Coping with Insomnia During Cancer Care

Good sleep is an important part of cancer treatment

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Coping with insomnia during cancer care is an important part of treatment. If you are having trouble sleeping, you are not alone. Up to 80 percent of people receiving chemotherapy experience insomnia. Not getting enough sleep can affect your immune function, too. Poor immune function can make it harder for your body to recover after each cycle of chemotherapy.

These tips and ideas will help tackle insomnia.

Insomnia can have a serious medical cause, such as sleep apnea or thyroid problems. If simple fixes don't work, talk to your doctor about insomnia.

  1. Talk to your doctor if treatment is affecting your sleep. Several new sleep medications have become available in the past few years. Most of the newer medications are considered unlikely to cause serious addiction problems. These medications can be used on an occasional basis, only as needed. Another plus is that the new medications are less likely to cause that next-day drowsy feeling that previous sleep medications may have caused.

    Even if you're not interested in medication, talk to your doctor about insomnia. You may be referred to a sleep specialist who can give you other ways to beat insomnia.

  2. Go dark. Even tiny amounts of light make sleep difficult. Our bodies produce melatonin, a hormone, in response to darkness. Melatonin signals the body that it's time to sleep. Light suppresses melatonin. Even light from an alarm clock or cell phone is enough to decrease melatonin levels.

    Make your bedroom completely dark. If this isn't possible, wear soft eye shades to completely block out light. Eye shades cost just a few dollars and are worth the investment in your health. Complete darkness is essential for good sleep and for a healthy immune system. Some studies even link low melatonin levels to increased cancer risk.

  1. Create a bedtime routine. Going through the same steps each night before bed can help your body learn to wind down. If you follow the routine consistently, your body and brain will know it's time for sleep at the end of the routine.

    Your routine might include a warm shower or bath, sipping herbal tea or doing some light stretches. Some people like to read before bed. Just be sure whatever you are reading is not too stimulating -- no politics, war coverage, disaster reporting or other topics that upset or annoy you.

  1. Cut back on computer and TV time. The type of light from computers and TV may interfere with the body's production of melatonin. Plus, TV and computer time can be very stimulating, which will not help you sleep. Give yourself at least one TV- and computer-free hour before bed.

  2. Use the bedroom for sleep only. Don't keep a computer or TV in the bedroom. The temptation to turn them on, especially if you wake up in the middle of the night, is too great.

    Don't keep a huge pile of unfolded laundry, or other chores, within your vision in the bedroom either. This can create a nagging feeling of things being left "undone," which interferes with sleep.

    Don't eat in bed, read in bed, or do anything in bed other than sleep (and sex). This is another way to signal your body that when you get into bed, it's time to sleep.

  3. Yawn more. It sounds weird, but if you force yourself to take two to three very deep yawns, this can cue the body to relax and get ready for sleep.

  4. Keep consistent wake and sleep times. Try to get up at about the same time every day. Do this on weekdays and weekends. Also, try to go to bed at about the same time each night.

    The human body thrives on routine and sleeping is no exception. By getting yourself on regular bedtimes and wake times, you'll take advantage of the body's natural desire to find a stable routine.

  1. Avoid alcohol. Alcohol may help you fall asleep faster, but it causes wakefulness later in the night for many people. Alcohol can prevent the body from getting the deep sleep needed for good health as well.

    Alcohol also can cloud your judgment, so that you're more likely to watch that one last TV show or play that one last round of the video game. Alcohol will make this seem like a fun, good idea at the time, but you'll regret it when you're lethargic and sleep-deprived the next day.

    No matter how you look at it, alcohol and good sleep do not go together.

  2. Avoid heavy meals in the evening. A full stomach makes falling and staying sleep more difficult. Sleeping on a full stomach also can contribute to heartburn (acid reflux), a sure sleep-killer.

    This is a tough tip for most people, but it helps a lot. In the U.S., most of us eat our biggest meal for dinner.

    A healthier option is to eat a hearty breakfast and a good, solid lunch. Have a substantial snack in the afternoon or right when you arrive home from work. Then have a light meal for dinner.

  3. Try progressive relaxation. Start by clenching your toes and the muscles of your feet for a few seconds. Then completely relax your feet. Next tighten the muscles of your ankles and calves for few seconds, then release. Next focus on tightening then relaxing the thighs.

    Continue moving up the body until you've reached the muscles of your head and face. After you tighten and release this last group of muscles, you should be relaxed and ready for sleep.

  4. Try patterned breathing. Patterned breathing is when you focus on breathing in and out to a specific count. A common and relaxing pattern is four and eight.

    Breathe in deeply through your nose for the count of four. Then slowly release your breath through your mouth for the count of eight. Repeat this breathing pattern, four in and eight out, for five to ten breaths.

    This type of pattern is relaxing because you focus on the counting, which frees your mind from other worries. It also can help your body regulate oxygen levels in a way that enhances relaxation.

  5. Avoid napping. Quick 10-20 minute "power naps" are OK, but any longer and it will be more difficult to sleep at night.

    This "rule" can be tough for someone in cancer treatment, because fatigue is a side effect of some cancer therapies. If you are so fatigued that you simply cannot avoid napping for long periods of time, talk to your doctor.

    Extreme fatigue can have a medical cause, such as low blood counts. Your doctor may be able to treat the underlying cause, which will lessen fatigue.

  6. No coffee, cola or caffeinated tea after 12 noon. Caffeine is metabolized (processed) differently by different people. For some people, the body is still processing caffeine up to 10 hours after you have it.

    If your body metabolizes caffeine slowly, you can have a cup of coffee at 2 p.m. and still be affected by the caffeine at 10 p.m. that evening. To be sure caffeine isn't affecting you, keep your lattes to the mornings only.

  7. Keep the temperature cool. An overly warm bedroom can make sleep more difficult. Instead, keep the room as cool as you can. Pile on the blankets for warmth. You can remove blankets as needed. If the room is too hot, you're just stuck sweating it.  Keeping the temperature below 63 degrees may help you sleep better.

    References:

    Hill SM, Frasch T, et al. "Molecular mechanisms of melatonin anticancer effects." Integrative Cancer Therapies 2009 8:337-46.

    MedicineNet.com. Ten Tips to Avoid Insomnia and Get a Good Night's Sleep. Accessed: March 8, 2010. http://www.medicinenet.com/script/main/art.asp?articlekey=47584#

    Oncology Times. Insomnia More Common Than Previously Thought. Accessed: March 8, 2010. http://journals.lww.com/oncology-times/Fulltext/2010/01250/Insomnia_More_Common_in_Patients_Receiving.2.aspx

    Sleep Disorders. Medline Plus. Accessed: March 8, 2010. http://www.nlm.nih.gov/medlineplus/sleepdisorders.html

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