Treatments for Cancer Related Insomnia

1
Treatments for Cancer Related Insomnia - Natural Remedies and Medications

Cancer patient resting on sofa
IstocKataryzynaBialasiewicz

Insomnia is an extremely common problem affecting people with cancer, and as noted in a previous article, can have serious ramifications for your quality of life and even survival. The treatment of insomnia during and after cancer treatment should take several thoughts into consideration, and is an area in which a combination of therapies be very helpful.

First, take a look at your sleep hygiene, and sleep routine. Spend a while thinking about what you could change as well as what you are doing well. As a next step, there are many activities such as relaxation which have worked for many people. If your symptoms persist, talk to your doctor about cognitive behavioral therapy - talk therapy -- which has been found to be very helpful in studies evaluating cancer-related insomnia.

Since we are talking about cancer, it's very important to note that while supplements have recently gained immense popularity in treating symptoms such as insomnia, some of these may interact with the treatments for cancer. For that reason, always talk with your doctor about your insomnia, and how it is impacting your life. The importance of good sleep -- which can affect even the outcome of cancer -- should be given high priority in your care.

2
Establish a Sleep Routine

Woman yawning in bed
Establishing a sleep routine is a first step in treating insomnia. Istockphoto.com/Stock Photo©RyanKing999

Establishing a regular bedtime routine -- something known in medical lingo as "stimulus control therapy" - should be a first step in treating bothersome insomnia. Your routine should begin early in the evening, and take place at the same time each evening whether it is a weeknight or a weekend night. Try to get up at roughly the same time each day as well.

What if you can't sleep? Sleep therapists recommend that if you are still awake 20 or 30 minutes after lying down that you get up and leave your bedroom; returning to bed only when  you are sleepy.

Some people find that a warm bath, reading, or having a cup of herbal tea helps them relax at bedtime. Exercising during the day may help, but talk to your doctor and make sure you don't exercise too close to bedtime.

Make your room as dark as possible, using shades or curtains as needed if you have a light outside your window or if the moon is shining. It's best to avoid night lights, but if you require one for safety issues, try to purchase a light which reduces your exposure to light at night. Our bodies manufacture the "natural sleep hormone" melatonin during the night, and this is produced most efficiently in complete darkness.

Limit the amount of time you spend in bed (this is called "sleep restriction therapy") as unrealistic sleep expectations may contribute to a sense of insomnia.

Check out these sleep routines and sleep rituals for more ideas.

3
Evaluate Your Sleep Hygiene

An alarm clock with a woman sleeping in the background
Evaluate your sleep hygiene if you are suffering from insomnia. Istockphoto.com/Stock Photo©Wavebreakmedia

Use your bedroom for sleep, and sex only, not for catching up on work or watching TV – though an exception may be for people who fall asleep better listening to the “white noise" of a radio or TV.

Avoid discussing anxiety-provoking topics in the evening. Listening to the news on a radio or TV may not be a good idea.

Limit caffeine intake and alcohol consumption in the evening. Some people are very sensitive to caffeine, even if consumed early in the afternoon. Alcohol may appear to help people sleep, but alcohol interferes with good sleep structure and can be detrimental.

Avoid large meals in the evening, especially spicy meals. For more ideas, check out these better sleep guidelines.

Sleep Diary

Some people have found it helpful to keep a sleep diary, to better understand the amount of sleep they are getting, as well as to look for what may be causing a loss of sleep. If you decide to try this, keep a list of not only the time you fall asleep, but also times of awakenings, and the restfulness of sleep you get. Make note of daytime behaviors and any thoughts that may have interfered with your sleep. Also, make note of things such as pain and hot flashes. Then ask yourself – is there something you are worrying about or something easily treatable that is causing problems with your sleep? If so, talk to your loved ones, your oncologist, or your cancer support team.

4
Breathing Exercises

Woman taking a deep breath
Breathing exercises may help with insomnia. Istockphoto.com/Stock Photo©AntonioGuillem

You may have heard people talk about using breathing techniques to help with sleep difficulties. How can breathing exercises help with insomnia? There are a few ways. By focusing on your breathing you can take your mind off of thoughts which may be keeping you awake. It also takes your focus off the task at hand; sleeping is usually something that occurs naturally that you don't have to think about.

Check out these simple breathing exercises for rapid stress relief.

5
Relaxation Therapy

Woman meditating on a beach
Relaxation therapy may help with insomnia. Istockphoto.com/Stock Photo©kieferrix

Stress in our lives can significantly impact our sleep. Physical changes related to stress, as well as the release of stress hormones set up an environment that is meant to keep us alert. But whereas the stressors of the past often required this diligence (say, if you needed to run from a lion) the psychosocial stressors of the present era are often present in our thoughts--thoughts that may run through our minds at the same time we are counting sheep.

Relaxation therapy mixed in during your daytime routine, as well as at night, is a good way to improve your ability to fall and stay asleep. Take a moment to think of activities that relax you. Is it listening to music? Knitting? Reading an inspirational book? Yoga? These activities vary with each person, and one person may find an activity stressful rather than stress relieving.

If stress is impacting your sleep, check out these top relaxing techniques for effective stress management or start reducing stress immediately with this 2-minute video on relaxation technique. Some people find great help in using guided imagery for relaxation, both during the day and at night.

6
Integrative Treatments - Mind/Body Therapies

Woman receiving a back massage
Mind/body therapies such as massage may help insomnia. Istockphoto.com/Stock Photo©ValuaVitaly

Mind/body therapies, sometimes called "alternative therapies," are increasingly becoming recognized as a helpful adjunct for coping with the symptoms of cancer -- including insomnia. Many of the larger cancer centers are now taking an integrative approach to oncology by incorporating these treatments. Some that have been helpful for people with insomnia include:

7
Cognitive Behavioral Therapy

Elderly couple sitting on a couch and speaking to a therapist
Cognitive behavioral therapy may help with insomnia. Istockphoto.com/Stock Photo©lisafx

Cognitive behavioral therapy (CBT) is usually considered the recommended first line of treatment for cancer-related insomnia. CBT uses various cognitive (thought) and behavior techniques to address insomnia by targeting dysfunctional attitudes, beliefs, and habits people with cancer have about sleep.

CBT has been found to help directly with insonmia but also appears to play a role in improving mood, decreasing fatigue, and improving the overall quality of life for people living with cancer.

Techniques such as sleep restriction may be used, but the advantage of CBT is that it addresses the fact that everyone with cancer has different factors predisposing to insomnia and responds to different treatments. If your insomnia is not improving with the measures described earlier, make sure to talk to your oncologist about this option.

8
Acupuncture

Acupuncture needles in foot
Acupuncture may help with insomnia related to cancer. Istockphoto.com/Stock Photo©AndreyPopov

Acupuncture is now offered as an integrative therapy at several large cancer centers. With acupuncture, a practitioner places thin needles along the meridians (energy fields) of the body in an attempt to balance the flow of energy (qi) through the body.

Acupuncture appears to have some benefits for people with cancer, including assisting in the control of chemotherapy-induced nausea, in relief of cancer pain, in easy fatigue, and in helping to manage xerostomia (dry mouth) due to radiation therapy.

Recently, a review of studies published to date was encouraging that acupuncture may play a helpful role in the management of sleep disorders related to cancer treatment.

If you consider trying this therapy it's important to talk to your oncologist and find a practitioner who is familiar with treating people with cancer.  A low white count or a reduced platelet count due to chemotherapy could increase the chance of infection or bleeding related to placement of the needles used in this therapy.

9
Melatonin

Stethoscope and melatonin
Melatonin may help with insomnia due to cancer - but ask your doctor. Istockphoto.com/Stock Photo©designer491

There has been a lot of information published recently about the role of melatonin as a treatment option for insomnia. While this hormone, sold as a nutritional supplement, may help some people -- those with a form of insomnia known as "delayed sleep phase syndrome" -- it is NOT helpful for most people with insomnia.

It is also important to point out a few more thoughts. Since melatonin is sold as a nutritional supplement it does not face the same regulations as a prescription medication would face -- in other words, you can't be certain exactly how much melatonin you are actually getting. The amount of melatonin in many of these supplements is actually much greater than the amount recommended for the treatment of delayed sleep syndrome.

On the other hand, melatonin is being studied for a possible role in treating breast cancer, and a reduction in the amount of melatonin produced by the pituitary gland when people are awake at night due to night shift work is now considered a probable carcinogen.

All of that translates into a recommendation to talk with your doctor if you are suffering from insomnia, and carefully discuss the best options for your particular form of insomnia and your particular cancer type -- whether or not that includes melatonin.

10
Other Sleep Supplements

Bowls filled with dried berries, seeds, and other super foods
Nutritional supplements are sometimes used for insomnia. Istockphoto.com/Stock Photo©baibaz

You may have heard about the benefits of alternative treatments for insomnia, yet with cancer, it is important to talk to your doctor about any nutritional supplement or herbal preparation you take. As noted earlier, these products are not regulated as prescription medications have been. In addition, some herbal therapies could interfere with the efficacy of some cancer drugs. Keep in mind as you look at these products that something such as hemlock could be considered natural, plant based, and can even be grown organically. Yet it didn't do Romeo and Juliet much good.

Valerian root showed a modest benefit with regard to insomnia, but according to "Up to date" there is not currently enough evidence to support its use. In contrast, the aromatherapy treatment lavender oil may not have been shown to be beneficial from a scientific standpoint, but if it is used as a part of your sleep ritual, may be something that is helpful for you, and unlikely to interfere with any treatments you have been prescribed for your cancer.

11
Over the Counter Medications

Woman speaks with a pharmacist
Over-the-counter medications for insomnia. Istockphoto.com/Stock Photo©Wavebreakmedia

Walking through the pharmacy you may see many options for the treatment of insomnia. Most of these include some form of an antihistamine such as diphenhydramine (Benadryl). Even though these preparations have been effective when used short term for some people with insomnia, it is critical that people discuss the use of these medications with their oncologist before taking anything. Diphenhydramine is known to interfere with some cancer treatments, and with one treatment, in particular, can cancel out the effects of the cancer medication entirely.

12
Prescription Medications

Stethoscope and pills on an Rx pad
Prescription medications are sometimes needed for insomnia. Istockphoto.com/Stock Photo©18percentgray

Sometimes sleep disturbances can continue to be a problem despite good sleep practices and other measures. When this occurs, a prescription medication for insomnia may be considered on a short-term basis, to "get you over the hump." This is especially true when people have tried other measures and reached a point in which even the thought of trying to sleep has become stressful.

It can't be emphasized enough that these should only be used as short-term treatments (with perhaps the exception of some advanced cancers) and that some -- especially the benzodiazepines -- may be highly addicting. Since many of these medications list fatigue and decreased alertness as side effects, caution needs to be exhibited when performing activities such as operating an automobile, even during the day following the use of medication the night before.

Options may include (follow the links to learn more about these options):

  • Rozerem - This medication works as a melatonin agonist and is approved specifically for the treatment of insomnia. Though it has been found to have some impact in this setting, a recent study done specifically on people with cancer found this medication was not helpful, and rather cognitive behavioral therapy was most effective.
  • Nonbenzodiazepine medications
  • Benzodiazepine medications

Other medications with indications for other conditions may work for some people with insomnia. Check out this sleeping pill overview for more information. Make sure to talk to your doctor. Insomnia in people with cancer is not a small problem, and can have serious consequences.

Sources:

Garland, S. et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatric Disease and Treatment. 2014. 10:1113-24.

Chien, T., Liu, C., and C. Hsu. Integrating acupuncture into cancer care. Journal of Traditional and Complementary Medicine. 2013. 3(4):234-9.

Haddad, N., and O. Palesh. Acupuncture in the treatment of cancer-related psychological symptoms. Integrative Cancer Therapies. 2014. 13(5):371-85.

Heckler, C. et al. Cognitive behavioral therapy for insomnia, but not armodafinil, improves fatigue in cancer survivors with insomnia: a randomized placebo-controlled trial. Supportive Care in Cancer. 2015 Nov 5. (Epub ahead of print).

Howell, D., and T. Oliver. Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice. Annals of Oncology. 2014. 25(4):791-800.

Johnson, J. et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Medicine Reviews. 2015 Aug 1. (Epub ahead of print).

Matthews, E. et al. Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: a randomized, controlled trial. Oncology Nursing Forum. 2014. 41(3):241-53.

National Center for Complementary and Integrative Health. Sleep Disorders. Updated 10/28/15. https://nccih.nih.gov/health/sleep

Ronanelli, M., Faliva, M., Perna, S., and N. Antoniello. Update on the role of melatonin in the prevention of cancer tumorigenesis and in the management of cancer correlates, such as sleep-wake and mood disturbances: review and remarks. Aging Clinics and Experimental Research. 2013. 25(5):499-510.

Continue Reading