Difficulty sleeping (insomnia)
Insomnia means having difficulty falling or staying asleep. Many people affected by cancer have trouble sleeping for lots of different reasons.
We hope this information helps you understand some of the causes of sleep problems and find ways to cope with them. It could also help you discuss insomnia and ways to manage it with your doctor or specialist nurse.
Insomnia is described as having some or all of the following symptoms:
difficulty getting to and staying asleep, or waking up too early
difficulty sleeping despite good conditions for sleep, such as a comfortable bed in a quiet, darkened room
daytime activities being affected by lack of sleep, for example problems concentrating at work, falling asleep during the day or starting to feel depressed.
Other types of sleep problems
You may be worried that you have insomnia if you only sleep for a few hours every night. However, having short periods of sleep can be perfectly normal and some people may only need 3-5 hours a night. Other people, such as night shift workers or parents with small children, might be sleep deprived. This generally means that they would be able to sleep quite well given the right conditions.
Some people find they wake up several times in the night. They may also feel as though the quality of the sleep they had was poor, for example, if they didn’t experience a deep sleep or do not feel refreshed by the sleep. This could be because of a change in sleep pattern, possibly due to aging or a changed environment.
For most of us, losing one night’s sleep will not have any overall effect other than feeling tired the next day. However, long periods of sleeplessness can lead to confusion, anxiety and depression. If you are worried about sleep problems, talk to your doctor or specialist nurse as they may be able to give you some advice.
Many different factors can influence sleep. Some are everyday things that anyone can experience and some are more common in people affected by cancer. Here are some possible causes for not being able to sleep well:
a bedroom that’s too hot, too cold or too noisy
an uncomfortable bed
a poor sleep routine
a partner who has a different sleep routine from your own
stimulants such as cigarettes, alcohol or caffeine
lack of physical activity
medicines that make you feel alert, such as steroids
anxiety, worry and emotional distress
physical problems such as pain, discomfort or feeling unwell
sleeping for too long during the day.
Having a good sleep pattern and a regular bedtime routine (sometimes known as sleep hygiene) can help improve sleeping.
Small cues such as a hot drink, brushing your teeth or reading in bed for a while can let your brain know that it’s time to sleep. Here we give some suggestions of things that could help you sleep better:
Sleep for the right amount of time
Spending too much time in bed is likely to affect the quality of your sleep. Try to sleep for just long enough to feel refreshed the next day, without oversleeping.
Increase your physical activity if you can
This could help you sleep better in the long term, although it may feel difficult if you’ve recently had treatment and are struggling with energy levels or side effects. However, even regular short walks or a bit of gentle gardening can help to build stamina and improve the quality of your sleep. We have more information about the benefits of physical activity before and after cancer treatment.
Wake up and go to bed at the same time each day
This will help you get into a good sleep routine.
Get out of bed if you can’t sleep
Rather than lying in bed tossing and turning, get up. You could try reading or listening to some soothing music. Wait until you feel tired again and then go back to bed.
Keep your bedroom for sleeping
If you wake during the night and find it difficult to return to sleep, go to another room in the house. If you need to sleep during the day, go to your bed and sleep.
Reduce light and noise at night time
Light makes it hard to fall asleep and affects the body’s internal clock. Noise can also keep you awake - even occasional loud noises, such as an aircraft flying overhead, can affect sleep. If your bedroom is noisy, you could use ear plugs.
Keep a steady temperature in your bedroom
If your room is either very warm or very cold, your sleep may be affected. The room temperature should be comfortably warm.
Have a bedtime snack but avoid stimulants
Hunger can disturb sleep. Try having a light bedtime snack, warm milk or a hot drink before going to bed. But avoid food and drinks that contain stimulants such as caffeine or lots of sugar (for example, coffee, tea, cola or chocolate drinks) for a few hours before bedtime.
Limit how much alcohol you drink at bedtime
While alcohol can help people to fall asleep more quickly, the sleep tends to be broken. It may also give you a dry mouth and an unpleasant taste that can wake you, so it’s best to limit how much alcohol you have near bedtime.
Know how naps affect you
Some people find that daytime naps help them sleep better at night, while others sleep less well after them. Find out what suits you best.
Try mental exercises
These could also help you sleep, as they focus your brain away from worries. Here are a few mental exercises that you might like to try, which usually take about 10 minutes:
Try to remember the lines of a song or poem.
Make alphabetical lists, for example of names or countries.
Relive, in detail, a favourite experience.
Being diagnosed with cancer can naturally cause feelings of worry and anxiety, which can stop you being able to sleep. Many people find they stay awake, going over and over the same thing in their mind. It may help to do some of the following:
Write down your concerns
If you wake at night and are worrying about things, write them down. There’s probably nothing you can do about them immediately, but if you note them down, you can then work through them during the day with support from relatives, friends, or your doctor or specialist nurse.
Talk to someone
Many people find that their fears and worries are reduced simply by telling someone else about them.
This type of ‘offloading’ can be a real relief and you may find that you sleep better afterwards. Try talking to a close friend or family member. You might prefer to talk to someone outside the family circle such as a counsellor. Your GP may be able to refer you to a local counsellor or you could talk to the Samaritans, a 24-hour confidential helpline, by calling 08457 90 90 90.
Try relaxation techniques
Simple breathing and relaxation exercises may be very useful in reducing anxiety and stress. They can also reduce muscle tension. Many people with cancer and their relatives find that these simple methods relax them and give them a sense of calmness.
Almost anyone can learn relaxation techniques. You can learn them at home using a CD, tapes or podcasts, or you may be able to join a group. Self-help exercises need motivation and regular practice to provide proper benefits. It may be easier to stay motivated by attending group classes.
Lying flat can be uncomfortable for people who are breathless or in pain, but many relaxation exercises can be done sitting up or using pillows for support. The organisations Talking Life, Penny Brohn Cancer Care and The Pain Relief Foundation produce relaxation tapes and CDs, which are available to buy.
Some hospitals and support groups offer relaxation sessions. You can ask if they are provided at your hospital.
Watch Alfie tell his story of how he coped with depression after a cancer diagnosis.
Medicines that prevent sleeping
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Many medicines for cancer and some other illnesses can prevent you from sleeping. Drugs used to treat cancer that can cause sleeplessness include prednisolone, dexamethasone, imatinib (Glivec®) and pamidronate (Aredia®).
Not everyone who takes these will have problems sleeping, as medicines affect people in different ways. You can discuss the possibility of your medicines affecting your sleep with your doctor or specialist nurse, as they may be able to give you suggestions. For example, it can help to take medicines that make you very alert (such as steroids) in the morning.
Or if some of your medicines cause drowsiness, it may be more helpful to take these at bedtime. However, it’s important to check with a member of your healthcare team before making any changes to your medicine timings.
Some other medications don’t cause sleeplessness directly but prevent you from sleeping due to other side effects. Many of the hormonal therapies for breast and prostate cancer can cause hot flushes and sweats, which can keep you awake at night. Your doctor or specialist nurse may be able to offer some help and advice with these side effects so that you’re able to sleep.
Treating insomnia with sleeping tablets
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If sleep becomes very difficult and is affecting your daily life, then it can sometimes help to take a short course of sleeping tablets. Doctors are normally keen for this to be a short-term solution, as sleeping tablets can have side effects.
Generally, sleeping tablets are only prescribed for 1-2 weeks. If you think this may help, talk it over with your doctor, as they can advise whether tablets are suitable in your situation.
There are different types of sleeping tablet that work in different ways:
Benzodiazepines work by increasing the effect of a substance in the brain called gamma-aminobutyric acid (GABA). GABA is a chemical messenger that gives a feeling of calm and drowsiness. Some benzodiazepines are short-acting and can help you to get to sleep; others are long-acting and can help you to stay asleep. Temazepam, diazepam and lorazepam are all examples of benzodiazepines.
Non-benzodiazepines work in a different way from benzodiazepines and have a different chemical structure, but similarly help you to sleep by increasing GABA in the brain. Zolpidem, zaleplon and zopiclone are all examples of non-benzodiazepines.
Side effects of sleeping tablets
Most people experience the side effects of sleeping tablets the next day, once they wake up. These are often described as being a bit like a ‘hangover’. They usually go away quite quickly. Some of the most common side effects of sleeping tablets are:
clumsiness or poor coordination
feeling lightheaded, dizzy or still sleepy
difficulty concentrating and thinking clearly, or feeling ‘foggy’.
Tolerance and dependence
Doctors may sometimes seem cautious when it comes to prescribing sleeping tablets. This is because sleeping tablets can cause problems with tolerance and dependence. It’s helpful to understand the difference between these two terms.
Tolerance to a drug means that as you continue to take it, it begins to feel as though it’s no longer helping and a higher dose is needed to get the same effect.
In time, the higher dose will also begin to feel as though it has no effect, while side effects may worsen.
Dependence on a drug means that you may get withdrawal symptoms if the tablets are suddenly stopped. Withdrawal symptoms can include feeling anxious or restless and difficulty sleeping. For some people, this can feel much like the insomnia for which the tablets were prescribed.
Tolerance and dependence may sound frightening, but most people don’t have these problems if they’re only taking sleeping tablets for a short period. Your doctor will also check how you’re getting on while you’re taking sleeping tablets to prevent this from happening.
Melatonin is a naturally occurring hormone that is available as a tablet. It’s used to treat insomnia as well as some other conditions. In the UK, melatonin is only licensed to be given as a short-term treatment of insomnia for people over the age of 55. This is because it’s not very effective for people younger than 55. So far, research has shown that melatonin causes fewer problems with tolerance and dependence. However, for most people it only reduces the time it takes to get to sleep by 10-15 minutes.
Sleeping tablets don’t always need to be prescribed by a doctor. Over-the-counter sleeping tablets can be useful in the short term. However, many people find they develop a tolerance to these drugs if they take them for long periods.
Over-the-counter sleeping tablets often contain anti-allergy medication (antihistamine) and aren’t suitable for everyone. They may also not be recommended if you’re taking some other types of medicine. If you are thinking of trying an over-the-counter remedy, speak to your doctor, specialist nurse or pharmacist first.
Treating insomnia with behavioural therapies
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Behavioural therapies help to change the way you think, feel and behave when it comes to sleeping, bedtime or worrying at night. There are three main types of behavioural therapy that can be used for improving sleep:
For some people, spending too much time in bed means they wake up too early. Sleep restriction aims to help you go to bed at certain times, usually later than you normally would, so that you get regular amounts of quality sleep.
People who regularly have difficulty sleeping can have a strong link between their bed and not sleeping. This therapy aims to break that link by only using the bed for sleeping. Other activities such as watching TV, using a laptop, organising things or eating should be done elsewhere in the house. If lying in bed worrying is the problem, this therapy recommends you go to another room and try to distract yourself until you feel tired. This aims to break the link between your bed and worrying.
Cognitive behavioural therapy (CBT)
This is carried out by a trained therapist and aims to change negative ways of thinking that may increase worries and anxiety. Reduced anxiety may help you get more sleep.
Some of these therapies can be carried out by a GP with specialist training or you may be referred to a clinical psychologist. You could speak to your GP about whether some of these therapies might be right for you.
The British Snoring and Sleep Apnoea Association
The British Snoring & Sleep Apnoea Association was formed to help snorers and their bed partners end the nights of disturbed and lost sleep, to end the bad feelings that often develop, and to help them return again to peaceful nights together.
The Pain Relief Foundation
The Pain Relief Foundation carries out research leading to the alleviation of chronic pain and find improved methods of treating chronic pain.
Penny Brohn Cancer Care
Penny Brohn Cancer Care (formerly Bristol Cancer Help Centre) is a national charity specialising in the Bristol Approach to cancer care, for people with cancer and those close to them.
The Royal College of Psychiatrists
The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the UK.
The Sleep Council
The Sleep Council aims to raise awareness of the importance of a good night’s sleep to health and wellbeing, provide helpful advice and tips on how to improve sleep quality and provide helpful advice on choosing the right bed for optimum sleeping comfort.
Talking Life Ltd
The publishing arm of Talking Life Ltd produces specialist self-help health audio tapes & cds.
The information in this section is based on our Insomnia fact sheet and has been compiled using a number of reliable sources, including: