Cancer turns life upside down for millions in the United States every year. An estimated 1.7 million new cases of cancer are diagnosed annually in the U.S., and each of those people enters a life-altering journey as they fight this terrible disease. For most patients, treatment involves some combination of chemotherapy, radiation, surgery, and medication. Thankfully, these treatments are constantly evolving and improving. From 1991 to 2015, the overall cancer death rate in the country fell by 26 percent, and these rates continue to drop every single year.
If you or a loved one has been diagnosed with cancer, you are probably prepared for some of the well-known challenges of treatment, including nausea and hair loss. Yet cancer leaves behind another concern that many people do not anticipate— many cancer patients find themselves struggling to get adequate sleep during treatment.
Sleep is an important part of the body’s natural healing abilities. Studies have found that in a person getting enough sleep, wounds can heal almost a day faster than they do in someone who is sleep-deprived. This is true for other medical issues as well. In the fight against cancer, you need as many healing capabilities as possible working as well as they can. Sleep makes an important contribution toward this fight.
Fighting cancer takes much of your physical and emotional strength. This is an exhausting journey that can leave you tired and ready for a good night’s sleep at the end of the day. Yet you may find yourself unable to sleep after crawling into bed at night.
There are several reasons that sleep can be a problem for cancer patients. First, the side effects of cancer treatment and the many medications prescribed to fight this disease can make it difficult to sleep. Second, cancer itself may cause pain that inhibits proper sleep. Also, some cancer patients battle emotional and mental health concerns that further hinder sleep.
In one study of breast cancer patients, for example, half of the women who received radiotherapy struggled with insomnia, and 20 percent had clinically significant insomnia problems. This is just one study of one group of cancer patients, but the problem occurs for thousands of others as well.
In order to give your body the best chance at healing and fighting this aggressive disease, you need to sleep. Thankfully, there are steps you can take to help improve the quality of your sleep, even on a cancer-fighting journey.
This guide will look at how cancer affects your sleep, why you may be struggling to sleep well, and what you can do to get better sleep while continuing to fight this disease. With these tips, a restful night’s sleep may be just around the corner.
The Connection Between Sleep, Cancer, and Treatment
Before discussing ways to get better sleep, it helps to understand the link between cancer and sleep. Studies have found that sleep deprivation actually contributes to cancer risk, and other studies have found that poor sleep is a side effect of cancer and cancer treatment. Here are some facts illustrating this relationship:
- According to one 2014 study, men struggling with insomnia are twice as likely to develop prostate cancer than those who sleep well.
- In 2010, researchers found that sleeping fewer than six hours per night led to a 50 percent increase in the risk of colorectal cancer. The recommended amount of sleep for adults is seven to eight hours, so even losing one hour of sleep leads to a higher risk of cancer.
- Women suffering from lack of sleep are prone to more aggressive breast cancer. A 2012 study found that fewer hours of sleep can lead to the contraction of more aggressive forms of breast cancer in postmenopausal women.
- Shift work, which has been shown to induce sleep disorders, can also increase cancer risk. One study following women working night shifts showed that working up to three night shifts per week increased their risk of breast cancer by 30 percent.
- The lack of melatonin is also connected to cancer risk. A study in 2003 found that women showing reduced levels of the sleep hormone melatonin had higher risks of developing breast cancer.
The list of studies connecting sleep with cancer risk can seem endless, but that’s part of the reason you need to understand the connection. Not only does lack of sleep increase your risk for cancer, but if you are diagnosed, you will find that having cancer makes it harder to sleep. Why is it more difficult to sleep when you’re battling cancer? Here are some of the causes of poor sleep for those fighting cancer.
- Some treatments can make you feel drowsy during the day. Chemotherapy, for instance, can cause drowsiness. If you take a nap while you’re feeling drowsy, you may struggle to sleep later at nighttime. Anti-nausea medications can have a similar effect.
- The stress of knowing you have cancer makes it difficult to sleep. Stress, regardless of the cause, makes sleep harder to come by. It can create a state of hyperarousal, which makes it almost impossible to get quality sleep.
- Increased anxiety and depression can affect sleep. When you suffer from these mental health concerns, you may struggle to get enough sleep. Depression affects 20 percent of people with cancer while anxiety affects 10 percent. These numbers contrast with 5 and 7 percent, respectively, in the general population not battling cancer.
- Between 30 and 75 percent of people who have cancer also experience sleep disturbances. These may include sleep apnea episodes or restless legs syndrome. Though the cause of these disturbances varies, it’s clear that cancer affects sleep, and lack of sleep affects healing and future cancer risk.
For more information about the connection between cancer and sleep, visit:
- Journal of the National Cancer Institute: Melatonin and Breast Cancer: A Prospective Study
- National Institutes of Health: Sleep Duration and the Risk of Cancer – A Systematic Review and Meta-analysis Including Dose-response Relationship
Sleep Apnea, Cancer, and What to Do About It
Recently, researchers have found a link between sleep apnea and cancer. This isn’t surprising, especially considering that sleep apnea has been linked to a higher risk of other conditions, such as stroke, cardiovascular diseases, and heart attacks. Here’s what you need to know about sleep apnea and how you can get better sleep if you have this disorder.
- A Spanish study found that severe sleep apnea increases a person’s risk of developing cancer by 65 percent.
- A Wisconsin study found patients who suffered a high number of sleep apnea episodes were five times more likely to die of cancer. This study shows why controlling sleep apnea is so important, especially for those already battling cancer.
- 80 percent of patients with head or neck cancer also have a diagnosis of sleep apnea. While this doesn’t illustrate a definitive causal relationship, it does show a possible connection.
- The steroids many cancer patients take to boost their immune responses can cause weight gain, which has been linked to sleep apnea.
- Have a sleep study done if you suspect you have sleep apnea. Sleep studies are the most effective ways to diagnose sleep apnea.
- Talk to your doctor about a CPAP, or continuous positive air pressure machine. These devices gently blow air at a consistent rate into your airway while you sleep, which regulates your breathing and reduces the risk of apnea episodes.
For more research on the link between sleep apnea and cancer, visit:
- National Institutes of Health: Fragmented Sleep Accelerates Tumor Growth and Progression Through Recruitment of Tumor-Associated Macrophages and TLR4 Signaling
Insomnia, Cancer and What to Do About It
The most common problem cancer patients face when it comes to sleep is simply insomnia. Insomnia, or the inability to fall or stay asleep, can be caused by anything from anxiety to medication. Signs of cancer-related insomnia include challenges falling asleep, frequent nighttime waking, or waking up too early. Here are some tips to deal with insomnia while fighting cancer:
- Avoid naps. Chemotherapy and other medications can make you tired during the day, but napping for too long can make it difficult to sleep at night. If you need to nap, consider napping before 3:00 pm. Keep naps short, around 20 minutes, to avoid problems with nighttime sleep.
- Keep a sleep journal. For a few weeks, journal about your sleep. Include details about your day, such as what medications you used, when and what you ate and drank, and your exercise routine. This will help you see what you may be doing to contribute to the problem, and also give you something to show your doctor if you need medical help to sleep.
- Make the room environment dark. Light, even just the light from an alarm clock or nearby charging device, can make problems with insomnia worse. Make your environment dark by eliminating all sources of light. A sleep mask can help, if you don’t mind wearing something over your eyes. Hang blackout curtains if your room gets too much light.
- Discuss moving your medication timing with your doctor. If you are taking medications like steroids that make sleep difficult, consider asking your doctor if you can time the medications so they don’t need to be taken near bedtime. Similarly, if you’re taking medications that make you drowsy, find out if you can take them near bedtime instead of during the day. Only change medications at your doctor’s advice.
- Turn off screens early. Two hours before bedtime, stop looking at electronics, including the television. In the hours leading up to bedtime, relax with non-screen-related activities, like reading or working on a craft.
- Create a sleep routine. Going to bed and waking up at the same time every day will condition your body to naturally sleep during your normal sleeping hours. In addition, keeping the same routine when you go to bed and doing your tasks in the same order will prepare your body for sleep.
- Invest in the best mattress for support and comfort. A mattress that is comfortable and provides good support will go far in helping you sleep more effectively. Consider the level of support and whether or not the mattress has cooling technologies, such as open-cell foam, innersprings, or gel-infused foams.
- Keep your room cool. The ideal sleeping temperature is between 65 and 70 degrees. If you find that you are uncomfortable, try adjusting the temperature within that range. Keep in mind that some medications may affect your body’s temperature, but for most people this range is ideal.
- Declutter and clean the bedroom. If the bedroom is cluttered and messy, it can add to feelings of stress. This can make it more difficult to sleep restfully. Transform the room into a calm sanctuary by taking the time to clean it well.
- Spend time in the sun. Take any precautions necessary to protect sensitive skin, which is often a problem when treating cancer. Sunlight helps regulate your body’s natural sleep rhythm, plus, vitamin D can help make your sleep more restful— just apply sunscreen whenever you go outside.
- Get some moderate exercise. If you have the strength to do so, get moderate exercise early in the day. A 20-minute walk, if your body is able, will help increase your ability to sleep. However, avoid strenuous activity late in the day as your raised heart rate can delay sleep.
- Treat the underlying problems that lead to insomnia. Treating the anxiety or pain keeping you up at night may help alleviate your insomnia.
For more information about cancer, insomnia, and what you can do about it, visit:
- Cancer.net: Sleeping Problems: Insomnia
- Cancer Treatment Centers of America: How Does Insomnia Affect Cancer Patients?
- National Institutes of Health: Insomnia in Cancer Patients
Anxiety and Depression, Cancer, and What to Do About It
Cancer and cancer treatment are emotionally trying. Many patients struggle with anxiety and depression as a result. These mental health concerns can create problems with sleep, as patients find their minds whirling at the end of the day with questions of “what if” or “what’s next.” If you’re dealing with anxiety and depression as a result of your cancer, and it’s affecting your sleep, here are some strategies to consider.
- Practice relaxation techniques to distract your mind from anxious thoughts. When you lie down to sleep, you may find your mind wandering to all of the aspects of your treatment that you have to handle in the coming months, and what your diagnosis means for you and your family.
- Keep a pen and paper by your bed. If you wake up with your mind racing, write down your thoughts. This may help you release them and get back to sleep. In the morning, you can decide whether or not you need to address those thoughts.
- Discuss your needs with a counselor. Behavioral counseling is highly effective in treating anxiety. Sometimes, just having someone to talk to about what you’re going through can alleviate many of your concerns and struggles. Your counselor should be a trained professional, not a trusted friend or family member since your loved ones are also dealing with their own fears and anxieties during your battle. To get the best results, look for a counselor who has worked with cancer patients before, as that counselor will likely have a better understanding of what you are going through.
For more information about anxiety, cancer, and its effect on sleep, visit:
- American Cancer Society: Anxiety, Fear, and Depression
- National Cancer Institute: Adjustment to Cancer – Anxiety and Distress
- JAMA Oncology: Cancer-Related Anxiety
- Anxiety and Depression Association of America: Sleep Disorders
Daytime Sleepiness, Cancer, and What to Do About It
Cancer treatments often cause fatigue. In fact, after receiving radiotherapy, cancer patients report nearly double the degree of fatigue than they normally feel. This is a temporary side effect for most patients, but the treatment definitely can disrupt sleep. Taking a nap to combat daytime sleepiness can then lead to problems sleeping at night. Here are some strategies to help you overcome this particular challenge.
- Take naps if you need them. Take naps early in the day and limit them to 30 minutes or less. Naps lasting any longer than that or taken later in the evening will likely lead to insomnia at bedtime.
- Plan daily exercise in the morning. If you’re physically able, get some exercise, but try to complete activities in the morning instead of the afternoon. This will send a jolt of endorphins into your system, which can combat sleepiness.
- Eat lightly. Large, carb-heavy meals can make you even more sleepy during the day. Make sure you’re getting adequate nutrition with the help of your doctor.
- Limit caffeine. When you feel sleepy during the day, you’re likely to reach for a can of soda or a cup of coffee for the caffeine help, but avoid this temptation.
- Understand the reality of cancer-related fatigue. Sometimes, having cancer simply means you are more tired than usual. This is a temporary problem, but give yourself the grace to manage it while you are in the midst of treatment. Your body is working hard to heal and fight this disease, and it is going to be tired.
- Plan time for extra sleep at night. The process of fighting cancer takes a toll on your body, and you will need more sleep than normal. It is beneficial to give yourself this time, but for the most restorative benefits, aim to get most of your sleep at night, rather than during daytime naps. If you typically sleep 7 hours, plan to sleep 8 or 9 while in treatment.
For more information about cancer and daytime sleepiness, visit:
- American Family Physician: Excessive Daytime Sleepiness
- SemanticScholar.org: Cancer-related Fatigue Presenting with Excessive Daytime Sleepiness
- Science Direct: Excessive Daytime Sleepiness
Restless Leg Syndrome, Cancer, and What to Do About It
Though less common than excessive sleepiness or insomnia, restless leg syndrome still plagues quite a few cancer patients. Though this condition only affects about 5-10 percent of the population, those with cancer are twice as likely to experience it than those without. The constant movement and sensations in the legs and other limbs associated with restless leg syndrome can make sleep difficult, but these tips can help.
- Rule out other potential conditions. Other more dangerous problems can mimic the problems of restless leg syndrome. For example, peripheral neuropathy, which causes damage to the nerves, can cause similar sensations. Leg cramps can make your legs twitch but may have another root cause. Always discuss your symptoms with your doctor to ensure that you don’t have another underlying problem.
- Discuss your medications. Medications for cancer and co-occurring disorders can contribute to restless leg syndrome. For example, SSRI (Selective Serotonin Reuptake Inhibitor) medications, taken by many cancer patients suffering from depression, can worsen this condition.
- Eliminate caffeine. Eliminating caffeine may help your restless leg syndrome symptoms to settle.
- Exercise carefully. Mild exercise can help this condition, but strenuous exercise can make it worse. Keep in mind your overall physical health and the effects of your cancer treatment when considering exercise.
- Consider iron supplements. Sometimes people suffer from restless leg syndrome because of iron deficiency. Talk to your doctor about testing your iron levels, and take supplements if needed to address any deficiencies.
- Test for vitamin and mineral deficiencies. Cancer depletes many of your body’s resources, so you may be suffering from other deficiencies that are causing or exacerbating your restless leg syndrome. In addition to iron, magnesium and vitamin D are common culprits. Talk to your doctor about vitamin and mineral testing, and take appropriate supplements if you discover a deficiency.
- Stretch and massage the legs. When your legs are actively bothering you and preventing your sleep, try stretching them or massaging them. This might reduce the restless sensation so you can sleep.
For more information about restless leg syndrome and cancer, visit these resources:
- National Institutes of Health: Restless Legs Syndrome as a Cause of Sleep Disturbances in Cancer Patients Receiving Chemotherapy
- UW Health: The Challenges of Restless Leg Syndrome
Therapies that Help Cancer-Related Sleep Problems
In addition to medical interventions, some therapies can help people battling sleep problems due to cancer. Some to consider include:
- Invest in cognitive behavioral therapy. Cognitive therapy can help combat cancer-related insomnia, particularly by helping cancer patients address their underlying emotions and anxiety. This therapy involves meeting with a therapist to learn cognitive and behavioral strategies to manage anxiety and depression.
- Practice sleep restriction therapy. Sleep restriction therapy can teach the body that bedtime is for sleeping, and it often works well for people who tend to toss and turn for a long time before falling asleep. This therapy creates a state of sleep deprivation temporarily to teach your body how to sleep through the night. To get started, if you typically sleep for six hours, go to bed five hours before your desired wake-up time. Do this for one week, and you will create a little sleep deprivation. Then, move your bedtime back by 30 minutes so you’re sleeping 5½ hours, and then wait a few days. Keep increasing the increments until you are sleeping through the night for 7 to 8 hours. Eventually, your body will learn to fall asleep immediately when you lie down.
- Consider light therapy. Light therapy uses lightboxes to mimic outdoor sunlight and stimulate your body’s natural sleep and wake cycles. By sitting next to the specially programmed lightbox at specified intervals each day, you may be able to retrain your body to follow a normal sleep and wake cycle.
For more information about these therapies and how they can help you sleep, visit:
- Mayo Clinic: Insomnia Treatment – Cognitive Behavioral Therapy Instead of Sleeping Pills
- National Institutes of Health: How Does Sleep Restriction Therapy for Insomnia Work?
Products to Help Cancer Patients Sleep Better
Sometimes, it’s the overall effect of cancer and its treatments that prevents sleep. Cancer patients may not suffer from restless leg syndrome or daytime sleepiness, but they may find that bodily pain or night sweats keep them up at night. For these types of symptoms, certain products can make sleep easier to attain.
- Invest in cooling bedding. Sometimes cancer patients can suffer from night sweats, especially during chemotherapy treatment. Cooling pillows, sheets, or mattresses help prevent excessive heat when sleeping.
- Reduce anxiety with a weighted blanket. Weighted blankets place a small amount of pressure on your body. This can limit sensations associated with anxiety and restless leg syndrome and may help you sleep better. When choosing a weighted blanket, choose one that weighs about 10 percent of your body weight.
For more information about products that help cancer patients achieve restful sleep, visit:
Sleep is Tough for Cancer Patients, But Help Is Available
Getting a good night’s sleep when fighting cancer is not easy. The challenges of this disease and its aggressive treatments, combined with the challenge of daytime sleepiness, can make it difficult to sleep through the night. Thankfully, you can manage the challenge of sleep during your cancer battle. With the right sleep hygiene, close communication with your medical team, and careful attention to sleep time and duration, you can conquer this challenge as you continue to fight hard against cancer.