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How to overcome sleepless nights after cancer

This article originally appeared in Cancer Support Community on February 9, 2017.

How often do you feel pressure to get a good night’s sleep? We often read news headlines about the health effects of sleep deprivation (perhaps at 3 a.m. when we can’t sleep). For some, feeling like we need “enough” sleep can become internalized and take on a life of its own in our thoughts. This, in turn, certainly does not help induce sleep.

Sleep disruption is usually considered to be insomnia disorder when it is associated with distress about not sleeping and other negative consequences that are believed to be due to poor sleep. A pattern develops and becomes more the norm than the exception. Insomnia is not directly a result of another medical condition but certainly can develop secondarily to one.

Worry about sleep affects a huge segment of the population, particularly those who have been diagnosed with cancer. While problems sleeping are certainly not unique to those with cancer, the prevalence of insomnia among those diagnosed is estimated at between 30-60% at some point during or after treatment. This may not come as a surprise if you’re among those affected. Multiple reasons may contribute to why insomnia affects those diagnosed with cancer at higher rates. Sometimes medical issues or cancer-related pain complicate a sound night of sleep. Sometimes aspects of cancer treatment (such as steroids, certain chemotherapies, or hormone treatments) have negative consequences on sleep or our natural circadian rhythms. Often general fatigue and increased daytime napping while in treatment can affect typical sleep patterns. And for many, stress and concerns related to the cancer experience, with or without accompanying anxiety or depression, are the primary causes for the insomnia. Of course, any combination of these factors may contribute.

Despite their prevalence, sleep difficulties (and accompanying distress) are often overlooked in cancer care. While there may be medical considerations about how insomnia or sleep difficulties can be managed, there will be a point when this will need to be addressed, by the patient and/or the healthcare team. When your symptoms become a significant source of distress and you are having difficulty managing symptoms on your own, you owe it to yourself to talk to a health care provider about your concerns.

Here are some tips to have your sleep concerns meaningfully addressed by your healthcare team:

Make discussing sleep a priority. Come prepared to your appointment ready to describe the history of your sleep concerns. How long have you had trouble sleeping? Is this a new issue or something that you’ve experienced since before your cancer diagnosis?

Keep track of your sleep and wakings. This can be an extremely useful tool to better understand the extent of the sleep disturbance. You can download a sleep diary online and start tracking your sleep yourself, or you can keep your own notes in any format that works for you. What does your sleep look like? Do you have trouble falling asleep, staying asleep, or do you wake up too early? How many times a week do you have trouble sleeping like this? What time do you go to bed, wake up, and nap during the day?

Pay attention to how you manage your sleep on your own. What helps, and what doesn’t? Effectively treating insomnia will mean thoughtfully evaluating all of these factors. Successful approaches will modify what is perpetuating the insomnia and reinforce what is already working.

Consider a new approach. A variety of approaches can be successful in managing insomnia, and you won’t necessarily know what will work for you unless you try. Whether you ultimately have success with modifying your sleep environment or sleep behaviors alone (also commonly referred to as “sleep hygiene”), or you utilize medication, yoga, meditation, acupuncture, or psychotherapy in addition to modify your sleep habits, being open is key.

Tips for behavioral changes warrant further description than what can be provided here, but here are a few quick suggestions. “Sleep hygiene” tips include general guidelines about caffeine consumption (reduce intake and drink early in the day); regular exercise and avoiding vigorous exercise before bedtime; structuring your sleep area to be quiet, dark, and cool; and avoiding watching the clock as you lie awake. These tips are often necessary for improvement but are not always sufficient in completely getting rid of insomnia.

When insomnia has become a long-term problem, you’re likely to have success with a remedy that breaks ineffective sleep patterns. Cognitive behavioral therapy for insomnia incorporates cognitive and behavior change techniques and targets the beliefs and habits involving sleep that are not working. It is considered the “gold standard” of treatment of insomnia because research findings of its effectiveness are strong. This is likely because it involves changing habits and thinking across multiple dimensions.

Regardless of what you end up trying and what works for you, educating yourself about sleep, recognizing your sleep behavioral patterns, and making changes are necessary. The Cancer Support Community has produced several resources on sleep in cancer survivorship, including a webinar and resources for managing treatment-related fatigue and sleep disorders available on the CSC website. Seeking outside help with insomnia may also be what is needed to help achieve a better night’s sleep.

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