Breast Cancer & Insomnia: How to Manage Symptoms

Sleepless Nights During & After Treatment

woman with insomnia
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It’s after 11p.m. You’re tired. You think you can sleep. You get into bed, feeling sleepy, and then without warning you are wide-awake. After an hour of trying to fall asleep, you give up, get up and begin roaming the house, watching TV, trying to read, or surfing the net trying to turn your head off and escape your thoughts. You wind up getting back to bed in the early morning hours and getting just a few hours sleep.

Maybe your sleep problem is different. You have no problem falling asleep; your problem is staying asleep. You wake in the early morning hours, after just a few hours asleep. Sometimes you can get back to sleep after an hour or so, but sometimes you can’t.

This is no longer a rare occurrence; it is getting to be a regular routine for you ever since your breast cancer diagnosis. It leaves you exhausted the next day, and sometimes irritable.Your breast cancer-related insomnia is becoming a way of life. It’s not healthy; it is taking a toll on you both physically and emotionally.

If you see yourself in the above descriptions, you are are not alone. Insomnia is common among breast cancer patients in treatment as well as those who have completed treatment.

Many  patients receiving chemotherapy will have difficulty sleeping while going through treatment. Radiation treatment can cause insomnia. Pain, anxiety, depression, and certain medications can also cause insomnia. Hormone therapy, taken for five to 10 years after active treatment to reduce the incidence of recurrence, is known to cause insomnia.

Physical changes as a result of your surgery may contribute to you being unable to get to sleep or stay asleep, as well as hot flashes and night sweats, which are common side effects of hormone therapy medications.

According to a study presented at the Oncology Nursing Society (ONS) 40th Annual Congress 2015, about 75 percent of breast cancer survivors experience long-term sleep problems.

Stress is a major cause of insomnia. A diagnosis of breast cancer and going through treatment with all its changes—both short and long term—are a cause of major stress for most of us. Bedtime, when there are no distractions, is usually the time when we cannot turn the worry off. If you are newly diagnosed, breast cancer tends to be the last thing on your mind each night and the first thing on your mind when you awake.

Managing Your Insomnia

Begin managing your insomnia by having a talk with your oncologist to discuss what might be causing your insomnia. He or she will want to treat symptoms such as pain, hot flashes, nausea, and depression to see if that will enable you to get a good night’s sleep.

If your insomnia continues, you may be treated with medication that tends to be strong and can be dangerous if you are taking other medications for anxiety. You can find yourself feeling more tired the next day as a result of taking sleep-inducing medication. There is also a risk of becoming dependent. These medications are meant for short, not long-term use.

Non-prescription sleep medication that you can purchase over the counter can also cause problems. Most of these medications contain antihistamines, which make the person taking them feel sleepy, but they can also cause drowsiness the next day.

Herbal sleep aids, which are also available over the counter, such as melatonin, kava-kava, and valerian are also used by some who have insomnia. Since they are not required to meet the strict government standards of prescription medications, little is know about their side effects, and how they may interact or interfere with chemotherapy drugs or hormone therapy medications.

Before you take any medication or supplement, for any reason, be sure to speak with your physician to be sure taking it will not reduce the effectiveness of your chemotherapy or hormone therapy.

There are simple, practical things that you can try to improve your sleep that do not require medication:

  • Exercise daily; be sure to stop three hours before bedtime.
  • Drink only caffeine-free beverages.
  • Avoid heavy meals during the day.
  • Before bed drink warm, caffeine-free drinks, such as warm milk or decaf tea.
  • Avoid alcohol for several hours before bedtime.
  • Keep naps short during the day, so you are tired and ready to sleep at night.
  • Take pain medication at the same time each night.
  • Take a warm bath before bed.
  • Wear light-weight, comfortable night clothes.
  • Keep bedding comfortable.
  • Don’t watch TV in bed before trying to sleep.
  • Keep the bedroom cool.
  • Read a book.
  • Listen to music.
  • Meditate.

During my first breast cancer, when I couldn’t get to sleep, I’d get up, go on my computer and write whatever was on my mind until I was too tired to write anymore. The act of writing gave me somewhere to go with my concerns. When I was done, I’d promise myself that I would read what I had written after I had slept and would try to get answers for those concerns. It worked; I could go back to bed and sleep.

Joining a breast cancer support group also helped reduce my sleepless nights. If you are not feeling well enough during treatment to go to a community-based support group, an online or telephone support group can help a great deal in reducing your anxiety and feelings of isolation.

If your insomnia persists after eliminating the underlying causes, such as pain, there are other non-medication approaches that have a track record of success in reducing the incidence of sleep disturbance, including:

  • Counseling, which is usually available in cancer treatment centers where a therapist can help you deal with the stress of a breast cancer diagnosis. Counseling can be done individually or in groups.
  • Stimulus Therapy is a therapy that focuses on creating a regular schedule of sleeping and waking. This involves:
    • Developing  a routine before bedtime that will help you get to sleep and stay asleep. It requires that you choose to go to bed only when you are sleepy. If, after 20 minutes in  bed, you are still awake or cannot get back to sleep after waking, get up and return to bed only when you again feel sleepy.
    • You need to get up at around the same time each day. If you need to nap, keep your nap to no more that 30 minutes, with no napping after 3 in the afternoon.
    • You need to think of your bed only for sleep and sexual activities. Watching television, eating, or reading in bed are not considered conducive to sleep.
    •  Your time spent in bed needs to be limited to time sleeping. Limiting time in bed will result in mild sleep deprivation, which leads to more efficient sleep.
  • Relaxation Therapy is about developing techniques and activities that result in muscle relaxation. Methods may include:
    • Biofeedback, which is training patients to control their muscle tension, blood pressure, or heart rate and other bodily processes. It is used as an alternative to medication for anxiety.
    • Most of us can benefit from more informal relaxation techniques training that is often available in treatment environments provided by a relaxation therapist who specializes in working with cancer patients. Community centers often offer classes in relaxation techniques that you can do on your own. You may find deep breathing, stretching, and meditation can help you relax. A quiet time hobby, such as knitting or quilting, can also relax you before bed.
  • Cognitive Therapy helps the person with insomnia to identify long-held attitudes about sleeping and having insomnia that could be part of anxiety about being unable to sleep. Such beliefs can include unrealistic sleep requirements and attributing daytime cognitive impairment to not getting enough sleep. In actuality, memory problems can be caused by the side effects of active treatment, especially chemotherapy and medications for pain as well as sleep deprivation.

You need to sleep to heal and function emotionally as well as physically. Whatever is causing your insomnia, get help.

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