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Difficulty sleeping (insomnia)

Insomnia is when you have difficulty falling asleep or staying asleep at night. 

Most people will experience insomnia at some point during their lives. It can be due to lots of different reasons. Some things that can cause insomnia when you have cancer include: 

  • symptoms caused by the cancer (such as pain or sickness)
  • side effects of treatment 
  • worry, anxiety or depression 

If you often have insomnia, it can interfere with everyday life. You may feel very tired, have low energy, poor concentration, irritability and an inability to cope.

Symptoms caused by the cancer

If you feel sick, have pain or other symptoms caused by the cancer and it’s affecting your sleep, let your doctor know. They can prescribe medicine to help.

Treatments that can affect sleep

The following treatments do have the potential to affect sleep.

Steroids

You may be taking steroids as part of your cancer treatment. Steroids cause sleep disturbance. It can help if you take them in the morning.

Anti sickness drugs 

Some anti sickness drugs can make you feel restless. If this happens, tell your doctor as you might be able to have a different type.

Cancer drugs

Some cancer treatments such as targeted cancer drugs can cause insomnia. Ask your pharmacist or doctor if the drug you are taking can affect your sleep.

Hormone treatment

If cancer or its treatment has affected your hormone levels, or you are taking certain hormone drugs, then you may experience hot flushes and sweats. These can interfere with your sleep. Talk with your doctor if hot flushes are a problem for you.

Worry, anxiety or depression

A cancer diagnosis can cause many different feelings including worry and anxiety. This is natural and can be hard to cope with.

Worry can disrupt your sleep. You may be worrying about the disease, treatment or disruptions to family and work life. You might find that thoughts run over and over in your head.

You might feel depressed and find that although you are managing to fall asleep you wake in the middle of the night unable to get back to sleep again. This can be very frustrating.

If you really can't sleep it's best not to lie there. Try getting up and do something quiet such as reading or doing a crossword or a jigsaw until you feel tired. Then try again. You might find it helpful to write down your thoughts and worries in a journal.

Talking through your worries can help. If you don’t want to talk to family or friends, then you might find counselling helpful. Your GP should be able to refer you for some counselling.

What can help?

There are things you can do to try to help improve your sleep.

  • Make sure you turn off mobile phones, tablets and TV at least 2 hours before going to bed.
  • Try to be physically active during the day.
  • Have a regular bedtime routine.
  • Try to avoid caffeine 6 hours before you go to bed as it can keep you awake.
  • Try to avoid alcohol as it can affect sleep quality.
  • Listen to relaxing music before bed.
  • Meditate, practice mindfulness or try deep breathing at bedtime.
  • Make sure the temperature in the bedroom is not too hot or cold.
  • Minimise noise and light in the bedroom.
  • Have a relaxing bath before bed.
  • Try putting a few drops of lavender oil on your pillow or use a lavender cushion.
  • Give your feet a massage with some oil or moisturiser.

Sleeping tablets

If you’re finding it very difficult to sleep then your doctor might prescribe sleeping tablets. You usually only take these for a short amount of time. This is because sleeping tablets can have side effects.

Speak with your doctor if you think you need sleeping tablets. They can talk it through with you. 

There are several types of sleeping tablets and they work in different ways. 

Benzodiazepines

Benzodiazepines act as a sedative, they slow down the body’s functions. They work by increasing the effect of a brain chemical called gamma amino butyric acid (GABA). GABA helps give us a feeling of calm and drowsiness.

Benzodiazepines can be helpful in the short term but they may stop working if you take them continuously for more than a few months. This is because your brain adjusts to them. 

Examples of benzodiazepines: 

  • temazepam 
  • diazepam
  • lorazepam

Non-benzodiazepines

These work differently to benzodiazepines as they have a different chemical structure. But they do increase GABA in the brain so will make you feel calm and drowsy. 

Examples of non -benzodiazepines:

  • zolpidem (Stilnoct)
  • zopiclone (Zimovane) 

Benzodiazepines and non benzodiazepines shouldn’t be taken for longer than a few days or weeks without being reviewed by your doctor. 

Melatonin

Melatonin is a hormone that occurs naturally in the body and helps with the control of our sleep pattern. As we get older the amount of naturally occurring melatonin in the body decreases. 

Melatonin is available as a tablet also known as Circadin. Taking melatonin can help you sleep. Doctors prescribe this for people over the age of 55 as a short term solution for sleep problems. 

Other remedies

You can also buy herbal tablets and other remedies to help promote sleep. These can be bought over the counter in pharmacies. Some of these may be helpful in the short term. However, it is possible to develop a tolerance to these so that over time they become less effective. Talk to the pharmacist for advice. 

Side effects of sleeping tablets

Sleeping tablets can make you feel groggy the next day. Some people describe it as feeling hungover, like after a night of drinking too much alcohol. This feeling should wear off. Other side effects can include: 

  • dizziness, feeling light headed or sleepy
  • finding it hard to concentrate - 'foggy feeling'
  • clumsiness

You shouldn’t drive or operate machinery if you feel tired, dizzy or unable to concentrate. 

It’s possible to develop a tolerance to sleeping tablets or become dependent on them. 

Tolerance to a drug is when the effects of the drug don’t seem to work anymore, and it feels like it is no longer helping. You may need a higher dose to get the same effect. After a while the higher dose of the drug will start to have less effect, although the side effects of the drug can get worse. 

Dependence on a drug is when you get withdrawal symptoms if you suddenly stop taking it. Withdrawal symptoms can include: 

  • feeling anxious
  • inability to sleep
  • a jittery, restless feeling

Your doctor will only prescribe a small amount of sleeping tablets and then review how you are feeling. 

Relaxation techniques

Relaxation techniques such as mindfulness, meditation and breathing exercises can help you to feel calmer and cope with worries and anxieties. This in turn could help you to relax and sleep. 

You can read about meditation and other mindfulness based techniques in our complementary therapies section. 

There are a number of organisations who produce CDs and podcasts and there are lots of meditation apps available, such as Headspace. 

Penny Brohn is a cancer charity. They offer advice and support to cancer patients and focus on complementary therapies, nutrition and relaxation techniques. They have a selection of meditation CD's.

Other complementary therapies

Acupuncture

Studies have looked at acupuncture to see if it might help with insomnia in people with cancer. There are mixed results. It did appear to help some people, however more studies are needed in order to know how beneficial it might be. 

Reflexology

Reflexology is a complementary therapy that applies gentle pressure to the feet or hands to stimulate energy pathways in the body. It can bring about a state of deep relaxation. Some studies have looked at whether it might help with sleep in cancer patients. It did appear to help relax some people however more studies are needed.

Talk to someone

Counselling can help if your thoughts and emotions are affecting your sleep. There are different types of counselling including cognitive behavioural therapy (CBT). This type of counselling helps you change how you respond to situations or emotions.

If you are worried about disturbed sleep then do talk to your doctor or specialist nurse.  

Last reviewed: 
31 Dec 2019
  • Electronic Medicines Compendium

    Accessed December 2019

  • Acupuncture for Managing Cancer-Related Insomnia: A Systematic Review of Randomized Clinical Trials

    T Choi and others

    Integrative Cancer Therapies 2017. Vol 16;(2) 135–146.

  • Troublesome Symptoms in Cancer Survivors: Fatigue, Insomnia, Neuropathy, and Pain

    D Pachman and others

    Journal of Clinical Oncology 2012. Vol 30; (30)

  • The Relationship Between Insomnia and Cognitive Impairment in Breast Cancer Survivors

    K Liou and others.

    JNCI Cancer Spectrum 2019. Vol 3;(3)

  • Effects of plantar reflexology on sleep and quality of life in patients with breast cancer undergoing chemotherapy and hormonal therapies
    S Magno and others

    Journal of Clinical Oncology 2017: 35; (15)

  • A randomised, controlled trial of the psychological effects of reflexology in early breast cancer

    D Sharp and others 

    European Journal of Cancer 2010. Vol 46;(2) 312-322
     

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