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Sleep Problems After Cancer: What You Should Know and How to Cope

As a cancer survivor, you know all too well that your health problems didn’t simply vanish the moment you stopped your cancer treatment. While your post-treatment experience is unique, sleep problems are common for cancer survivors. It can be extremely frustrating to have sleep problems during your recovery. Just when you thought you could get back to normal, sleepless nights have you feeling comatose. Your exhaustion causes you to spend your newly cancer-free days napping. In this article, we'll provide information on insomnia and sleeping problems as well as some ways to help you improve your sleep.

What is insomnia?

Insomnia can include difficulty falling asleep, the inability to stay asleep, or waking up too early. Up to 75% of both newly diagnosed and recently treated cancer patients experience insomnia. That’s twice as high as the general population. Short-term insomnia is when your sleep problems last for a few days or weeks. Chronic or long-term insomnia is when you experience sleep disruptions for three or more nights a week and for more than three months.

Even if you have one or two bad nights of sleep a week, your body will suffer. If you need eight hours of sleep to function well, but you only slept for six hours last night, you will “owe” your body two hours of sleep. This concept is called sleep debt.  Any amount of sleep deprivation will have consequences, but the more sleep you “owe” your body, the worse you will function and feel.

If you get a full night of sleep (depending on age, most people need seven to nine hours) but still feel exhausted in the morning, you may have sleep quality issues. Sleep quality issues might show up as daytime weariness, drowsiness, fatigue, lethargy, or sluggishness. Sleep quality issues are more common in those who have sleep disorders like obstructive sleep apnea. These conditions make it hard for your body to fully rest while asleep.

What causes sleep problems after cancer?

Your sleep problems may be a combination of cancer-related and habit-related factors. It’s likely that your normal habits and routines were disrupted due to your cancer diagnosis. You could be dealing with changes in your body that have been caused by cancer, surgery, or chemotherapy. You might have pain as a result of your cancer or treatment. Some of your medications could have sleep-impacting side effects. Your stress levels may still be high from having cancer and going through treatment. Having mental health conditions like depression and anxiety make it harder for you to sleep, too. 

What happens if sleep problems aren't managed?

Sleep is a critical part of good health. If you're not sleeping, you're at a higher risk of developing a handful of other diseases. Those who don't sleep are more likely to experience chronic health problems like heart disease and high blood pressure, diabetes, and mental health problems like depression.

Aside from health problems, trouble sleeping can affect your work and social life. You could find yourself dozing or nodding off during work meetings and social events, or even while driving. Research from the Centers for Disease Control and Prevention (also known as the CDC) shows that sleep deprivation can lead to mental and physical impairments that are similar to alcohol intoxication.

It’s important to talk to your doctor about your sleep problem. They can rule out any health-related factors, or provide care for them. Below are some signs that it's time to seek medical help for your trouble sleeping:

  • You have symptoms of Obstructive Sleep Apnea (heavy snoring or interrupted breathing during sleep)

  • You have symptoms of Restless Legs Syndrome (uncomfortable feelings in the legs while sleeping or resting that get better when you move them)

  • You have symptoms of Narcolepsy (you fall asleep suddenly or lose muscle control while wide awake)

  • Frequent urinating (this may be a sign of bladder problems or sleep apnea)

  • Frequent teeth grinding or clenching

  • Severe emotional distress

What steps can I take to improve my sleep?

Establish a good nighttime routine

It's important to have a good nighttime routine before you go to bed. Adding some relaxing activities to your evening may help you unwind and feel sleepy. Some people benefit from meditating, reading, or journaling. If you have an active mind while you’re trying to sleep, mindfulness practices like journaling and meditation can be particularly helpful. These give your mind a chance to relax and process the day. 

Here are some more ideas for ways to unwind:

  • Take a relaxing shower

  • Do yoga or gentle stretching

  • Put on some nature sounds

  • Go for a slow evening walk

  • Make a cup of caffeine-free herbal tea

Going to bed and waking up at the same time every day also helps your sleep. When you're consistent with your bedtime, your body will naturally begin to adjust and you'll feel sleepy when it's time for bed. Similarly, getting up at the same time in the morning can make it easier to get out of bed. Do your best to stick to the same times, even on days you don't work.

Watch what (and when) you eat

Eating close to bedtime can make it harder for you to sleep, especially if you eat large meals. This is even more important if you have Gastroesophageal reflux (GERD). GERD is also known as acid reflux or heartburn. Those who have trouble sleeping are also more likely to develop GERD. Eating close to bedtime can make these symptoms worse, which can cause you to wake up throughout the night.  

If you do have GERD, it’s a good idea to talk to your doctor about treatment as medication may be necessary to manage your symptoms. Sleeping in an elevated position with an extra pillow behind your head and upper body can reduce acid reflux. It’s also a good idea to avoid greasy, high-fat foods and acidic foods like tomatoes and citrus. Adding high-alkaline foods like bananas, cauliflower, cucumbers, and pears to your diet can help reduce stomach acid.

What you drink can affect your sleep, too. Alcohol suppresses REM (rapid eye movement) sleep, which is the deepest form of sleep. This means that after a night of drinking, your sleep isn't as deep or restful. You're likely aware that caffeine can make it harder to sleep, but drinking caffeine even six hours before bedtime can make it hard to fall asleep and stay asleep. Try to avoid caffeine during the second half of your day.

Get moving

Exercise is helpful for all sleep problems, but it's especially helpful for sleep quality issues. Exercise is often used alongside other treatments for sleep concerns. Of course, not sleeping well makes it harder to exercise. This can create a vicious cycle of not sleeping because you're not moving enough, and not moving enough because you're exhausted from a lack of sleep. If this cycle sounds familiar, try some easy forms of movement like walking or stretching, or exercise for short amounts of time at first. As you add in more exercise, your energy levels and sleep will improve gradually with time. This will make it easier to be more consistent. You'll want to work up to at least 30-40 minutes of aerobic exercise (like biking or jogging) two or more times a week.

Limit screen time

Using light-emitting devices like your phone and the TV close to your bedtime can make it harder for you to sleep. These devices expose you to blue light, which delays your body's melatonin production. Melatonin is the hormone your body makes to help you feel sleepy. When you’re exposed to bright light, your body delays the production of melatonin because it thinks it’s not time for bed yet. This means you may have a harder time falling and staying asleep. Try to to shut off screens at least two hours before you go to bed. If you're having a hard time breaking your screen use habit, using blue light blocking glasses may help reduce the effects.

Spend your mornings outside

A recent study found that exposing yourself to bright morning light helps reset your circadian rhythm. Your circadian rhythm, also known as your body's internal clock, is responsible for when you feel alert and when you feel sleepy. It's best to get real sunlight, but bright artificial light works, too. Morning light exposure causes your body to start making melatonin sooner at night, which means you fall asleep more easily when it's time for bed. Bright morning light can also help with premenstrual syndrome and seasonal affective disorder (SAD).

Keep your bedroom comfortable and only for sleep

It's important to make sure your bedroom is dark, noise-free, and kept at a cool, comfortable temperature. If you share your bedroom with another person, make sure you communicate these needs. Establishing good sleep habits often takes agreement and alignment from the people in your life.

If you use your bed for active things like watching TV or using your phone, your brain can begin to associate your bed with wakefulness. Similarly, if you only use your bed for sleep, your brain will be more likely to associate your bed with sleep.

If it takes you more than 20 minutes to fall asleep, or if you wake up and can’t fall back asleep for more than 20 minutes, it can help to get out of bed and do something relaxing until you feel sleepy again. It’s important to avoid using screens as part of your relaxing activity. Remember that blue light exposure can make it harder to fall back asleep.

Consider Cognitive Behavioral Therapy for insomnia (CBT-i)

Cognitive Behavioral Therapy for insomnia (CBT-I) helps you address any sleep-related behaviors that are preventing you from falling asleep and staying asleep. Research has shown that CBT-i may be more effective at treating insomnia than benzodiazepines like Xanax and Ativan that are often prescribed for sleep. CBT-i can be provided in-person by a trained therapist, or it can be done digitally through a self-led course. CBT-i focuses on three main areas:1. Predisposing factors: your traits that make you more likely to develop insomnia2. Precipitating factors: situations that may trigger insomnia3. Perpetuating factors: thoughts and behaviors that make you more likely to have chronic or long-term insomnia

CBT-i helps you identify any thoughts and behaviors that are negatively affecting your sleep while also giving you tools and strategies to change them. At Goodpath, we offer a digital CBT-i course as part of our integrative sleep program to treat chronic insomnia.

If you smoke, consider quitting

It's no surprise that smoking has a negative impact on many areas of your health, but it affects your sleep, too. If you're feeling ready to quit, creating a Quit Plan can make the process a little easier:

1. Set a date. 

The best time to quit is within two weeks of making your decision. Nicotine withdrawal usually peaks within the first three days of quitting. Your motivation is highest when you first make the decision to quit, so use that momentum to carry you through those tough first few days. 

2. Lean on your friends, family, and loved ones for support.

All of life's difficult moments are easier when you have support. Think about what kind of support would be helpful. Would you like to have someone to reach out to when you have the urge to smoke? Or, would it help to ask others who still smoke to avoid doing so when you're around? Maybe you can ask for guidance from someone you know who has quit. Be sure to advocate for yourself and your needs.

3. Plan ahead for challenges.

The process of quitting is not easy, especially during the first few weeks when you're experiencing withdrawal symptoms. You may also have formed habits around smoking that require work to unlearn. For example, you may have the habit of taking a smoke break every day during lunch. Think about ways to redirect your urge to smoke. Some people find something to keep their hands active, or chew a piece of gum.

4. Get rid of tobacco products and any smoking triggers.

Quitting is easier when you make it harder to access tobacco. It can help to get rid of lighters, ash trays, and other items that remind you of smoking, too.

5. Find healthy ways to cope.

Many people smoke as a way to cope with stress or other difficult emotions. Find some healthy ways to cope with these emotions so you'll feel less tempted to use tobacco.

Related article: Life After Cancer

Sleep support from Goodpath

At Goodpath, your sleep program includes information about sleep, coach support for accountability and gentle guidance, and analysis of your sleep habits based on your self-reported sleep data. All of our programs are tailored to your unique needs based on your health history and your concerns. Click here to fill out a brief sleep assessment to improve your sleep today.