Sleep Problems

Many people with cancer have trouble sleeping. Sleep problems can affect you in different ways. Any change in your usual sleeping habits can make it harder to do everyday activities. There are treatments available and steps you can take to help manage your cancer-related sleep problems.

Getting at least seven hours of sleep each night is advised for most adults. But many things can affect your sleep, including your age, stage in life, home and work life, stress level, and other non-cancer related problems.

For some people, sleep problems are short-term, lasting less than 3 months. But for other people, these problems might last several months or years. Sleep problems can also come and go based on your emotions and the side effects of your treatment.

If you have sleep problems, you might notice you have less energy than usual. Sleep problems can also affect what you are able to do at home, work, or school. It might make it harder to enjoy social activities, friends, family, or hobbies.

Types of sleep problems in people with cancer

There are a few different types of sleep problems you might have.

Insomnia

Having trouble falling asleep or staying asleep is called insomnia.

Insomnia can be short-term (lasting for a single night, a few days, or a few weeks), or it can be chronic (lasting for three months or longer).

People with insomnia don’t get as much sleep as they need. This can lead to fatigue (a physical, emotional, and mental feeling of tiredness). It can also lead to feeling sleepy during the day or having trouble doing your usual daily activities.

If you have cancer and insomnia, you might:

• Have trouble falling asleep
• Wake up during the night and have trouble going back to sleep

If you had insomnia before you were diagnosed with cancer, you are more likely to continue having trouble sleeping after your cancer diagnosis. If this is true for you, then you might need to try some new ways of managing your sleep problems. 

Hypersomnia

People with hypersomnia feel very sleepy during the day or want to sleep for longer than normal at night. Signs of hypersomnia include:

• Sleeping for 10 or more hours at a time (or more than 12 hours for children)
• Longer periods of deep sleep than usual
• Trouble staying awake during the day
• Sleepiness that doesn’t get better after sleeping or taking a nap

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

Hypersomnia and fatigue are similar, but they are not the same. Hypersomnia is feeling too sleepy during the day and includes sleeping for a long time at night. Fatigue is a lack of energy and exhaustion that does not get better after you sleep.

For some people, sleep problems can make cancer-related fatigue worse. Cancer-related fatigue can also make sleep problems worse, because you might want to nap during the day. Daytime naps often make it harder to sleep at night.

Restless legs syndrome

Restless legs syndrome (RLS) makes you feel like you have to move your legs when you’re trying to rest or sleep. Your legs may also feel itchy or irritated, often causing jerking movements that keep you awake. RLS usually happens more during the evening hours.

RLS can happen to people who don’t have cancer, but some people get it during chemotherapy. 

Sleep apnea

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

Sleep apnea is rarely caused by cancer or cancer treatment. It is usually something a person has before they are diagnosed with cancer. But 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.

What causes sleep problems?

There are many reasons why people with cancer have sleep problems. Some of these reasons are related to cancer, but some are not. You may have already had sleep problems before cancer.

Tell your cancer care team if you are having trouble sleeping, or if your sleep patterns change over time.

Cancer and cancer treatment

Sleep problems can be caused or made worse by:

• Having a tumor in your brain, whether it started in your brain or came from another part of your body
• Certain cancer treatments, including some surgeries, radiation therapy, and chemotherapy
• Some medicines used to manage cancer and non-cancer conditions (such as steroids)

Side effects of cancer and treatment

Many side effects of cancer and cancer treatment can cause you to wake up during the night and make it harder for you to fall asleep. This includes:

• Pain
• Peripheral neuropathy
• Fever
• Nausea and vomiting
• Anemia
• Heartburn
• Leg cramps
• Hot flashes and sweating
• Shortness of breath
• Changes to your hormone levels
• Hypothyroidism which causes low levels of thyroid hormone           

Learn more about managing cancer-related side effects.

Mental health and coping struggles

Having cancer can cause many emotions. This includes worry, distress, anxiety, and depression. Some of these emotions might cause sleep problems.

Learn more about coping with mood changes during and after cancer treatment.

Lifestyle habits

Your daytime habits sometimes add to your sleeping problems. Habits that can affect your sleep include:

• Not getting enough physical activity during the day
• Taking longer naps or too many naps
• Falling asleep outside of the bedroom
• Spending many hours on a screen
• Using tobacco
• Drinking alcohol and caffeine

Sometimes the place where you sleep also makes a difference. You might have trouble sleeping if the room is too hot, cold, or noisy.

Other times, sleep disruptions can’t be controlled as easily, such as if you need to use the bathroom often, have nightmares or sleep terrors, or sleepwalk.

Symptoms of sleep problems

People with cancer and sleep problems report:

• Feeling more tired than usual during the day
• Feeling the need to rest and sleep more (fatigue)
• Having trouble getting to sleep or staying asleep (insomnia)
• Getting too much sleep but still feeling tired (hypersomnia)
• No being able to function as well during the daytime
• Feeling distressed about their sleep problems
• Having a poor quality of life

Treating sleep problems

Sleep problems can be very different for each person. Start by describing your symptoms to your health care team. This helps them figure out the best way to treat your problem.

Your health care team might suggest that you meet with a sleep specialist. A sleep specialist may be able to help you figure out why you’re having trouble sleeping. Ask your health care team about a referral, if needed.

Below are some common ways to treat cancer-related sleep problems. You might need to use more than one way to help with your sleep.

Cognitive behavioral therapy (CBT)

Thinking or worrying about sleeping can make your sleep problems worse. Cognitive behavioral therapy (CBT) is one way to help you feel less anxious about sleep. The goal of CBT is to recognize your sleep habits and patterns and then find ways to manage them.

Relaxation

There are many ways to relax, calm your thinking, and wind down before bed. Relaxation methods can help you fall asleep, stay asleep, and go back to sleep if you wake up during the night.

Some examples of relaxation methods are:

• Focused breathing
• Meditation
• Mindfulness
• Progressive muscle relaxation
• Music therapy
• Hypnosis
• Guided imagery 

You might be able to learn these methods on your own. But if you’d like help, ask your cancer care team for resources or a referral to a sleep specialist.

Learn more about mindfulness and other relaxation methods.

Managing medicines

Sometimes, medicine is used to manage sleep problems. Your health care team can help you decide if this is right for you.

Other types of medicine can cause sleep problems. This includes steroids and hormones, and some medicines for pain, seizures, anxiety, and depression.

Don’t make any changes to your medicines without first talking to your health care team. Tell them about any medicines you are taking.

Treating side effects

The side effects of your cancer or cancer treatment might cause sleep problems. Many of these side effects can be managed, and this might help you sleep.

You might sleep better if these cancer-related side effects are well managed:

• Pain
• Depression
• Anxiety
• Peripheral neuropathy
• Nausea and vomiting
• Hot flashes and sweating

Learn more about treating cancer-related side effects.

Sleep apnea

Cancer and cancer treatment are not usually the cause of sleep apnea, but many people with cancer have sleep apnea for other reasons. This needs to be treated to prevent other problems.

A continuous positive airway pressure device (CPAP) is the usual treatment for sleep apnea. A CPAP helps you breathe while you sleep. Tell your cancer care team if you have, or think you might have, sleep apnea.

Tips for managing sleep problems

There are many things you can do to help manage your sleep problems.

Bedtime routine

It’s important to have good habits before bedtime. (This is often called sleep hygiene.) Examples of good sleep hygiene include:

• 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. There are many helpful apps to choose from.
• Avoid screens. Don't watch TV or use screens in bed, or for 30-60 minutes before you 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.