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Losing Sleep Over Cancer

Medically reviewed by Smita Patel, DO, Susan Kerrigan, MD and Marianne Madsen on January 19, 2023

It’s not easy to sleep when you have cancer. Anxiety about the disease, treatment side effects, and crowded, noisy hospitals all conspire to rob patients of much-needed rest. Unfortunately, people battling both cancer and insomnia often never mention the disorder to their doctor. That can be a mistake. Getting enough sleep is vital to your recovery. Here’s what you should know about how to beat insomnia even if you’re fighting cancer.


A Tired Nation Needs a Break


Americans rarely brag about a good night’s sleep. We love to post about our healthy diet or fitness achievements. When we talk about sleep, it’s usually to brag about how little we need. A few years back, articles about Apple CEO Tim Cook’s 3:45 a.m. wake-up time inspired a slew of articles claiming that starting your day at four in the morning was a sure-fire productivity booster. Besides the near physical certainty that lots of folks who rise early will be soundly snoozing during afternoon meetings, early wake-up calls won’t help you get the job done if you’re emailing your boss at midnight. 


Most experts recommend that healthy adults get between seven to nine hours of sleep per night. Sure, plenty of driven executives may claim to need less than six. It’s just study after study has shown that lack of sleep contributes to everything from obesity to type 2 diabetes to cardiovascular issues. Yet more than one out of three American adults admit they average less than seven hours of sleep per night while half of them say they are tired on a regular basis. And that was before the pandemic. Since COVID-19 altered routines while shifting many 8 to 5 office workers to “always on” remote work, there has been a rapid increase in reported sleep disorders while two-thirds of adults in the United States say they don’t get all the sleep they need


As neuroscientist Athena Akrami, PhD, who is studying the role of COVID-19 in sleep disturbance explains, “Once sleep is disrupted, it can impact mental and physical health, which may in turn cause further sleep disruption. A vicious cycle may form that is very difficult to diagnose and treat properly.” A weakened immune system and increased inflammation are among the many health risks associated with chronic insomnia. Both are of concern to cancer patients. Unfortunately, at least one out of four must deal with insomnia even as they are dealing with the disease.


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Insomnia - Alternative Therapies

Insomnia - Alternative Therapies

Sleep and Cancer


Although pretty much everyone endures a restless night or a tired morning once in a while, chronic insomnia is defined as having trouble sleeping at least three nights a week for three months or more. Some symptoms of either chronic or short-term insomnia include frequently awakening during the night, having trouble falling asleep, or awakening too early in the morning. All those symptoms can affect cancer patients, some of whom never experienced insomnia prior to starting treatment for the disease.


Cancer occurs when damaged cells multiply and spread rather than die off. Studies have connected the disease to inflammation which is exacerbated by inadequate rest. So getting enough sleep if you have cancer is extremely important. 


Over a decade ago, a doctor surveyed a couple of dozen cancer patients about their sleep challenges. They responded with a variety of concerns. They felt their insomnia deserved greater recognition. They wanted more information about how to deal with their lack of sleep. Perhaps most significantly, many admitted that while they felt their lack of sleep was a serious issue they were uncomfortable mentioning it to their doctors. 


In the 2020s, an increasing number of health professionals are working to help their patients get a good night’s rest. One study examined ways to introduce insomniac cancer patients to medications used to treat sleep disorders in healthy patients. Another more recent study instead used step-up cognitive behavioral therapy. With this type of treatment, patients begin with the least resource-intensive treatment, like talk therapy. They only progress to more involved therapies if initial, simpler methods don’t succeed. Because of the potential for problems when cancer patients take drugs for insomnia, prescription sleep aids are a last resort. Indeed, even for the general population, starting with cognitive behavioral therapy (which trains insomniacs to control their thoughts in order to induce relaxation and rest) is a recommended first step.


While many approaches are still being studied, the ones with the most evidence for helping cancer survivors sleep are CBT, mindfulness-based therapies, qigong/tai chi, and acupuncture.


In fact, the advice for cancer patients who are having trouble sleeping mirrors the advice given to the general population. That includes developing a sleep routine, performing relaxation exercises, and avoiding spicy food and alcohol before bed. For patients, bringing comfy things from home like pillows, blankets, or a sleep mask can help them get a decent night’s sleep in a hospital. Asking if you can keep your door shut may help as well. In fact for cancer patients, speaking up and letting your doctor know the challenges you are facing — including insomnia — are an important step to getting the care you need. 


Written by John Bankston

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