Tips For Managing Sleep Problems (Insomnia)

What is insomnia?

Insomnia, or trouble sleeping, is a common problem for patients with cancer. Insomnia can lead to fatigue, memory and concentration problems, mood changes, and psychiatric disorders. Symptoms of insomnia may be

• Having a hard time falling asleep.
• Waking up many times during the night.
• Not feeling refreshed when you wake up.
• Trouble getting back to sleep.
• Feeling tired during the day.
• Having a hard time getting focused or paying attention during the day.

What causes insomnia?

• Risk factors include personal or family history of insomnia, depression, anxiety, and being older.
• Causes can include medications, recent or prolonged hospitalization, chemo, radiation, or hormonal therapy, pain, hot flashes, nausea, and vomiting.
• Spending too much time in bed, napping, and doing things in bed that affect sleep (watching tv, scrolling, or reading).
• Having irregular sleep patterns.

How should insomnia be treated?

• Start with identifying and treating the underlying cause sof insomnia, such as pain, nausea, worry, depression, and hot flashes.
• A mix of prescription medication and psychological therapy may help with short-term relief.
  • Prescription medications that are commonly used include
    • Clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril), estazolam (Prosam), triazolam (Halcion), zaleplon (Sonata), zolpidem (Ambien), eszopiclone (Lunesta), diphenhydramine (Benedryl).
    • Side effects can include next-day effects (like a hangover), risk of dependence, and rebound insomnia (even worse insomnia) when the medication is stopped.
    • These medications should not be taken for more than 2-4 weeks
    • You shouldn't take these medications with other things that can make you tired or alcohol.
• Use over-the-counter "sleep aids" with caution.
  • Many of these agents contain antihistamines, which can cause sleepiness, but may be less effective than prescription medications and may cause more side effects.
  • Talk to your provider before using any over-the-counter herbal products such as melatonin, kava-kava, and valerian as they could interact with your cancer treatment.
    • Remember, herbal products are not required to undergo the same rigorous testing as prescription medications. Their side effects and interactions with other drugs or medical conditions are not as well known.

What if I don't want to take medication for my insomnia?

There are many things you can do to help you sleep without using medications. These methods are primarily about changing your sleepy time behaviors.

• Associate bedtime and the bed/bedroom with sleep. Create a bedtime routine and have a regular sleep-wake cycle (consistent bedtime and wake time).
  • Use the bed for sleep and sex only.
  • Try not to watch TV, play on your phone/tablet, read or, eat in bed.
• Go to bed only when sleepy.
  • If unable to fall asleep, leave the bedroom and return when sleepy.
• Try not to nap. Limit naps to 30 minutes and try not to nap after 3 pm.
• Use relaxation techniques such as deep breathing, journaling, stretching, meditation, or prayer before bed.
• A warm shower or bath, a warm glass of milk, or a cup of chamomile tea at bedtime may help you relax.
• Avoid alcohol-you may feel sleepy at first, but it can lead to disrupted sleep.
• Avoid caffeine, nicotine, heavy or spicy meals, and alcohol for 4 to 6 hours before bedtime.
• Exercise (as little as 20 minutes, three times a week) can promote better sleep, although this should not be done too close to bedtime.
• Keep the place where you sleep dark, quiet, cool, and comfortable.
• Reduce anxiety.
  • If having a clock nearby causes anxiety, remove it or put it where it is more hidden.
  • Be realistic about sleep requirements and managing insomnia.

Getting enough sleep is a very important part of taking care of yourself. If you are having sleep issues, talk with your provider.