Herbie Murray
Sleep disorders are a common side effect of cancer treatments, with sleep often being impacted for a long time after treatment. Many people who have survived cancer treatment experience poor sleep, with 51% of cancer survivors reporting disturbed sleep. Sleep disorders can be treated successfully, but an accurate diagnosis is essential. Cancer survivors may experience sleep disorders due to physical changes caused by cancer or surgery, side effects of medications or other treatments, stress and anxiety, or health problems not associated with cancer. Chemotherapy, in particular, has been associated with inflammation and the production of sleep-modulatory cytokines, which can cause chronic fatigue. To sleep better after chemotherapy, it is recommended to stick to a consistent sleep schedule, avoid napping during the day, limit the use of electronics before bed, and create a relaxing sleep environment.
| Characteristics | Values |
|---|---|
| Common sleep disorders after chemotherapy | Insomnia, hypersomnia, narcolepsy, restless leg syndrome |
| Reasons for sleep disorders | Physical side effects, stress, anxiety, medication side effects, irregular sleep patterns, fear of cancer recurrence |
| Recommended actions | Consistent sleep schedule, exercise, avoid caffeine, alcohol, nicotine, heavy meals, bright lights, electronics, naps, cognitive behavioral therapy, integrative therapies, medication |
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What You'll Learn
Stick to a sleep schedule
Sleep disorders are a common side effect of cancer treatments, and many people who have survived cancer treatment experience poor sleep long after treatment has ended. Sleep is essential for your body to refresh, replenish, and rebuild, and it helps your immune system work better. Most adults need at least 7 hours of sleep each night, but you should talk to your doctor about what's right for you.
Go to bed and wake up at the same time every day:
Consistency is key when it comes to regulating your sleep. Try to go to bed and wake up at the same time every day, even on weekends. This helps to establish a regular sleep pattern and can improve your overall sleep quality.
Develop a bedtime routine:
Create a standard, predictable bedtime routine that helps signal to your body that it's time to wind down and prepare for sleep. This could include activities such as reading a book, listening to calming music, or taking a warm bath. Aim to start your bedtime routine at roughly the same time each night to reinforce your body's sleep-wake cycle.
Avoid napping during the day:
While it's tempting to take a nap when you're feeling tired, especially during chemotherapy, excessive napping during the day can disrupt your nighttime sleep. If you must nap, limit your nap time to 20-30 minutes, no more than twice a day.
Avoid stimulants and electronics before bed:
Caffeine, nicotine, and electronic devices can stimulate your brain and make it difficult to fall asleep. Avoid caffeine and nicotine close to bedtime, and try to stop using electronic devices at least one hour before you plan to sleep. Instead, opt for relaxing activities that can help you unwind and prepare for sleep.
Make your bedroom sleep-friendly:
Ensure your bedroom is quiet, dark, and relaxing, and maintained at a comfortable temperature. The ideal temperature for sleep is 68°F. Remove electronic devices such as TVs, computers, and smartphones from your bedroom, and consider using earplugs or a sleep mask if necessary.
Keep a sleep diary:
Consider keeping a sleep diary to track your sleep patterns and any factors that may be affecting your sleep. Include information such as the time you go to bed, how long it takes you to fall asleep, your nap schedule, your exercise routine, and any medications, caffeine, or alcohol consumption. This can help you identify patterns and make informed decisions to improve your sleep.
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Avoid caffeine, nicotine and alcohol
Sleep allows your body to refresh, replenish, and rebuild, and it is common to feel very tired during and after cancer treatment. Sleep disorders are an unpleasant side effect of cancer treatments, and insomnia and hypersomnia are common sleep disorders that cancer survivors experience.
One way to improve sleep after chemotherapy is to avoid caffeine, nicotine, and alcohol. Nicotine is a stimulant that can cause sleep disorders, and caffeine can also negatively impact sleep, especially if consumed in the late afternoon or evening. Alcohol is known to worsen nausea and vomiting and can increase the risk of gastritis. Chemotherapy can cause liver damage, and alcohol consumption can worsen this damage.
Additionally, alcohol does not help achieve a restful night's sleep, contrary to popular belief. While a small amount of alcohol may help boost your appetite, excessive drinking is not recommended during chemotherapy. It is best to check with your doctor or healthcare team to ensure that alcohol will not negatively interact with your chemotherapy drugs.
It is important to note that caffeine, when consumed in moderation, can be beneficial for chemotherapy patients experiencing nausea and heartburn. However, excessive caffeine can lead to dehydration, which is crucial to avoid as many chemotherapy medications are eliminated through the kidneys and liver.
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Exercise regularly
Exercise is an excellent way to improve sleep quality after chemotherapy. It is, however, important to consult your doctor or a specialist before starting an exercise routine, especially if you are still undergoing treatment. This is because different people undergoing chemotherapy will be able to perform different types of exercise.
Once you have the go-ahead from your doctor, you can start slowly with light and gentle exercises such as walking, tai chi, yoga, or stretching. Walking is generally safe for most patients undergoing chemotherapy and is a good way to stay active without overexerting yourself. Yoga, in particular, can help with flexibility and get you ready for more vigorous exercises.
When you feel comfortable, you can gradually increase the intensity of your workouts. The American College of Sports Medicine and American Cancer Society recommend 150 minutes per week of cardiovascular exercise and 2-3 days of strength training per week. You can focus on major muscle groups such as the quads, hamstrings, core, and upper back.
Exercising regularly can help to improve your sleep by reducing inflammation, promoting neuroplasticity, and enhancing the brain's ability to modulate pain. It can also help to elevate your mood, reduce anxiety, boost your energy levels, and improve your overall quality of life.
Additionally, setting exercise goals can help to keep you motivated. This could be as simple as committing to exercise three days a week or signing up for a charity walk or 5K event. You can also track your progress using a journal, pedometer, or fitness-tracking smartphone apps.
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Keep a sleep diary
Sleep disorders are a common side effect of chemotherapy, and insomnia is a frequent issue for cancer patients. If you are having trouble sleeping after chemotherapy, keeping a sleep diary can be a useful way to identify what is keeping you awake at night and to help your doctor understand your sleep patterns.
A sleep diary is a record of your sleep habits and can be used to identify any behaviours that could be modified to improve your sleep. It can also be used to track the effectiveness of any changes you make to your bedtime routine. In your diary, record the medicines you take, when you go to bed, how long it takes you to fall asleep, your nap schedule, and how much you are exercising. Also, note any caffeinated or alcoholic drinks you have consumed, as these can affect your sleep.
You can also use your sleep diary to record your thoughts, concerns, and responsibilities, as these may be keeping you awake at night. It is important to write down any stresses, anxieties, or fears that may be causing sleep problems, but it is best to do this early in the day, rather than just before bedtime.
Keeping a sleep diary can help you to identify patterns in your sleep habits and any changes that could be made to improve your sleep. For example, you may notice that you sleep better on days when you have exercised or avoided caffeine. Alternatively, you may find that certain thoughts or worries are keeping you awake, and you can then work on addressing these issues.
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Try cognitive behavioural therapy
Chemotherapy can be particularly disruptive to sleep. Sleep disorders are common in people who have undergone chemotherapy, and insomnia is a frequent issue. Cancer and its treatment can upend sleep routines, with patients taking more naps or waking up anxious in the middle of the night.
Cognitive behavioural therapy for insomnia (CBT-I) is recommended as a first-line treatment for insomnia by the American Academy of Sleep Medicine and the American College of Physicians. CBT-I targets the behaviours and thoughts that cause a person to sleep poorly. For example, a patient may develop a habit of taking naps during chemotherapy, which can then affect their ability to fall asleep at night.
CBT-I can help patients identify and change thoughts and behaviours that interfere with sleep. This can include reducing arousal or stimulation when trying to sleep, and changing sleep-related behaviours that are incompatible with good sleep. CBT-I can also help patients set appropriate expectations for sleep. For example, the expectation of falling asleep within 5 minutes every night and sleeping for 9 hours straight is probably unrealistic.
CBT-I can also involve tracking sleep patterns and developing a sleep period that is better aligned with how much sleep a patient needs. This can include giving patients a planned bedtime so they don't go to bed when they're not tired, and teaching stress reduction techniques. Patients can also be taught stimulus control, sleep restriction, relaxation, paradoxical intention, and cognitive therapy techniques.
In addition to CBT-I, there are other steps you can take to improve your sleep after chemotherapy. These include:
- Sticking to a consistent sleep schedule
- Avoiding napping during the day
- Avoiding bright lights and activities that stimulate your senses within a few hours of bedtime
- Avoiding the use of electronics in bed and before bedtime
- Avoiding caffeine, nicotine, and alcohol
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Frequently asked questions
Sleep issues are common during and after cancer treatment, with 51% of survivors reporting disturbed sleep over nine years after treatment. Sleep disorders are most common after chemotherapy, with insomnia and hypersomnia being prevalent and often chronic problems.
There are several ways to improve sleep after chemotherapy, including:
- Maintaining a consistent sleep schedule
- Avoiding napping during the day
- Removing electronic devices from the bedroom
- Avoiding caffeine, nicotine, and alcohol before bed
- Keeping the bedroom dark, quiet, cool, and comfortable
- Trying muscle relaxation, biofeedback, imagery, hypnosis, and thought-stopping techniques
- Taking a bath, reading a book, or listening to calming music before bed
- Getting morning sunlight to increase melatonin
If you continue to experience sleep issues, it is important to reach out to your healthcare provider to determine better coping strategies or treatments. Keeping a sleep diary to track your sleep patterns and habits can be helpful to share with your doctor. Cognitive behavioral therapy for insomnia (CBT-I) is also recommended to address problematic sleep behaviors and thoughts.
