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Getting the Sleep You Need When Cancer Keeps You Awake

by Philip Gehrman, PhD, and Holly Barilla

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Insomnia can cause excessive fatigue and daytime sleepiness, making it hard to stay alert during the day.

Many people with cancer have trouble sleeping. Pain, illness, medication, cancer treatments, side effects, and the psychological distress of diagnosis can disrupt sleep in people with cancer. And for many cancer survivors, insomnia continues to be a problem even after active treatment is finished.

Sleep-related problems have been reported in 50 percent to 80 percent of cancer survivors, a percentage that is nearly three times higher than in the general population. Even two to five years after treatment, insomnia persists in 20 percent to 40 percent of cancer survivors.

Insomnia is defined as difficulty falling asleep or staying asleep, such that it negatively affects aspects of daily life. Some ways in which insomnia can affect an individual include excessive fatigue and daytime sleepiness, difficulty with concentration and motivation, irritability, and low energy. This can take a significant toll on quality of life for many people.

It may seem surprising that cancer survivors often continue to have insomnia even years after they complete treatment. However, what seems to happen is insomnia takes on a life of its own over time, becoming somewhat of a “habit” that your body gets stuck in. Like most bad habits, it tends to stick around for a long time if not addressed. Fortunately, many options are available to help cancer survivors get a better night of sleep.

The most common treatment for insomnia is sleeping medications. Several have been shown to produce at least some improvement in sleep. The advantage of medications is that they lead to fast improvements in sleep. Some disadvantages are that they can produce unwanted side effects, and for some people, they are less effective over time. Perhaps the biggest disadvantage of sleep medications is that instead of breaking the habit of insomnia, they simply cover it up. Therefore, when you stop taking medication, the insomnia returns.

It may seem surprising that cancer survivors often continue to have insomnia even years after they complete treatment.

An alternative to medication is cognitive behavioral therapy for insomnia, which is specifically designed to break the habit of insomnia. Cognitive behavioral therapy for insomnia consists of a series of coping strategies that are taught in four to eight treatment sessions. For example, stimulus control is a strategy that reinforces the relationship between sleep and the bed. For many people with insomnia, their bodies have learned that the bed is a place for tossing and turning with an active mind rather than a place for sleep, so some re-learning is needed.

Another strategy is known as sleep hygiene, which focuses on the relationships between daytime behaviors and our ability to sleep at night. Here are some basic sleep hygiene tips that can help you get more restful sleep:

  • Sleep only when you are tired.
  • Go to bed at the same time every evening and wake up at the same time every morning.
  • Increase exercise and light exposure during the day by taking a walk outside.
  • If you are unable to sleep after about 20 minutes, get out of bed and only get back into bed when you are tired.
  • Try to avoid caffeine, alcohol, and tobacco after lunch.
  • Avoid excessive napping. Limit naps to no longer than 30 minutes.

People with insomnia often say that they would be able to fall asleep at night if only they could “shut my mind off.” Indeed, having an active mind at night makes it difficult to get a good night’s sleep. One strategy to reduce mental activity at bedtime is to set aside a “thinking time” earlier in the night when you write down all of the things that are on your mind. By writing them down, there is less pressure to think about them when you are lying in bed trying to sleep.

Insomnia is a common difficulty for cancer survivors that can seriously affect their ability to function at their best during the day. When insomnia becomes chronic, it tends to stick around for many years if left untreated. However, there is no reason to suffer with insomnia. With sleep medications and cognitive behavioral therapy, insomnia can be effectively treated, helping cancer survivors feel more alert and energized.

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Dr. Philip Gehrman is clinical director of the Behavioral Sleep Medicine Program and an assistant professor of Psychology in the department of Psychiatry of the University of Pennsylvania School of Medicine in Philadelphia, PA. Holly Barilla is a clinical research coordinator in the department of Psychiatry of the University of Pennsylvania School of Medicine. She currently runs multiple studies within the Behavioral Sleep Medicine Program involving people who have insomnia alone or insomnia and a history of depression or cancer.

This article was published in Coping® with Cancer magazine, July/August 2011.