Difficulty sleeping (insomnia)

Many people affected by cancer can have difficulty sleeping. This is known as insomnia. Long periods of not sleeping well can lead to other problems. There are some things you can do to try and improve your sleep. These include:

  • having a regular bedtime routine
  • being more physically active during the day
  • making sure your bedroom is not too hot, too cold, too light or too noisy
  • having a snack before bed, but avoiding caffeine, sugar and alcohol.

If worry and anxiety are keeping you awake, talking to someone may help. Writing down your worries a few hours before bedtime can help clear your mind. Breathing and relaxation exercises may also be useful to reduce anxiety and stress.

Some medicines used in the treatment of cancer can affect your sleep. Your doctor or nurse can give you advice on coping with this.

You may be able to take sleeping tablets to help. These can have side effects, so they are usually prescribed for only one to two weeks. There are also some behavioural therapies that can help. Your GP can tell you if these are suitable for you.

What is insomnia?

Insomnia means having difficulty getting to sleep, staying asleep or waking up feeling tired (fatigued). Many people affected by cancer have trouble sleeping, for lots of different reasons.

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 having 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, some people may only need around six hours sleep a night. Some older adults have less sleep at night, but catch up with a short afternoon nap which can be refreshing. 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 during the night. They may also feel as though they did not have good-quality sleep. For example, you may not be getting good-quality sleep if you did not experience a deep sleep or do not feel refreshed the next day. This could be because of a change in sleep pattern, possibly due to ageing or a changed environment.

Losing one night’s sleep will not have any effect other than leaving you feeling tired the next day. However, long periods of sleeplessness can lead to anxiety, depression, concentration problems and difficulties making decisions. If you are worried about sleep problems, talk to your doctor or specialist nurse.


Causes of insomnia

Many different factors can influence sleep and cause insomnia. Some are everyday things that anyone can experience and others are more common in people affected by cancer.

Here are some things to think about which may be affecting your sleep:

  • Is your bedroom too hot, too cold, too light or too noisy?
  • Is your bed uncomfortable?
  • Do you have a poor sleep routine?
  • Do you have a partner who has a different sleep routine from your own?
  • Do you smoke, or drink alcohol or caffeine?
  • Are you currently not doing any physical activity during the day?
  • Do you take medicines that make you feel alert, such as steroids?
  • Are you anxious, worried or suffering from emotional distress?
  • Do you have any physical problems such as pain, discomfort or feeling unwell?
  • Are you sleeping too much during the day?


Things you can do to help with insomnia

Having a good sleep pattern and a regular bedtime routine (sometimes known as good sleep hygiene) can help improve sleeping.

Small things such as having a hot drink, brushing your teeth or reading in bed for a while can let your brain know that it’s time to sleep. We have included some suggestions below of other 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. Most adults need between 7 and 8 hours but this can vary, so work out what is best for you.

Try to increase your physical activity

This could help you sleep better in the long term, but it may be difficult if you’ve recently had treatment and are struggling to cope with energy levels or side effects. However, even something small such as regular short walks or gentle gardening can help to build up your strength 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 are unable to sleep

Rather than lying in bed, take a brief break from trying to sleep. Try getting out of bed and to empty your mind of thoughts or frustrations with not being able to sleep, and go back to bed after 10 minutes. You can repeat this if you are still unable to settle. Avoid watching television or using computers, phones or anything with a bright light when you are up.

Keep your bedroom for sleeping

If you wake during the night and find it difficult to return to sleep, go to another room in your home. If you need to sleep during the day, go to your bedroom and sleep.

Reduce light and noise at night time

Having too much light in the bedroom can make it hard to fall asleep and can affect the body’s internal clock (also known as the circadian rhythm). The body’s internal clock works on a 24-hour cycle that helps us recognise the differences between being awake and when we need to sleep.

Noise can also keep you awake. Even occasional loud noises, such as an aircraft flying over your home, can affect sleep. If your bedroom is noisy, using ear plugs may help.

Maintain a constant 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 a few hours before bedtime. Drinks that contain caffeine or sugar include:

  • coffee
  • tea
  • cola
  • chocolate drinks.

Limit how much alcohol you drink before 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. It’s best to limit how much alcohol you have near bedtime.

Understand how naps affect you

Some people find that daytime naps can 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.
  • Try to remember, in detail, a favourite experience.


Worry and anxiety as a cause of insomnia

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 the same thing in their mind. It may help to try some of the tips below.

Write down your concerns

If you wake at night and are worrying about things, write them down. There might be nothing you can do about them immediately. But if you write them down, you can then work through them during the day with support from a family member or friend, or from 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. Doing this can often 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 your family, such as a counsellor. Your GP may be able to refer you to a local counsellor or you could contact Samaritans by calling their 24-hour confidential helpline on 116 123.

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 CDs, 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. We have a free CD which can help you learn the ways to manage breathlessness.

The following organisations also have 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.


Medicines that can cause insomnia

Many medicines for cancer and some other illnesses can prevent you from sleeping. Drugs used to treat cancer that can cause sleeplessness include:

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 advice. For example, it can help to take medicines that make you very alert (such as steroids) in the morning.

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 do not 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

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 normally want this to be a short-term solution, as sleeping tablets can have side effects.

Generally, sleeping tablets are only prescribed for one to two weeks. If you think this may help, talk about it 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. These 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 get to sleep. Other types are long-acting and can help you stay asleep. Temazepam, diazepam and lorazepam are all examples of benzodiazepines.
  • non-benzodiazepines. These 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 following day, once they wake up. These are often described as being like the after effects of drinking too much alcohol (a hangover). They usually go away quite quickly.

Some of the most common side effects of sleeping tablets are:

  • clumsiness or poor coordination
  • feeling light-headed, dizzy or still sleepy
  • difficulty concentrating and thinking clearly, or feeling ‘foggy’.

Tolerance and dependence on sleeping tablets

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. It can also mean that you need a higher dose 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:

For some people, this can feel similar to the symptoms of insomnia, for which the tablets were prescribed.

Tolerance and dependence may sound worrying, 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

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. 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 to 15 minutes.

Over-the-counter medicines

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 are not 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 medicine, speak to your doctor, specialist nurse or pharmacist first.


Treating insomnia with behavioural therapies

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.

Sleep restriction

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 good-quality sleep.

Stimulus control

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 television, 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. This type of therapy 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.

Cognitive Behavioural Therapy for Insomnia (CBT-I) is a programme which combines sleep hygiene, sleep restriction and stimulus control with relaxation techniques. It can help you deal with worries about not having enough sleep and the effect this can have on your day-to-day routine.

CBT-I is available through some psychology services either on an individual basis or in groups.

If you think some of these therapies could help you, speak to your GP.

Back to Other side effects

Avoiding infection

Cancer and its treatments can weaken the immune system. It’s important to try and avoid infection if your immunity is reduced.

Chemo brain

Chemo brain describes changes in memory, concentration and the ability to think clearly. These changes can sometimes happen during or after cancer treatment.

Nausea and vomiting

Cancer and its treatment can make you feel sick (nauseous) or be sick (vomit). There are drugs that can help control this.