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Tired of Feeling Tired?

Tips for Sleeping Well through Cancer

by Marie-Hélène Savard, PhD, and Josée Savard, PhD

Wellness image

Sleep disturbances are among the most common side effects reported by cancer survivors, affect­ing between 30 and 60 percent of survivors at some point during or after treatment. Insomnia is characterized by trouble falling asleep or staying asleep through the night or complaints of a light and nonrestorative sleep. In its more severe forms, insomnia occurs several nights a week, causing significant impairment in daily functioning and marked distress.

Several factors are likely to trigger insomnia or make preexisting insomnia worse in cancer survivors, including the emotional reaction to the cancer diagnosis itself, hospitalization, cancer treatment and its side effects, inconti­nence, fatigue, cancer-related pain, shortness of breath, and some medica­tions. In many cases, the in­somnia will stop when the trigger goes away or when a person adapts to it. In others, however, insomnia can become chronic (lasting longer than six months).

Poor sleep behaviors and inaccurate beliefs about sleep can contribute to the maintenance of insomnia over time. The good news is, with the right man­agement techniques, you can learn to sleep well again.

Changing Poor Sleep Behaviors
People with insomnia often start nap­ping during the day, going to sleep earlier in the evening, or spending more time in bed to ensure they get enough sleep and to recuperate from sleep loss. These behaviors are particularly likely in people with cancer, who are often encouraged to get more rest in order to recover from their cancer treatments.

Author of Article photo

Dr. Marie-Hélène Savard

Although these strategies may be useful at first, during the active phase of treatment, they can contribute to worsening insomnia over time. Poor sleep behaviors can desynchronize the body’s bio­logical clock and can create a detrimental association between the bed/bedroom and sleeplessness rather than with the state of relaxation needed for sleep.

To resynchronize your body’s sleep-wake cycle, you need to establish a steady sleep-wake schedule. And to reassociate the bed and bedroom with sleeping, you should avoid activities that are incompatible with sleep in the bedroom. Here’s how you do that:

Set aside at least one hour to relax before going to bed.
Go to bed only when you feel sleepy (which is different from feeling fatigued).
If you can’t fall asleep, or if you can’t go back to sleep during the night within 20 to 30 minutes of waking, get out of bed and leave the bedroom. Only go back to bed when you feel sleepy again. Repeat as many times as necessary.
Get up at the same time every day, regardless of how much sleep you got the night before. Use an alarm clock if necessary.
Use your bedroom for sleep and sexual activities only. Avoid activities like reading, working, listening to the radio, watching TV, or surfing the Internet in the bedroom.
Avoid napping during the day, but if necessary, nap in your bed before 3:00 p.m. for less than one hour.

Author of Article photo

Dr. Josée Savard
(Photo by Marc Robitaille)

Changing Inaccurate Attitudes about Sleep
People who have chronic insomnia tend to worry about their inability to sleep (I’m losing control over my sleep) and about its conse­quences (I can’t function during the day without eight hours of sleep; If I don’t sleep well, my cancer will come back). These beliefs represent un- realistic expectations about sleep and overestimations of the consequences of insomnia. As bedtime approaches, these beliefs can produce emotional, physiological, and cognitive arousal, called performance anxiety, which is incompatible with sleep. Hence, someone who experiences a few nights of poor sleep but maintains his or her usual sleep routine with- out worrying about it is unlikely to develop chronic sleep difficulties. However, a person who becomes overly anxious or worried by poor sleep and its daytime consequences is likely to enter a vicious cycle of insomnia, anxiety, arousal, and further sleep disturbances.

You can reduce the impact of these dysfunctional beliefs by learning to recognize them when they occur and replacing them with more adaptive ones. Here’s how:

  • Avoid worrying about the amount of sleep you should be getting and about how quickly you should be falling asleep. Sleep needs are different for each person, and they can vary over time.
  • Avoid blaming insomnia for every problem you experience during the day. Daytime fatigue or mood distur­bances are not always due solely to poor sleep. Many other factors can come into play.
  • Avoid giving too much importance to sleep in your life and dramatizing the consequences when a poor night’s sleep occurs. For instance, insomnia by itself cannot induce a cancer recurrence.
  • Try to become tolerant to a lack of sleep.

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Dr. Marie-Hélène Savard is a clinical psychologist and a research professional. Dr. Josée Savard is a clinical psychologist, professor, and researcher in psycho- oncology. Both work at Laval University Cancer Research Center and at the School of Psychology at Université Laval in Québec, Canada.

This article was published in Coping® with Cancer magazine, May/June 2013.