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When Cancer Won’t Let You Sleep

by Lianqi Liu, MD, and Sonia Ancoli-Israel, PhD

Knowledge image

Are you having trouble sleeping after being diagnosed with cancer? Don’t worry, you are not alone. Studies show that up to 75 percent of people with cancer experience sleep disturbances – twice as many as in the general population. But the good news is that treatments are available for your sleep problems.

Sleep problems can begin before or during cancer treatment and can last years after treatment ends. People with cancer may experience many types of sleep disturbances, including

  • difficulty sleeping, or insomnia;
  • excessive daytime sleepiness;
  • difficulty falling asleep;
  • difficulty staying asleep because of frequent and prolonged nighttime awakenings;
  • difficulty getting back to sleep;
  • sleeping fewer hours than normal;
  • napping at unusual times, such as midmorning; and
  • feeling tired, rather than refreshed, after a night’s sleep.

What causes sleep disturbances?
And why do so many people with cancer experience sleep disturbances? It may be because of the cancer itself, cancer treatment, or cancer-related depression. Or the cause might be unrelated to cancer but instead is a previously undiagnosed sleep disorder. The stress and anxiety of receiving a cancer diagnosis or the anticipation of beginning treatment may also cause sleep problems. In addition, chemotherapy and radiation therapy are both associated with sleep disturbances.

Some common sleep mistakes people with cancer make are going to bed too early, spending too much time in bed at night, and taking long naps during the day.

Author of Article photo

Dr. Lianqi Liu

In our laboratory, we have found that many symptoms associated with cancer treatment are actually present before the start of the treatment, particularly sleep disturbances, fatigue, and depression. Not only are these symptoms interrelated, but they also all get worse during chemotherapy.

We have also found that chemotherapy interferes with circadian rhythms – the normal sleep-wake cycle that allows the cyclical release of hormones and restoration of energy, and allows optimal body functions during the day. In addition, our bodies need bright light in order for our circadian rhythms to function properly. Our studies have shown that women undergoing chemotherapy are not exposed to much bright light. Therefore, spending more time outdoors during the day might help to improve disordered sleep.

How are sleep disturbances treated?
Specific intervention strategies are needed to deal with sleep problems in people with cancer and should target the problem as soon as symptoms appear, whether before, during, or after cancer treatment. In order to determine the type and cause of the sleep problem, a comprehensive sleep evaluation is necessary. The appropriate treatment can then be initiated.

Author of Article photo

Dr. Sonia Ancoli-Israel

For insomnia – the most common cancer-related sleep problem – the treatment of choice is a behavioral therapy called cognitive behavioral therapy. CBT is considered as effective, if not more effective, than prescription medications for the treatment of chronic insomnia in the general population. But if necessary, CBT can also be combined with pharmacotherapy (sleeping pills). In particular, CBT has been shown to be an effective treatment for insomnia in people with cancer.

What can I do to get a better night’s rest?
Some common sleep mistakes people with cancer make are going to bed too early, spending too much time in bed at night, staying in bed in the morning after waking up, taking long naps during the day, and spending time in bed worrying. All these things will actually make sleep worse. To improve your sleep quality, you should

  • go to bed and get up at the same time each day;
  • be in bed only when you are sleeping (not for hours before the start of sleep or after the end of sleep);
  • limit naps to one 30-minute nap in the early afternoon; and
  • find 15 to 20 minutes during the day when you can sit quietly and address your worries – so you don’t have to do it in bed at night.

We now know that sleep problems are common in people with cancer and in cancer survivors. Once a sleep evaluation is complete and a diagnosis made, appropriate treatments can begin. Adequate interventions will help you get out of the shadow of sleep problems and function better during the day.

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Dr. Lianqi Liu is an assistant project scientist, and Dr. Sonia Ancoli-Israel is a professor in the department of Psychiatry at the University of California, San Diego. Both have studied sleep in people with cancer for over ten years and have authored multiple publications on this subject.

This article was published in Coping® with Cancer magazine, March/April 2010.