Managing Treatments

Insomnia and Cancer: Treating Sleep Issues During and After Cancer

Insomnia is a problem for a large portion of the population, and it specifically impacts cancer patients. To maintain strength during cancer treatment, sleep is imperative. If you're having trouble sleeping, be sure to talk to a member of your care team.

Sleep isn’t just a luxury or a simple pleasure, or what makes you feel rested and alert. It’s the most important thing you do all day. That doesn’t make catching it easy, regardless of whether you’re healthy or not.

While sleep issues are present in 10 to 15 percent of the population, the National Cancer Institute says that the insomnia and cancer go hand-in-hand for 33 to 50 percent of cancer patients. As well, insomnia doesn’t always end when a person is in remission. “Symptoms of insomnia continue to be very high in patients two to five years after treatment for cancer,” says Dr. J. Kim Penberthy, Ph.D., a professor in the department of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine and psychologist at UVA Cancer Center.

What Happens When You Don’t Sleep

Whether you have insomnia and cancer, or just rest issues, a lack of sleep can affect your mood, memory and performance of daily tasks, according to the American Psychological Association. That can be a safety issue, since it can cause a decreased reaction time when you’re driving. It can also increase your risk and level of high blood pressure, diabetes and heart disease. It can worsen depression and anxiety disorders, too. If you’re a cancer survivor or patient, you may experience insomnia due to medications, chemotherapy, radiation, hormonal therapy, pain, hot flashes, nausea or other symptoms and side effects, says Dr. Penberthy. Other factors affecting sleep include irregular sleep schedules, excessive amounts of time in bed, napping and unrealistic sleep expectations.

If you’re looking for insomnia relief, here are some options:

Relaxation Therapy

Relaxation therapy helps calm your mind by allowing you to focus on relaxing imagery, meditation and muscle relaxation. It’s a way to help you clear your head and prepare for sleep, so you’re not focusing on your daily activities and racing thoughts. This form of therapy involves improving sleep hygiene, like having set bed and rising times, not watching television in the bedroom and getting exercise during the day, as the U.S. National Library of Medicine describes. Relaxation therapy shouldn’t make you tired the way medications might, but it isn’t designed to help with other symptoms you experience with cancer treatment.

Cognitive-Behavioral Therapy

“Cognitive behavioral therapy (CBT) for insomnia aims to improve sleep habits and behaviors,” says Dr. Penberthy. The cognitive element teaches you to recognize and change beliefs affecting your ability to sleep. This may include learning to control or eliminate any negative thoughts and worries that keep you awake. The behavioral part helps you develop good sleep habits and avoid hindering behaviors. “Cognitive behavioral therapy for insomnia can benefit nearly anyone with sleep problems, including cancer patients and survivors, and the effects seem to last,” she says. Unlike pills, CBT addresses the underlying causes of your sleep problems.

CBT usually involves in-person meetings with a mental health provider, like a psychologist or social worker, and implementation of strategies at home. Treatment length depends on your response to it. “Both in-person and online approaches have research support documenting their effectiveness,” says Dr. Penberthy. Internet versions of CBT for insomnia include programs such as CBTforInsomnia, Sleepio, SleepTutor and SHUTi.

Pharmacological Treatment

Medications are sometimes used to treat insomnia with cancer, according to the National Cancer Institute. There are different classifications of medicines used for sleep — some that require a prescription, some that don’t. Even with over-the-counter medications, it’s important to talk to your doctor before taking them. Some are addictive and should only be used short term. Physicians recommend making lifestyle changes while taking sleep medications so you can wean off the medication and have effective sleep tactics already in place.

Deborah Abrams Kaplan
Deborah Abrams Kaplan