Sleep Problems

If you have insomnia, you might:

• Have trouble falling asleep.
• Wake up at night and have trouble going back to sleep.

Insomnia can be short-term and last only for a single night, a few days, or a few weeks. It can also last longer and become chronic. This means it lasts for 3 months or longer and happens at least 3 nights of the week.

Insomnia when you have cancer

Most adults need at least 7 hours of sleep each night. Insomnia can prevent you from getting the amount of sleep you need. This can lead to a physical, emotional, and mental feeling of tiredness called fatigue. It can also cause you to feel sleepy during the day, making it harder to do your usual daily activities.

If you already have exhaustion or fatigue from your cancer or treatment, insomnia can make these problems worse. Your care team can help you find ways to manage this.

What if I had insomnia before my cancer diagnosis?

If you had insomnia before your cancer diagnosis, you are more likely to continue having trouble sleeping. You might need new ways to manage your sleep problems.

People with hypersomnia feel very sleepy during the day. You might also sleep for longer than usual at night.

Signs of hypersomnia include:

• Sleeping for 9 or more hours at a time
• Longer periods of deep sleep than usual
• Sleepiness that doesn’t get better after a nap or a night of sleep

Hypersomnia can make it hard to take care of your family, home, and work duties. Because you are so sleepy, you may find it difficult to do activities you normally enjoy.

Hypersomnia and cancer-related fatigue

Hypersomnia is similar to fatigue, but it’s not the same thing. Hypersomnia is the feeling of being too sleepy during the day. It also includes sleeping for a long time at night. Fatigue is a lack of energy that does not get better after you sleep.

Some people have both hypersomnia and cancer-related fatigue. It can sometimes be hard to tell the difference. Talk to your healthcare team if you are worried about either of these problems. They can help you find ways to manage.

Restless legs syndrome (RLS) makes you feel like you need to move your legs. It can come with creeping, crawling, or itching feelings. When you’re trying to rest or sleep, these feelings cause jerking movements that keep you awake.

RLS often gets better when you move. Walking or stretching can help lower the urge to move your legs. RLS usually happens more during the evening hours.

RLS when you have cancer

Anyone can get RLS, but it could also be related to your cancer or treatment:

• Some people get RLS during chemotherapy (chemo).
• Low iron can also cause RLS or make it worse.

Talk to your cancer care team if you have signs of RLS.

Sleep apnea is short pauses in your breathing while you sleep. Each pause can last as long as 10 seconds and can happen many times in one night. Many people with sleep apnea snore and wake up during the night. It can prevent restful sleep and make you feel tired or sleepy during the day.

Sleep apnea when you have cancer

Some cancers, like those in the head and neck, can raise the risk of sleep apnea. But cancer and its treatment do not usually cause this sleep problem. Many people with cancer have sleep apnea for other reasons.

If you have sleep apnea, it’s important to keep up with the treatment you are already getting. It’s also important to let your cancer care team know if you have sleep apnea.

Good habits before bedtime can help you sleep. This practice is often called sleep hygiene. You can improve your sleep hygiene if you:

• Keep a schedule. Try to go to sleep and get up at the same time each day.
• Have a relaxing bedtime routine. This includes activities like a bath, reading, meditation, calm music, or breathing exercises.
• Try a sleep or meditation app. Ask your care team which apps would be most helpful for you.
• Avoid screens. Don't watch TV or use screens in bed. Avoid looking at screens for at least 30-60 minutes before you go to sleep.
• Get a backrub or foot massage. Ask your partner or caregiver for a gentle backrub or foot massage near bedtime.
• Keep the clock out of sight. Try not to look at the clock when you are awake at night.

If you can’t fall asleep within about 20 minutes, or if you wake up and can’t go back to sleep, it’s time to try something new. Get up and go to a different part of your home. Stay in a darkened room and do something relaxing, like reading a book. Don’t go back to bed until you feel sleepy again.

What you eat and drink before bed can also affect your sleep.

• Avoid big evening meals. Try not to eat a big meal or drink a lot of liquids before bed.
• Stick to light snacks. If you need to eat before bed, have a light snack with some protein, like cheese or peanut butter.
• Try a warm drink. Warm, caffeine-free drinks like heated milk or decaf tea might help you relax.

• Manage lights, noise, and temperature. If possible, keep your room dark, quiet, and at a comfortable temperature.
• Wear comfortable clothes. Loose, comfortable clothing can sometimes help you sleep.
• Think about your bedding. Keep your bedding clean. Use pillows and blankets to make yourself as comfortable as possible.
• Only use your bed for sleeping and sex.

What you do during the day can make a big difference in how you sleep at night.

• Get sunlight in the morning. Try to spend time in bright daylight early in the morning.
• Avoid caffeine after midafternoon. You can also try cutting back on caffeine or not drinking it at all.
• Avoid tobacco, nicotine, and alcohol. Avoid them near bedtime or avoid completely.
• Set your to-do list aside. If worry or anxiety makes it hard to sleep, try writing a to-do list before bed and then putting it away for the night.
• Schedule a “worry time.” Make a set time to worry earlier in the day.
• Avoid daytime naps. If you need to nap, keep it to 30 minutes or less. Try to take only one nap per day.
• Get physical activity every day. It’s best to do this in the morning or afternoon.
• Avoid exercise close to bedtime. Try not to exercise within 3 hours of bedtime.
• Stretch daily. If you have RLS, daily stretching exercises might relax your muscles.

Ask your cancer care team if you need help finding an exercise or stretching routine. They can also refer you to a physical therapist to learn stretches that relax your muscles.

Sometimes it helps to keep track of your sleep habits so you can figure out patterns and problems.

• Keep a sleep diary. Record the times you sleep and wake up, including naps.
• Write down what works and doesn’t work. Write down anything that keeps you from falling or staying asleep, like side effects or worries. Also record anything that helps you sleep better.
• Ask your partner for clues. If you have a partner, ask them if they notice anything unusual when you are asleep.