When Sleep Won't Come
Anne Coscarelli, Ph.D.
Many women undergoing cancer treatment experience difficulty in sleeping. Several years ago, Patricia Ganz, MD, Carol Fred, LCSW, and I conducted a study where we asked women with a diagnosis of breast cancer how they were sleeping. We learned that of the 227 women involved, approximately 70% reported that they had difficulty sleeping during the first month after the diagnosis. Approximately 50% reported difficulty sleeping one year later. These data suggest that this is an issue that needs attention.
Stress and anxiety brought on by the diagnosis of cancer can cause disturbed sleep or insomnia. Individuals often report that it is difficult to fall asleep, or that they wake up and can not go back to sleep. They often find that certain thoughts keep repeating over and over making it difficult to relax enough to fall asleep.
Disrupted sleep can be very frustrating and sometimes harmful. Sleep is restorative, both for the body and for a peaceful and organized mind. Sleep deprivation can lead to difficulties in concentration, impaired judgment, and reduced reflexes. Lack of sleep also can make it very difficult to cope with and tolerate the range of emotions that are commonly experienced after a cancer diagnosis and during cancer treatment. Lack of sleep also can lead to increased pain and bodily discomfort. For persons with cancer, good quality sleep may be just what they need but the most difficult to obtain.
What can you do about sleep problems?
It is important to understand that people with cancer commonly have sleep problems. In many cases, sleep disturbances will resolve themselves over time as the initial crisis of cancer diminishes and order is re-established. It is still important, however, to make real efforts to increase your ability to sleep well. Here are some recommendations that may help:
Seek emotional support for your worries and concerns. Emotional support can come in a variety of forms. Having a friend or partner who will listen to your fears and worries can be very helpful and may help you avoid the repetitive thinking and reviewing that can keep you up all night. Clinicians such as our staff of licensed clinical social workers are available to help you sort out concerns and find appropriate solutions. Sometimes, just having a place to talk about your worries can relieve some distress and allow sleep to come more easily. Seeking comfort in a support group can have a similar result.
Learn stress management techniques. There are many different stress management and relaxation techniques that you can learn to help facilitate sleep. These techniques are skills that must be learned and practiced. They do not come automatically to most people. Many books and tapes are available on this subject. Our Center offers seminars which teach deep breathing techniques, mindful meditation, guided imagery, and self-talk. Partners and adult family members are welcome in our stress management class because they, too, frequently experience disturbed sleep.
Create the right environment for sleep. Beds and bedrooms often lose their effectiveness as places for sleeping. They become offices with computers and fax machines or entertainment centers with televisions and stereos. Using your bedroom for activities other than sleep can pose a problem - the bedroom stops being an environment for rest and relaxation, and this can impede your sleep.
Take a look at how your bedroom is used - are there ways in which you can reduce the stimulation (and sometimes the stress) associated with the activities that take place there? I have a firm rule in my house: work and distressing tasks never take place in my bedroom. A bedroom should be a sanctuary for rest and a peaceful place for comforting experiences. It also is important not to fall asleep in other places. Do you remember that awful feeling when you woke up in the middle of the night having fallen asleep on the couch while watching TV? If you are feeling drowsy, get yourself into your bedroom and into your bed. You will sleep better if you sleep consistently in the same place, and that place should be your bed.
Seek consultation about medications Talk to your physicians about your sleep difficulties. Sometimes, these difficulties may be affected or caused by the medications you are taking. There also are medications that can be prescribed to help with short-term sleep problems. In cases where the sleep disturbances are more long-term, anti-depressant medications often are very effective. Don't let the term anti-depressant alarm you - these medications are just a group of drugs that affect neurotransmitters in the brain that regulate basic functions such as mood and sleep. Many primary care doctors are comfortable prescribing these medications; we recommend, however, a consultation from a psychiatrist who is trained in the use of these medications. Our Center can give you referrals for such consultations. Not everyone who has sleep problems is depressed, but significant sleep disturbance is often a symptom of clinical depression, and these medications can have an impact on your mood as well. It is important, therefore, that you consult with a health care professional if you use these medications for sleep. Sometimes long-term use of certain drugs can lead to more disturbed sleep. Similarly, alcohol can have a negative effect on sleep even though initially it may seem to help.
Take good care of yourself. "Old fashioned" remedies such as a hot bath, warm milk, or a cup of herbal tea can be very relaxing at bedtime and may help facilitate your sleep. Keeping a regular routine in your life also will help. Establish a reasonable bedtime, time for relaxation, time for exercise (even if it is a brief walk), regular healthy meals, and eliminate caffeine. If you drink alcohol, just drink a light amount. Building this daily routine can help create clear distinctions between night and day and the activities associated with them. Try to have some quiet, pleasant and peaceful activities just before you go to bed.
Learn how to manage a bad night. No matter what you do, sometimes you may have a bad night. You may find yourself waking up frequently or worse, not being able to go back to sleep. If this happens, you may want to get up, leave the bedroom and go to another place in your home where you can do a relaxing or quiet activity. Read a magazine, a light book or some poetry, make some Sleepytime tea or something warm without caffeine, or watch an old Lucy or Green Acres rerun on TV. Do this activity for a short time and then return to your bedroom and try to sleep once again. If you find that you are tossing and turning, it's important to get out of bed. Doing something else will help you feel more in control which should help reduce your frustration. Pay attention to the thoughts going through your mind and try to replace self-criticism and worries with more constructive and comforting thoughts. Don't beat yourself up if you are having trouble getting to sleep. Talk to yourself and recognize that you are having a tough time. Give yourself permission to rest.
Anne Coscarelli, Ph.D.
Wallis Annenberg Director’s Initiative in Psychosocial Oncology
© Anne Coscarelli, Ph.D. All rights reserved.