Symptoms of Insomnia

The following are some common symptoms of insomnia:

• Difficulty falling asleep
• Waking frequently during the night
• Waking early in the morning and being unable to fall back to sleep
• Not feeling rested in the morning or feeling tired during the day
• Restlessness or anxiety as bedtime approaches

What Causes Insomnia?

There are many potential causes of insomnia for people living with cancer. A personal or family history of insomnia, the presence of a depression or anxiety disorder, and advanced age are all factors that can contribute to insomnia. Sleep disorders may also be caused by the effects of tumor growth, cancer treatments, certain medications, poor sleep habits, overnight hospital stays, and the psychological impact of cancer.

In addition, the following side effects of certain cancer treatments/medications can contribute to insomnia:

• Pain
• Anxiety
• Depression
• Shortness of breath (dyspnea)
• Itching (pruritus)
• Fever, night sweats, hot flashes
• Cough
• Headaches
• Fatigue
• GI disturbances (e.g., diarrhea, constipation, nausea)

Diagnosing Insomnia

Because it can arise from several different causes, it can be difficult to diagnose insomnia. Your doctor may take your medical history and perform a physical exam. Your doctor may ask about your sleep habits, exercise regime, current medications, use of caffeine or alcohol, sleep environment, and psychological well being. You may be asked to keep a sleep diary for a couple of weeks. Psychological tests, blood tests, and sleep tests (e.g., polysomnogram) may also help your doctor determine possible causes.

Treating Insomnia

Treatment of sleep disturbances like insomnia aims to identify and treat the underlying cause. Treatment may involve a combination of non-pharmacologic and pharmacologic approaches. The use of sleep medications is usually used on a short-term or intermittent basis only. Sometimes treating the cancer itself and the side effects of cancer treatment, as well as any comorbidities, may resolve the sleep disturbance. Another way to manage insomnia is a change in medication, treatment regime, or sleep environment/habits.

Some non-pharmacologic treatments include cognitive behavior therapy (to identify and change thoughts and behaviors that interfere with sleep), stimulus control therapy, sleep restriction procedures, relaxation techniques, and naturopathic therapies. In addition, behavioral management strategies, such as establishing a sleep routine may help. Another way to promote better sleep is to make lifestyle changes, including managing stress, anxiety and fatigue.

The Impact of Sleep Disturbances

Sleep is important for your physical and emotional health, especially if you are fighting cancer. Sleep disturbances can negatively impact your cancer treatment regime and your quality of life. For instance, poor sleep can make other cancer-related symptoms, such as pain and fatigue, worse. This may make it difficult for you to continue treatment. Sleep disruptions can also reduce the body’s ability to fight infection. Chronic insomnia can cause fatigue, irritability, concentration problems, depression, and anxiety. It can also affect your ability to cope with cancer treatment, complete daily tasks, and maintain your relationships with others.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS REPORT ANY SLEEP DISTURBANCES TO YOUR PHYSICIAN IMMEDIATELY.

Tips for Improving Sleep During Cancer Care

• Develop a pre-bedtime ritual. To help your body shift into sleep mode, establish a regular nightly routine. Lay out your pajamas, brush your teeth, take a warm bath, have a warm glass of milk or cup of chamomile tea, read a book, or listen to soft music. Avoid arousing activities before bedtime that cause excitement, stress, or anxiety, which can make it more difficult to fall asleep.
• Maintain a regular sleep schedule. Go to sleep and wake up at the same time each day, even on weekends. If you’re unable to fall asleep or go back to sleep after 20 minutes, don't lie in bed and think about how much sleep you're missing. Leave the bedroom and return when drowsy. If you need to nap during the day, limit naps to 30 minutes or less and do not nap after 3 p.m.
• Use your bed for sleep only. Reserve the bedroom for sleeping and sexual intimacy only so you can re-associate your bed with sleep. Go to another room to read, watch television, eat, and work. Also, getting intimate right before bed can make you revved up, so give yourself time to unwind afterward. Also, limit the time spent in bed to sleep only.
• Create a sleep-conducive environment. Keep your bedroom cool, well-ventilated, dark, and quiet. Sleep on a comfortable mattress with clean, dry, wrinkle-free sheets neatly tucked in, adequate bedcovers for warmth, and pillows for support. Wear loose, soft clothing to bed. Adjust the temperature in your bedroom to your personal comfort.
• Remove distractions from your bedroom. Keep your bedroom door closed to guard against distractions or noise from housemates or pets. Try using blackout curtains, eye shades, sleep masks, ear plugs, a white noise machine, humidifier, fan, etc. Move your clock out of sight to avoid looking at it during the night, which can heighten anxiety and worsen insomnia.
• Modify your diet. Avoid stimulants such as caffeine (e.g. coffee, tea, cola, chocolate) and alcohol for four to six hours before bedtime. Avoid heavy, spicy, or sugary foods late in the day. Instead, try a light snack two hours before bedtime, such as milk or turkey, which tend to promote sleep. Also, restrict fluids before bedtime to avoid waking up frequently to use the bathroom.
• Exercise regularly. Regular exercise can make it easier to fall asleep and help you sleep more soundly. Exercise may include as little as a 20-minute walk three times a week, depending on your doctor’s recommendations. Also, gentle stretching each day may help to relieve muscle tension, which can contribute to sleep impairment. Avoid exercising at least three hours before bedtime.
• Try to relax before bedtime. Use relaxation techniques (e.g., meditation, deep breathing, imagery, hypnosis, massage) just before going to sleep to reduce tension and anxiety. Sit in a dimly lit room before getting ready for bed and, once in bed, imagine yourself in a peaceful, pleasant scene. Avoid doing stressful or challenging activities in the evening.
• Take your medications as directed. Review all of your prescription and nonprescription medications with your doctor. Avoid taking medications right before bedtime that may keep you awake. Let your doctor know if you can't sleep because you are in pain, you feel anxious at night, or if you have recurrent nightmares.
• Keep a sleep diary. Record your sleep and sleep-related activities (e.g., the amount of sleep, the quality of sleep, the number of awakenings throughout the night) in a sleep diary. If you have problems with racing thoughts at bedtime, write down your worries/concerns and how you may address them. Share this information with your doctor.
• Manage stress during the day. Try different ways to reduce stress and tension during the daytime, such as relaxation techniques, deep breathing, stretching, meditation, massage, journaling, drawing, and music. Tell your doctor about other cancer-related symptoms, such as pain, depression, anxiety, and fatigue, which can contribute to sleep difficulties and vice versa. It may also help to join a support group or to seek professional counseling.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING SLEEP DISTURBANCES.

At Cancer Treatment Centers of America (CTCA), we understand sleep disturbances like insomnia can affect your energy level, mood, concentration, relationships, and overall quality of life during cancer treatment.

At CTCA, you'll have your very own care team comprised of cancer experts across multiple disciplines. Together, you and your care team will develop a comprehensive treatment plan that is built around your unique, whole-person needs.

Your plan will include the latest conventional cancer treatments combined with the following supportive therapies to address conditions like insomnia:

• Pain management: Your pain specialist will use various pain management techniques to help control your pain which can, in turn, improve sleep.
• Nutrition therapy: Your nutritionist will work closely with you to develop an individualized nutrition plan to fortify your body, combat fatigue, and promote sleep.
• Naturopathic medicine: Your naturopathic clinician will recommend natural therapies, such as nutritional supplements & botanical medicine, homeopathy, and traditional Chinese medicine to strengthen your immune system and help promote a healthy sleep pattern.
• Oncology rehabilitation: Your rehabilitation therapist will provide a personalized exercise program, including energy-saving techniques, to help you build strength and endurance.
• Mind-body medicine: Your mind-body therapist will provide techniques like relaxation techniques, guided imagery, and stress management to promote your emotional well-being and help you sleep better.
• Spiritual support: Your spiritual counselor will help nurture your spiritual well-being so that you may find inner peace and strength throughout your journey.
  

At CTCA, we understand sleep disturbances can interfere with your treatment regime, as well as your ability to lead a productive, fulfilling life. We are here to support you as a whole person, so you can move beyond cancer and find a new beginning.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.