Is Cancer Keeping You Awake?
by Kim Day, LISW-S, OWS-C, ACHP-SW
Sleep disturbances can occur during all phases of cancer, with both physical and psychological factors contributing to the problem. But before you despair and feel doomed to nights of tossing and turning, know that once the triggers for wakefulness are addressed, a host of strategies can help you get a good night’s sleep again.
It’s important to maintain good sleep hygiene, or behaviors that promote a normal sleep-wake cycle. While hot flashes, pain, incontinence, frequent urination, fatigue leading to daytime napping, certain medications, hospital stays, and worry can all contribute to sleep problems, many of these issues can be managed with a bit of ingenuity:
- Sleep in cotton nightclothes instead of synthetic materials and use lightweight blankets instead of heavy comforters to help manage hot flashes.
- Limit the amount of fluids you consume in the evening to prevent frequent nighttime bathroom trips.
- If pain is an issue, talk with your doctor about adjusting your pain medication so you are getting an adequate dose to help you get through the night comfortably.
- If you need to be in the hospital overnight, talk with the staff about ways to minimize interruptions during the night. You may not be able to eliminate all disturbances, but making your wishes known can help.
Don’t watch the clock at night. This will only feed your anxiety about not sleeping.
The following suggestions are also helpful for maintaining good sleep hygiene:
- Go to bed at the same time each night, and wake at the same time each day.
- Avoid napping, especially late in the day.
- Keep your bedroom quiet, cool, and dark.
- Avoid doing wakeful activities, such as watching TV, using a laptop, talking on the phone, and eating, in bed.
- Exercise regularly, but not within three hours of bedtime.
- Avoid caffeine at least six hours before bedtime.
- Don’t watch the clock at night. This will only feed your anxiety about not sleeping.
- Avoid hot baths in the evening. The process of falling asleep is tied to a decline in body temperature.
- Try to get some exposure to bright light each day soon after you wake up. This helps regulate melatonin.
- In the evening, allow yourself time to wind down before going to bed. A buffer between stimulating activities and a quieter time for relaxing encourages sleepiness.
If you still find yourself tossing and turning, trying too hard to sleep, don’t just lie awake in bed. Go to another room and do something quiet and relaxing. Listen to calming music or read something pleasurable as a way to make the switch from restlessness to peace.
At times, negative thoughts about sleep may perpetuate your sleeplessness and fuel your anxiety: I can’t stand this. I have to do something to get more sleep. I won’t be able to function tomorrow without eight hours of sleep. Try to replace them with these more positive thoughts:
- I’ve survived nights like this before.
- I can function even when I’m tired.
- I can be at peace while awake.
Incorporating yoga and mindfulness-based stress reduction practices into your daily routine may help calm anxious thoughts that disrupt sleep. Studies have shown that people who practice yoga experience better sleep quality, enhanced mood, less cancer-related distress, and improved quality of life. Progressive muscle relaxation can also promote a relaxed state and can prevent intrusive thoughts. This technique helps you to identify tension in the body and then release it.
Under the guidance of your doctor, treatment for relieving sleep problems may include the use of medication, but keep in mind that sleeping pills are a short-term fix. Since anxiety and depression are linked to insomnia, your doctor may determine that a low-dose antidepressant could be beneficial. You can also talk with a dietitian about your options for natural sleep remedies, such as chamomile tea and magnesium-rich foods.
Though frustrating, sleep disturbances are not life threatening, and they do respond well to treatment. Try the suggestions outlined here, connect with an oncology social worker for additional support, and look forward to sound sleep and sweet dreams.
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Kim Day is a clinical oncology social worker at University Hospitals Seidman Cancer Center in Cleveland, OH. She works with adult cancer survivors in the ambulatory setting. She is on the board of directors of the Association of Oncology Social Work and sits on the peer review committee for Master’s Training Grants in Clinical Oncology Social Work for the American Cancer Society.
This article was originally published in Coping® with Cancer magazine, September/October 2013.