What bedtime habits can help me sleep during cancer treatment?
The National Cancer Institute lists five, and they are more specific than "get a good night's sleep."
- Go to bed only when sleepy, in a quiet, dark room and a comfortable bed.
- If sleep does not come, get out of bed, and return when sleepy.
- Stop television and other electronic devices a couple of hours before bed.
- Do not eat or drink a lot before bedtime.
- Keep active during the day with regular exercise, but not in the few hours before bed, which can make sleep harder.
This is common company. NCI says studies show as many as half of all people have sleep-related problems during cancer treatment, and its health professional summary puts the figure at one-third to one-half.
The first two rules are the strongest
They look like the softest items on the list. They are the most evidence-backed, and they have a name.
NCI's health professional summary describes them as behavioral strategies: stimulus control and sleep restriction. Both seek to limit the time spent in bed that does not involve sleeping.
The logic is about association. Hours spent lying awake in bed, frustrated and watching the clock, teach the brain that bed is a place for alertness. Getting up when sleep does not come, and going back only when sleepy, breaks that link. It feels wrong, because leaving a warm bed at 2 a.m. seems like the opposite of resting.
What is actually keeping you awake
NCI's patient page names the causes: treatment side effects, medicines, long hospital stays, stress, and other factors.
The health professional summary is more specific, and several items on its list are fixable. Pain. Symptoms from surgery, including frequent monitoring and opioid use. Corticosteroids given with chemotherapy. Caffeine and nicotine. Some antidepressants. Dietary supplements including some vitamins and diet pills. Environmental factors. Depression, anxiety, and delirium.
Habits alone will not touch a steroid dose or uncontrolled pain. Both may be adjustable.
The same summary lists a full sleep hygiene assessment: time in bed, daytime napping, intake of caffeine, alcohol, or heavy, spicy or sugary food, exercise, and the sleep environment. Its behavioral suggestions include a fixed bedtime, restricting smoking, diet, and excessive alcohol 4 to 6 hours before bed, and more exercise.
In hospital the environment is the problem. NCI notes that minimizing noise, dimming lights, adjusting room temperature, and grouping care tasks to reduce interruptions can increase uninterrupted sleep. Those are reasonable things to ask a ward nurse for.
What comes after habits
The next step is not a sleeping pill. It is cognitive behavioral therapy for insomnia, shortened to CBT-I.
NCI says several large randomized trials and meta-analyses provide the evidence base for it, though most of those trials were in people without cancer. Its components are cognitive restructuring, behavioral strategies, relaxation training, and basic sleep hygiene education. A CBT therapist helps change negative thoughts and beliefs about sleep into positive ones.
Sleep medicine still has a place. NCI says a doctor may prescribe it for a short period if other strategies do not work, and that the choice depends on the specific problem, such as trouble falling asleep versus trouble staying asleep, and on other medicines being taken.
Age changes the dose. NCI's summary says hypnotic prescriptions for older patients must be adjusted, with dosages reduced by 30% to 50%.
What to bring to the appointment
Keep a plain sleep log for two weeks: time into bed, roughly how long until sleep, what caused waking, and time of getting up. Patterns show on paper that memory blurs.
"I am not sleeping well" is easy to set aside in a busy visit. "I am awake from 2 to 4 most nights, and it is the bone pain" gets a plan. NCI's own suggested questions include whether a sleep therapist could help. Our guide to sleep routine during cancer treatment covers building one, and fatigue covers the daytime side of it.
NCI's sleep problems page was reviewed on August 12, 2021.
Sources
Want the full picture? Read our complete explanation: Sleep Problems in People With Cancer
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