Sleep problems

Many people who have cancer have problems sleeping. You may find it hard to fall asleep, have problems staying asleep or wake too early. Or you may sleep too much. Other problems are sleep apnea, where breathing stops and starts when you're sleeping, and sleep-related movement disorders such as restless legs syndrome. But the most common sleep problem that people with cancer have is insomnia, which is difficulty falling or staying asleep.

Sleep problems need to be taken seriously. Coping with cancer can be harder when you don't sleep well. Poor sleep can make your mood, pain and fatigue worse. It can weaken the immune system and affect healing during treatment. It can also affect your memory and make it hard to think clearly.

Causes

Cancer or its treatments can affect your usual sleep patterns. Being in the hospital, which is often noisy, busy and different from home, can also make it harder to sleep. And your sleep problems may become worse if you are anxious, stressed, depressed or in pain.

Different side effects and symptoms – such as nausea and vomiting, shortness of breath, diarrhea, constipation or flu-like symptoms – can lead to sleep problems or make sleep problems worse. And if you're getting up in the night to urinate (pee) more often or have night sweats or hot flashes at night, you probably aren't getting a restful sleep.

Medicines such as hormone therapy, steroids, sedatives, antidepressants and anticonvulsants can also affect your sleep.

Symptoms

Symptoms of sleep problems can vary but may include:

  • finding it hard to fall asleep
  • waking up feeling tired or not feeling refreshed by sleep
  • feeling very sleepy during the day
  • irregular breathing during sleep
  • moving around more during sleep
  • problems concentrating
  • feeling irritable

Diagnosis

Your healthcare team will try to find the cause of your sleep problems. This usually involves asking you questions about your sleep, such as:

  • How long does it take you to fall asleep?
  • Do you wake up during the night? If so, are you able to fall asleep again?
  • What is the total amount of time you sleep each night?
  • Do you take daytime naps? When and for how long?
  • Do you wake up feeling refreshed or tired?
  • What is your energy level like?
  • Are you taking anything that may affect your sleep, such as medicine, caffeine (such as coffee, tea or soda) or alcohol?
  • Do you have pain, shortness of breath, nausea, vomiting or any other side effects that interfere with your sleep?
  • Do you feel anxious, depressed, confused or worried?
  • Are you taking any medicine to help you sleep?
If you experience severe daytime sleepiness, interrupted breathing at night or disruptive movements, you may be referred to a sleep specialist for an at-home sleep study or a polysomnogram. An at-home sleep study tracks your breathing, heart rate, oxygen levels and body position. A polysomnogram is done in a clinic or hospital and records brain wave changes, eye movements, breathing rate, blood pressure and heart activity during sleep.

Managing sleep problems

Your healthcare team will try to find the cause of your sleep problem (for example, the sleep problem is a side effect of the medicines in your treatment plan), and they will suggest ways to manage that cause. If they can't find an underlying cause, they will focus on the sleep problem itself. Treatment will depend on the type of sleep problem you experience but may include:

Medicine Your healthcare team may prescribe medicine as a short-term solution to help you sleep or relieve symptoms that are interfering with sleep.

Cognitive behavioural therapy – This is a specific treatment for insomniathat is provided by a trained therapist. It can help you recognize the thoughts and behaviours that cause sleep problems, or make them worse, and replace them with habits that help you sleep better. This treatment works as well as prescribed medicines but an advantage is that it does not have side effects.

Sleep equipment – If you have interrupted breathing during sleep, special equipment can help you breathe and get a better quality of sleep.

Things you can do to try to get a better sleep include:

  • Get up at the same time every day, no matter how much you slept the night before. Sleeping in is tempting after a night of poor sleep, but it will only make it harder for you to fall asleep that night.
  • Be physically active at least once a day, preferably in the morning or afternoon rather than in the evening.
  • If you nap during the day, try to limit the length of the nap to 30 minutes and don't nap after 3 p.m.
  • Don't keep your worries and fears to yourself. Talk to someone about them during the day or write them down. This will help you manage them and it will also help keep your mind clear for sleeping at night.
  • Avoid drinking caffeinated drinks 6 to 8 hours before bedtime.
  • Avoid sugar and alcoholic drinks in the late evening.
  • Avoid using a cellphone, tablet or computer or watching TV at least 60 to 90 minutes before bed. The light can influence the sleep hormones that your body makes.
  • Do something pleasant and relaxing in dim light before bed. Have someone give you a back rub or massage your feet. You can also read a book or take a warm bath.
  • Create a bedtime routine and follow these same steps every night when getting ready for bed.
  • Don't take sleep medicine or pain medicine too early. Try taking it just before you fall asleep so that the effect doesn't wear off in the middle of the night.
  • Make your bedroom dark, cool and comfortable. Use a white-noise machine to reduce sound disruption.
  • Go to bed only when you're sleepy. If you can't fall asleep within 20 minutes, get out of bed and do something pleasant and relaxing in dim light. Return to bed when you're sleepy.
  • To build a strong connection between your bed and sleep, don't use your bed for anything other than sleep and sex. Don't spend extra time in bed trying to sleep. This will only make you frustrated and alert and you might start associating your bed with being awake.
  • Try meditation or relaxation exercises, deep breathing or listening to soothing music to help you sleep.

Expert review and references

  • Blaivas AJ . Sleep disorders - overview. PubMed Health. U.S. National Library of Medicine; 2012.
  • Cohen MZ, Bankston S . Cancer-related distress. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 26: pp. 667-684.
  • Doghramji K . Approach to the patient with a sleep or wakefulness disorder. Beers, M. H., & Berkow, R., (Eds.). Merck Manual for Healthcare Professionals. Rahway, NJ: Merck Research Laboratories; 2012.