says as many as half of people with cancer have problems sleeping. That is not a personal failing or a sign of weak nerves. It is common, and it is worth taking seriously.

Insomnia during cancer is often more than one thing. NCI lists tumor effects, treatment side effects, symptoms such as pain and nausea, the hospital environment, and the stress that comes with the diagnosis itself.

Before changing your bedtime routine, spend three nights noticing which of these is yours. Someone woken at 2 a.m. by pain needs better pain control, not a darker room. Someone lying awake with a racing mind needs something different again.

Write down what wakes you and what time. That log is more useful at an appointment than any description of feeling tired.

Several drugs used in cancer care can disturb sleep, and NCI names them.

NCI lists hormone therapy, corticosteroids, sedatives, tranquilizers, and antidepressants as medicines that can affect sleep. If your worst nights land on the same days of every cycle, tell your team.

Ask two questions about any of these: does the dose have to be at that hour, and is there an alternative.

Cognitive behavioral therapy for insomnia is a structured program. The National Heart, Lung, and Blood Institute (NHLBI) describes it as a 6- to 8-week treatment plan. It is a non-drug approach. Ask your team whether it is right for you.

NHLBI says CBT-I includes:

• Stimulus control. A regular sleep-wake cycle.
• Sleep restriction. Limiting time in bed at first.
• Cognitive therapy. Reducing anxiety about sleep.
• Relaxation techniques.
• Sleep education.

Ask your oncology team, a psycho-oncology service, or a palliative care team for a referral.

NCI lists sleep habits such as these. Ask your team which fit you.

• Get regular exercise, but not within 3 hours of bedtime.
• Have a high-protein snack about 2 hours before bed, such as milk or turkey.
• Avoid caffeine and alcohol before bed.

You will find conflicting advice here, and it is worth knowing why.

NCI's sleep guidance says to avoid daytime naps. NCI's fatigue guidance says that if you are tired, take short naps of less than one hour, and warns that sleeping too much in the day can make night sleep harder.

Ask your care team which advice fits you. If you do nap, keep it under an hour.

NCI says that when behavior approaches do not work, a doctor may prescribe a sleep medicine for a short time.

NHLBI notes that benzodiazepines can cause dizziness, confusion, and muscle weakness, and are habit-forming. On melatonin, it says research has not proven it is an effective treatment for insomnia, and it can cause daytime sleepiness, headaches, and upset stomach. Do not start or stop a sleep medicine on your own.

• Poor sleep keeps happening, or is getting worse.
• Pain, nausea, hot flashes, or needing to urinate are what wake you.
• You snore loudly, gasp for air, or someone sees you stop breathing in your sleep.
• You feel very weak and tired even after resting or sleeping, or you cannot do your usual activities. NCI names this specifically as something to report.
• You are low, hopeless, or anxious most of the day as well as at night.
• You are taking anything to sleep, including over-the-counter products, that the team does not know about.

• Is one of my medicines likely causing this, and can the timing be moved?
• Can you refer me for CBT-I, and is there an online or telephone option?
• Is my pain or nausea well enough controlled overnight?
• Should I be napping, given how my days are going?
• If we try a sleep medicine, for how long and how will we stop it?
• Could this be sleep apnea rather than insomnia?

Read next: Cancer Anxiety and Uncertainty, Managing Stress During Cancer, Walking Plan After Chemotherapy, and Stretching After Cancer Surgery: What to Ask.

• Call 911 or go to the nearest emergency department if the sleepless nights have brought thoughts of ending your life, or you are struggling to breathe or cannot catch your breath after waking up gasping. You can also reach the 988 Suicide & Crisis Lifeline by call, text or chat at any hour.
• Call your care team the same day if a partner watches your breathing stop while you sleep, or you snore loudly every night. Pauses in breathing and loud snoring need to be checked, so tell your team.
• Call your care team within a day or two if poor sleep keeps happening or is getting worse, if pain or nausea is what wakes you, or if you feel low or hopeless most of the day as well as at night.

• https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq
• https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue
• https://www.nhlbi.nih.gov/health/insomnia/treatment
• https://988lifeline.org/