by Patricia Carter, PhD, RN, CNS
Sleep is a basic physiologic need, as important as food and air to our health and wellbeing. However, when you have been diagnosed with cancer, sleeping well can become more difficult. According to the National Cancer Institute, over half of all people diagnosed with cancer complain of difficulty sleeping at some point during or after treatment.
Why sleep is so important
Good sleep is vital because it provides you with the energy needed to fight your cancer. In addition, researchers have linked sleep quality (not just quantity) to the body’s ability to combat cancer. Long-term poor sleep changes the balance of two key hormones in the body: melatonin and cortisol. These two hormones may influence the behavior of cancer cells.
♦ Melatonin is the body’s sleep hormone. When melatonin is released from the brain in the evening, it helps the body prepare for sleep. Melatonin may also play a protective role in preventing cancer.
♦ Cortisol is the body’s stress hormone. When cortisol is released by the body, it gives you a boost of energy. It also helps release cells that aid the body in battling cancer. Cortisol levels are supposed to be at their lowest during nighttime sleep before they rise rapidly in the morning to give you energy for the day. However, shifted patterns, where cortisol levels peak in the afternoon, have been linked to increased risk for breast cancer. Poor sleep can also worsen other medical conditions, such as diabetes, heart disease, respiratory illness, anxiety, and depression. Each of these conditions can diminish your body’s ability to fight cancer and may reduce the effectiveness of your cancer therapy.
People with cancer are twice as likely to experience insomnia as are people without cancer.
Causes of sleep problems
Insomnia, which is characterized by difficulty falling asleep or staying asleep, waking too early, or experiencing non-restorative sleep, is the most common sleep problem in the nation. And people with cancer are twice as likely to experience insomnia as are people without cancer.
A person with cancer may have trouble sleeping for many different reasons. These may include physical changes caused by cancer surgery or by the cancer itself, side effects of cancer treatments or other medications, and stress about having cancer. Your healthcare provider can help you understand the factors that may be contributing to your insomnia and can work with you to make your sleep the best it can be.
Steps to sleeping better
Cancer or not, everyone has a bad night’s sleep from time to time. But for someone experiencing cancer-related insomnia, a good night’s sleep may seem like a far-off dream. However, there are some things you can do to bring this dream back into reach.
Engaging in a bedtime routine, or a healthy set of activities before bed, will signal the brain that it is time for sleep.
♦ Know your light sources. Melatonin (The sleep hormone, remember?) is released in response to an absence of blue light. Conversely, being exposed to blue light, like sunlight or light from electronics, turns off melatonin production. Using light appropriately will help to regulate your circadian rhythm and sleep-wake cycle. Be sure to get exposure to at least 30 minutes of blue light in the morning (to wake up), and avoid blue light in the evening (at least 30 minutes before bed) to allow melatonin to be released so you can fall asleep.
♦ Practice mindfulness-based stress reduction. Mindfulness-based stress reduction focuses on reducing stress through nonjudgmental awareness of the present moment, leading to improved psychological well-being. The key is to practice mindfulness-based stress reduction throughout the day to reduce the amount of stress you carry into the bed with you. Lower stress makes it easier to fall asleep and stay asleep.
♦ Pursue healthy sleep habits. Engaging in a bedtime routine, or a healthy set of activities before bed, will signal the brain that it is time for sleep. Make your bedroom a haven for sleep. Reserve the bed for sleep and sex only. No eating, watching TV, texting, surfing the internet, or doing work in bed, as this sends confusing signals to your brain about when it’s time to wind down. Your bedroom should be dark, cool, and quiet to promote sleep. You should also try to avoid stimulants in the evening. Consume your last caffeine at least six hours before bed, and restrict vigorous exercise to the first part of the day. Sleep works best when your mind and your body are calm and relaxed.
A note about sleeping pills …
If you’re having trouble sleeping, your healthcare provider may prescribe a sleep medication to help you get your sleep schedule back on track. Sleep medications should only be used as prescribed, and only for short periods. To combat chronic sleep problems, the best approach is to treat or remove the underlying cause.
♦ Try cognitive behavioral therapy. Cognitive behavioral therapy, or CBT, focuses on resolving anxieties you may
have about getting enough sleep. Through cognitive behavioral therapy, you learn to identify and change negative thoughts and beliefs about sleep into positive thoughts and images that will help you fall asleep more easily, and fall back to sleep when you awake in the night. Both in-person and video-assisted CBT sessions have been shown to be effective improving sleep.
Sleep is important for supporting every function in your body. Quality sleep will buoy your mental and physical health, regardless of where you are in your cancer journey. If you’re having trouble sleeping, talk to your healthcare provider. Your healthcare provider can offer you support, help pinpoint the cause of your sleeplessness, work with you to develop a better-sleep plan, and refer you to a sleep specialist if needed.
Dr. Patricia Carter is an associate professor of nursing at The University of Texas at Austin School of Nursing in Austin, TX, and an active member of the American Academy of Sleep Medicine, the Sleep Research Society, and the Oncology Nursing Society. She is a nurse scientist who has been designing and conducting intervention research with cancer survivors and their family caregivers for over 17 years. Dr. Carter is passionate about helping everyone get a better night’s sleep.
This article was published in Coping® with Cancer magazine, March/April 2017.