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When Night Falls

Addressing Sleep Disorders in People with Cancer

by Ann M. Berger, PhD, RN, AOCN®, FAAN

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Do you have trouble falling asleep or staying asleep?
Do you wake up early in the morning and can’t get back to sleep? Do you have these problems three or more nights each week? If your answer is yes, you may be among the one-third to one-half of all adult cancer survivors who have problems sleeping.

Some people who begin cancer treatment have a history of poor sleep, others develop poor sleep during treatment, and many develop problems sleeping after completing treatment. Insomnia is the most commonly diagnosed sleep disorder, but there are several other reasons why people have trouble sleeping. Other frequently diagnosed disorders include obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder.

Other symptoms of impaired sleep include waking up feeling unrefreshed (or like your sleep didn’t restore your energy) and feeling sleepy and fatigued during the day. Your doctor may refer you to a sleep center if he or she suspects you have a disorder.

You need to know that adequate and restful sleep can improve your daytime function and that YOU can help your body get the sleep needed to function at its best. Good sleep is described as falling asleep within 20 to 30 minutes after turning out the light and sleeping seven to nine hours per night with fewer than six awakenings and less than 30 minutes, or 10 percent, of your total time in bed spent awake.

Cancer, its treatment, and related side effects have been linked to higher rates of sleep disorders.

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Dr. Ann Berger

Many factors lead to poor sleep in the general population. Sleep deprivation occurs when a person doesn’t get the amount of sleep his or her body needs because of delayed bedtime, early wake time, or poor sleep habits. Sleep deprivation is often due to life demands (such as caregiving), multiple roles and responsibilities, jet lag, and shift work. Sleep disruption occurs when a person’s sleep is frequently interrupted by factors such as obstructive sleep apnea, restless leg syndrome, periodic limb movement disorder, gastroesophageal reflux disease, hot flashes, and various illnesses. Another important factor that may lead to sleep disruption is a poor sleeping environment (such as one that is bright, noisy, warm, or has pets), making it harder to get good, uninterrupted sleep.

Cancer, its treatment, and related side effects have been linked to higher rates of sleep disorders. In addition, chronic sleep problems can lead to depression, and depression is often accompanied by problems sleeping.

What should you do if you suspect you have either sleep deprivation or sleep disruption?
You need to discuss this with your healthcare provider. If you experience sleep deprivation, you can learn to use basic behavioral techniques that can help you get good sleep. If you experience sleep disruption that persists for more than a month, the next step is to determine your specific diagnosis. Based on your diagnosis, your doctor may prescribe medical treatment. Combining medical treatment with behavioral techniques is the best way to improve sleep and to have more energy if you are diagnosed with a sleep disorder.

You can employ several behavioral techniques to help improve your sleep. Begin by using your bed only for sleep and sexual activity. Empty your bladder and bowels before going to bed. Lie down to sleep when you are sleepy, at approximately the same time every night. Set a comfortable bedroom environment for sleep by turning down the lights and keeping it cool (70° F), quiet, and pet-free. If you can’t fall asleep within 20 to 30 minutes, get out of bed and go to another room to sit, read (use a book light), or listen to relaxing music. Return to bed when you feel sleepy. If you still can’t fall asleep, repeat this step as many times as needed. These behaviors assist you in associating your bed as a place to relax and fall asleep, not to toss and turn.

Plan to get up every morning (even on weekends) within 15 minutes of your regular wake time. Seek out 30 minutes of bright light in the morning. Limit your naps to 30 minutes, and complete naps at least four hours before bedtime. Find time to exercise for 30 minutes during the day. In the evening, you will benefit from a relaxing therapy; avoiding stimulants, alcohol, and nicotine; drinking fluids; eating your last meal of the day three hours before bedtime; and using a fan to create white noise.

You can improve your sleep. The benefits will include having more energy and enjoyment of life.

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Dr. Ann Berger has a PhD in Nursing and is director of the PhD program in Nursing at the University of Nebraska Medical Center in Omaha.

To learn more about sleep, visit SleepFoundation.org.

This article was published in Coping® with Cancer magazine, July/August 2009.