Sweet, elusive sleep.
If you're a cancer survivor with insomnia, you're not alone. Insomnia is experienced by up to 60% of cancer survivors. This topic is important for cancer survivors with fatigue because sleep quantity and quality not only impact your ability to think clearly and function day-to-day - it also effects your overall experience of cancer related fatigue. Essentially, insomnia has the potential to make your fatigue worse and more difficult to cope with.
In this blog post, I'll explore characteristics of insomnia in cancer survivors, available treatment, and tips you can implement today to start getting a better night's sleep.
An Overview of Insomnia in Cancer Survivors
Insomnia is defined as dissatisfaction with sleep quality, difficulty falling asleep, staying asleep, or waking up too early at least three times per week over the past three months. Cancer patients with insomnia prior to their cancer diagnosis often suffer worsening insomnia after diagnsois, while cancer patients without a history of insomnia may suffer from new sleeplessness as a result of the stress caused by a cancer diagnosis.
Cancer treatment and the experience of being a cancer patient create a situation that perpetuates the insomnia initiated by stress. The disruption of schedules and routines, treatment side effects, pain, financial worries, less exercise, and daytime naps result in poor sleep. For cancer survivors, insomnia can have health consequences including increased risk of infections, decreased quality of life, a higher risk of anxiety and depression, and increased severity of other cancer related symptoms like pain or fatigue.
Additionally, after cancer treatment is complete, many cancer survivors' insomnia persists due to the conditioned response to the worry about sleep, increasing the pressure to "get back to normal" without the rest required for optimal physical and mental function. A dysfunctional focus on sleep ensues, creating a viscous cycle where insomnia becomes a self-fulfilling prophecy.
Ready access to insomnia treatment is important as cancer patients morph into cancer survivors. Unfortunately, it becomes more difficult to access good advice about sleep at this vulnerable time because regular visits to the clinic and infusion center become much less frequent.
Conventional Insomnia Treatment
There are various approaches to insomnia treatment. First, you must talk to your doctor about possible treatable medical or mental health issues that are disturbing your sleep. As an example, one of my patients was exhausted from "insomnia" during chemotherapy.
Upon further investigation, we realized he was getting up multiple times nightly due to frequent urination. Additionally, because he was so desperate for sleep, he started drinking whiskey before bed to knock himself out. I urged him to see his Urologist to address his enlarged prostate and to stop drinking alcohol. He made the recommended changes and found himself sleeping like a baby!
Conventional therapies for insomnia include cognitive behavioral therapy and medications. Cognitive behavioral therapy is the treatment of choice because it gets rapid and durable results. It might include one or a combination of the following subset types of behavioral therapies: relaxation, sleep restriction therapy, cognitive therapy, and cognitive behavioral therapy.
An in depth description of each type of therapy is beyond the scope of this writing, but the important point to make about cognitive behavioral therapies is that they are NOT widely available. So although they are extremely effective, the default treatment for insomnia is often prescription sleep medication. Sleep medications do work, are appropriate in some circumstances, and should be discussed with your medical provider.
There are multiple complementary therapies with acceptable research evidence backing their use for insomnia in cancer survivors. None are superior to cognitive behavioral therapy as mentioned above, but they can be effective and some have the added benefit of helping decrease fatigue, increase physical activity, and increase quality of life. Alternative therapies for insomnia include but are not limited to:
Tai Chi - shown to produce clinically meaningful improvements in insomnia in survivors of breast cancer in a randomized clinical trial published in the Journal of Clinical Oncology in August 2017.
Acupuncture - shown to have clinically meaningful and durable effects in cancer survivors with insomnia in a randomized clinical trial published int he Journal of Clinical Oncology May 2018.
Gentle Yoga - Grade C recommendation for sleep disturbance in the American Society of Clinical Oncology's practice guidelines for integrative therapies during and after breast cancer treatment.
Mindfulness Based Stress Reduction - meditation produced a clinically significant change in sleep and psychological outcomes in a randomized trial published in the Journal of Clinical Oncology February 2014.
What can you do right now?
We've discussed things your medical provider can do to help you with insomnia, and we've seen it may be worth your time to explore complementary therapies for insomnia. But what can you do right now to get things moving toward restful sleep?
Before writing any prescription or referral for cognitive therapy, I like to counsel cancer survivors in the area of good sleep hygiene. Sleep hygiene refers to maintaining habits and practices in your life and environment that promote rest. Here is a list of things to do to improve your sleep hygiene:
Decrease back lit electronic use prior to bedtime (cell phones and tablets!).
Hydrate early in the day so you aren't up at night using the restroom.
Avoid caffeine after noontime and if you're ultrasensitive to caffeine, don't drink it at all.
Wake up at the same time everyday.
Go to bed at the same time every night.
Sleep as long as necessary to feel rested, 7-8 hours, and then get out of bed.
Don't smoke cigarettes!
No TV before bed.
Keep your sleeping room dark.
If you're not tired, don't try to sleep.
Resolve anxiety provoking issues before sleep (resolve differences with a spouse, etc.) If you can't, write feelings in a journal.
Exercise regularly, but not within 4-5 hours of bedtime.
No daytime naps.
Sleep hygiene has been studied and while it does not help sleep to the degree of cognitive behavior therapy, it has been shown to produce some improvement in sleep.
Cancer survivors commonly experience sleep disturbances that exacerbate cancer related symptoms and decrease quality of life. I recommend discussing insomnia with your cancer care team and trying the powerful, complementary interventions we've reviewed here. You must also be the guardian of your own sleep hygiene which may be just what you need to turn the tide of insomnia in a favorable direction.
If you'd like to move forward on the path to better sleep and wellness with Brio, why not try Brio's FREE Morning Checklist? The checklist is a 7 Point Solution to Cancer Survivor Fatigue. Find out more out by clicking on the button below.
Quality rest is an essential part of the healing process after cancer, so sleep well Survivors!