'Insomnia - being up to see the sunrise, and realise you haven’t been asleep yet'.
If you, or someone you care about, has cancer - you may be having trouble sleeping. Insomnia can be bad enough when life is cancer free. It can feel even worse if your days are filled with work, family, appointments, treatments, etc. For those of you living daily with cancer, at whatever stage, a good night's sleep can feel restorative, and help you face another day.
I googled ‘insomnia’, and found over 84,900,000 results. It seems like it is a big and universal problem. ‘Insomnia’ is a clinical term for people who have trouble falling asleep, difficulty staying asleep, waking too early in the morning, or waking up feeling unrefreshed. More than 30% of the population suffers from insomnia.
Symptoms you may recognise:
(from NHS website)
- find it hard to go to sleep
- wake up several times during the night
- lie awake at night
- wake up early and cannot go back to sleep
- still feel tired after waking up
- find it hard to nap during the day even though you're tired
- feel tired and irritable during the day
- find it difficult to concentrate during the day because you're tired
Causes of sleeplessness
Cancer and its treatments can cause disturbed sleep - sometimes because of symptoms. These may include having to get up to the toilet frequently, hot flushes and night sweats, steroid medications, and/or pain.
It's also at night time that anxiety and worries play on the mind more. It could be the big things, the 'what if ' questions, and emotional turmoil about an uncertain future. Financial concerns, practical issues, work and family problems - often loom larger in the middle of the night.
Tips to help get a good night's sleep
There is a plethora of advice about how to get a good night’s rest…and seasoned insomniacs among you may well have other tips to offer. Here is a list I have adapted from various websites (drawing together the main suggestions)
- It helps to establish a regular, relaxing bedtime routine. Avoid stimulants like coffee, chocolate, and nicotine before going to sleep, and never watch TV, use the computer, smartphone, or pay bills before going to bed. Read a book, listen to soft music, or meditate instead.
- Avoid alcohol - It’s tempting to think alcohol will help you sleep, but as it’s a stimulant, it tends to help keep you awake.
- Don't eat a big meal or spicy foods just before bedtime. A small snack containing tryptophan (a natural sleep-promoting amino acid) may help, such as turkey, banana or fish. (NHS Choices webpage on Insomnia)
- Only go to bed when you’re tired. It’s tempting to just doze on the settee, but if you’re feeling that level of relaxation, it’s worth stirring, and going to bed.
- Try to make your bedroom is cool, dark, and quiet. I know it sounds common sense, but have comfortable bedding and pillows, and if you wear nightwear, ensure they're loose fitting.
- Avoid looking at the clock (easier said than done) - turn it away from you, if you can.
- Worrying can be the big issue. Keep a notepad by the bed. Write the worries down, and close the pad. They can be revisited in the morning if necessary.
- Don’t lay there getting more anxious and cross about it. If you can’t get to sleep, or are awake in the middle of the night, get up, go into another room, maybe read, or do a crossword, or listen to some music. Tell yourself it doesn’t matter, and stay there for at least half an hour, before returning to bed.
- An eye mask and ear plugs can be helpful, if outside light and noise is an issue.
- Don't use the bedroom for anything other than sleeping or sex. Tempting as it is, don't watch television, fiddle about with your laptop, eat, or text. Switch off the electronics.
- Try not to ‘angst’ about the night’s loss of sleep. Sometimes it’s a case of accept it’s a ‘no sleep’ night, and tomorrow night will be better, as you’ll be more tired. Getting stressed about it, just adds to the frustration (and sleeplessness).
When to see further help
If you’re not sleeping, and it’s becoming an issue, it is worth going to see your GP to talk things through. Short term sleep medication is sometimes helpful, but isn’t a good long term solution. Doctors are often understandably reluctant to prescribe sleeping tablets. They may suggest a low dose sleeping tablet, for a minimal length of time, as it doesn’t fix the long term issues.
Talk through your difficulties in sleeping with your specialist hospital team - it may be that your medications can be part of the cause. Steroids, for example, can cause some difficulty getting to sleep at night. If it’s cancer symptoms, pain, discomfort, indigestion etc, then mention these to your GP, consultant, or specialist nurse. Symptoms can be checked out, and efforts made to help you be more comfortable so you can sleep.
You can buy 'over the counter' remedies to help with sleep, but it always wisest to check with your GP or pharmacist if you're on any other medications which they might interfere with. Many of the herbal tablets are based around Valerian - it is frequently combined with hops, lemon balm, or other herbs that also cause drowsiness. I've read that it's better if you take them for 2 -3 weeks continuously, rather than occasionally. (Royal College of Psychiatrist's webpage on 'Sleeping Well')
Some ‘over the counter’ medications contain anti-histamines. The side effect of anti-histamines is drowsiness. It therefore follows that if you take them, you need to be careful about the effects lasting into the following morning. They can also leave you with a dry mouth and throat, and can clash with some of your other medications, so do check.
Meanwhile, If you live near one of our Maggie’s Centres, you’d be welcome to drop in and talk about your difficulties sleeping. Some of our Maggie's Centres hold sleep workshops. Talking about the underlying issues, learning some relaxation skills and stress management, can ease the emotional burden which may be contributing to the restless nights.
Finally, I’ve added some links at the end of my blog, here which you may find useful. Let us know what works for you,
Blog updated - April 2020
Sleep and cancer Maggie's
Difficulty Sleeping (insomnia) - Macmillan Cancer Support
Sleep Disorders – Anxiety and Depression association of America
Sleeping problems - Cancer.Net
Insomnia – NHS
Sleep disruption - Breast Cancer Now
Sleeping well - Royal College of Psychiatrists
Sleep disorders - National Cancer Institute