Getting a Good Night’s Sleep
by Carol A. Enderlin, PhD, RN, and Martha Kuhlmann, MSN, FNP, PMHCNS
Sleep is an important way that our bodies restore our energy “charge” to keep us going. Seldom is sleep more important than when facing cancer. But sleep is so finely tuned to how we feel physically and mentally that it may be challenging when we need it the most. Understanding how sleep works can give insight into ways to improve sleep while coping with cancer.
How Sleep Works
The fine balance between being awake or asleep is maintained by a build-up of pressure either to wake up (after meeting sleep needs) or to sleep (after staying awake). This balance is disturbed if sleep is too short or interrupted frequently. Often, daytime naps are taken to make up for poor nighttime sleep. If naps are long or taken late in the evening, they may interfere with the normal pressure to sleep at night, causing your days and nights to be “mixed up.” The American Academy of Sleep Medicine and National Sleep Foundation recommend taking short naps (30 minutes) as needed before 3:00 p.m. to prevent interference with nighttime sleep.
Getting a good night’s sleep is essential to coping well with cancer.
Sunlight is important for sleep. It stimulates the daily production of melatonin, a hormone that peaks at bedtime and promotes sleep. If you stay indoors most of the time, you may not get the sunlight your body needs to sleep well at night. Sunlight is also good for bone health and depression. Taking a short outdoor walk daily can promote nighttime sleep, strong bones, and a more positive outlook.
Good Sleep Habits
As “creatures of habit,” having a regular sleep routine can help us be ready for sleep. Reserving the bedroom for sleep (and sex), unless ill, helps you become conditioned to fall asleep when in the bedroom. Activities like watching television or using the computer in bed can condition you to stay awake instead. Keeping regular sleep and wake times, even if awakened during the night, helps strengthen the pattern of nighttime sleep and daytime wakefulness. Irregular sleep and wake times make it harder for us to separate sleep and wakefulness. Routines like taking a warm shower before bedtime can help signal you to “wind down for the day.” Warm showers promote sleep by helping muscles relax and decreasing body temperature. Scented soap or lotion, like lavender (if tolerated), may promote relaxation through very gentle rubbing and massage and signal sleep time.
Although daytime exposure to sunlight helps us to sleep better at night, a dark environment is best for nighttime sleep. Window coverings should block environmental light from sleeping areas. Television and computer screens project very bright light, which interferes with deep sleep, and should be turned off or be located in a different room. Sleep masks are an alternative.
Environmental noise may interfere with falling asleep or reaching deep sleep. Using “white-out” background noise, like an air purifier or fan, may block out unwanted sound. Earplugs are an alternative.
Worry or difficulty “turning off your mind” at bedtime may delay sleep. Using simple relaxation methods like slow deep breathing, prayer, meditation, music, or guided imagery tapes may help you relax and focus on more positive thoughts. Set aside time early in the day to deal with demanding tasks and avoid them at bedtime.
Exercise, nicotine, and caffeine should be avoided at least three hours before bedtime to prevent stimulation of wakefulness. Alcohol should also be avoided three to six hours prior to bedtime, as it initially causes drowsiness but results in early morning awakening.
Pets may not share the same sleepwake patterns as humans. Cats are nocturnal by nature, sleeping during the day and active at night. Dogs may adopt their masters’ sleep routines but awaken to bark at environmental noise. Sleeping separately from pets may prevent sleep disturbance.
Sleep disorders may be present before a diagnosis of cancer or develop during treatment. Daytime sleepiness that interferes with daily function or uncomfortable leg sensations that worsen with sitting or lying down should be discussed with your healthcare provider. Difficulty falling asleep, staying asleep, or awakening too early are common problems for people with cancer. Medication may be prescribed for new symptoms, or you may be referred to a sleep medicine specialist for evaluation and treatment.
Self-awareness and practice of good sleep habits is important. If sleep disturbance develops or worsens, discuss concerns with your healthcare provider as soon as possible. Getting a good night’s sleep is essential to coping well with cancer.
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Dr. Carol Enderlin and Martha Kuhlmann are faculty in the College of Nursing at the University of Arkansas for Medical Sciences.
This article was originally published in Coping® with Cancer magazine, January/February 2012.