Sleeping problems are a common side effect for cancer patients due to medication side effects, treatments, and other lifestyle factors that may be hindering the ability to get a restful night’s sleep.  

Research shows that sleep helps to regulate blood sugar, prevent brain fog and forgetfulness, reduce stress, improve your mood, and strengthen your immune system. All these benefits of good sleep improve both internal health and day-to-day quality of life.1 

What causes sleep problems for cancer patients?

  • Both radiation and chemotherapy have been reported to affect sleep patterns.2 Ask your provider if the medications you are using could be contributing to your sleep problems.
  • Steroid-based medications can sometimes cause sleep disturbances in cancer patients. 
  • Medications that impact hormone levels, such as antiestrogens (tamoxifen) and aromatase inhibitors, can cause night sweats and hot flashes.3,4
  • Some anti-nausea medications can cause inability to fall asleep. If this occurs, notify your care team to potentially switch out your medications.4

How to Manage Sleep Problems

Wind-Down Plan

The first thing to try when looking to improve sleep is establishing an effective nightly wind-down routine. This can include lifestyle modifications like going to bed at the same time every night, changing the timing of your medications, practicing meditation, controlling the temperature in the room before and during sleep, and turning off all screens 1-2 hours before bed. Establishing a consistent sleep routine is an easy way to prime your body and brain for a good night’s sleep. 

Exercise 

Exercise has been studied in cancer patients and was shown to help promote sleep and relieve stress.5 This may make you feel more tired at the end of the day to help you fall asleep faster and stay asleep throughout the night. However, it’s important not to engage in vigorous exercises close to bedtime as this can prevent you from being able to fall asleep. Save your hard workouts for earlier in the day and choose more soothing exercises like yoga or stretching for evening movement.

Mindfulness and Meditation 

Mindfulness and meditation can be useful relaxation techniques to help you get into a calm state before bed. This can include guided meditation, imagery exercises, calming music, and breathing exercises. Check out OncoPower’s meditation resources or set up an appointment with our meditation specialist.

Nutrition

While you might not think of your eating habits as contributing to sleep disturbances, there are a few eating behaviors you can change to help you fall asleep and stay asleep at night. Try to avoid drinking caffeine post 2 pm or about 6-8 hours before bedtime. Caffeine is a stimulant, which can make you feel alert and prevent you from falling asleep. Additionally, although a sedative, alcohol can also contribute to sleep problems by reducing the amount of time you are in REM sleep, the most mentally restorative part of the sleep cycle. It’s best to avoid alcohol when experiencing trouble sleeping.6

Melatonin is a hormone that controls the body’s sleep-wake cycles. Melatonin production naturally goes down during the day when it’s light out and increases at night when it’s dark to make you tired and get the body ready for sleep. You can try adding natural melatonin-enhancing foods like nuts, oats, tart cherries, and Gogi berries to your meals and snacks to boost your melatonin.7  

Medications 

If lifestyle modifications are not helping to alleviate your sleep disturbances, some medications may be temporarily used to help with sleep. However, it’s important to consult your care team before taking any medications, supplements, or herbs, including CBD, that claim to help with sleep. This is because they can sometimes cause unwanted drug interactions with cancer medications.

Sleep Apnea 

If you are experiencing trouble sleeping, your provider may order a sleep study to assess you for sleep apnea. Sleep apnea is a common sleep disorder in which your breathing may stop or get very shallow while sleeping. These breathing disturbances may cause individuals to feel fatigued the next day despite sleeping for an appropriate amount of time. Consult a doctor or sleep specialist to learn more about making a plan to address your sleep apnea.2 

Other Things You Can Do To Manage Sleep-Wake Disturbances

  • Keep track of your sleep or wear a fitness tracking device that records your sleep
  • Avoid taking naps throughout the day
  • Make sure you are following your medication schedule and taking medications at the same time every day. Try OncoPower’s pill reminder feature to help with medication consistency.
  • Use blue light-blocking glasses if using screens before bed
  • Try to go to bed at the same time every night

Making sleep a priority is essential for overall wellness, but it is especially important after a cancer diagnosis. If you have any questions about sleep, join our community, and be sure to check out the free meditation resources on the OncoPower App.  

References

  1. Physical Health and sleep: How are they connected? Sleep Foundation. https://www.sleepfoundation.org/physical-health. Published April 14, 2022. Accessed March 30, 2023.
  2. Managing sleep problems. American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/sleep-problems/managing-sleep-problems.html. Published January 6, 2020. Accessed February 17, 2023. 
  3. PDQ® Supportive and Palliative Care Editorial Board. PDQ Hot Flashes and Night Sweats. Bethesda, MD: National Cancer Institute. Updated <07/29/2021>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/hot-flashes-pdq. Accessed <03/20/2023>. [PMID: 26389162]
  4. Difficulty sleeping (insomnia). Difficulty sleeping UK. https://www.cancerresearchuk.org/about-cancer/coping/physically/difficulty-sleeping. Published February 14, 2020. Accessed February 17, 2023
  5. Mustian KM, Sprod LK, Janelsins M, Peppone LJ, Mohile S. Exercise Recommendations for Cancer-Related Fatigue, Cognitive Impairment, Sleep problems, Depression, Pain, Anxiety, and Physical Dysfunction: A Review. Oncol Hematol Rev. 2012;8(2):81-88. doi:10.17925/ohr.2012.08.2.81
  6. Alcohol and sleep. Sleep Foundation. https://www.sleepfoundation.org/nutrition/alcohol-and-sleep. Published March 17, 2023. Accessed March 30, 2023.
  7. Melatonin: What you need to know. National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know. Accessed March 30, 2023.

Cancer fatigue versus normal fatigue

In general, everyone gets tired. Then, we go to sleep and feel better. Fatigue is an unusual tiredness that can profoundly affect your quality of life. It can last up to several weeks or longer. Cancer fatigue goes beyond that- it affects you physically, emotionally, and mentally. It usually comes on suddenly and no amount of sleep can help restore your energy. It is important to know that you are not suffering alone. Cancer related fatigue affects 80% to 100% of people with cancer.

What causes fatigue in cancer

The exact reason for cancer related fatigue is unknown. However, it may be related to several causes:

  • Cancer treatments (chemotherapy, radiation therapy, immunotherapy, bone marrow transplant, and biologic therapy) 
  • Medications
  • Anemia
  • Pain
  • Decreased Nutrition
  • Stress
  • Depression

How to recognize when there is a problem

Some symptoms are expected during and following cancer treatments:

  • Whole body tiredness
  • Decreased energy
  • Weakness
  • Inability to concentrate
  • Lack of motivation
  • Increased irritability
  • Anxiety
  • Insomnia

Talk to your doctor if you experience any of these symptoms persistently for weeks or longer. Your doctor may conduct a physical exam to evaluate the severity of your symptoms. He or she may ask questions to examine the nature of your symptoms. It may also help to keep a journal to track your fatigue and contributing factors.

How to manage cancer related fatigue

Cancer fatigue treatment is managed on an individual basis. However, the first step is to recognize that the problem exists. With the help of your doctor, you can determine the root cause of the problem. After that, an appropriate treatment can be prescribed. There are several actions that experts recommend to help ease your symptoms:

  • Blood tests can determine anemia. If you are anemic, your doctor may prescribe iron therapy, blood transfusion, Erythropoiesis-stimulating agents (ESAs), and supplements (B12 and folic acid).
  • Talk to your doctor about ways to manage pain. Several medications exist to manage pain. You can also try a non-pharmaceutical approach, such as acupuncture, massage, relaxation techniques, and meditation. OncoPower has a wonderful meditation suite you can use any time. 
  • Talk to a dietitian. He or she can recommend dietary changes to help improve your appetite and nutritional intake. If your intake is poor because of nausea, there are several treatments available that can help you. You can check out more information about that on this video presentation by our registered dietitian Rachel Spencer.
  • Seek mental health support. Therapy can help you manage stress, anxiety, and depression. In-person and online support groups can also help.
  • Physical activity is important. It can help improve your quality of life and energy. In fact, according to the American Cancer Society, physical activity may help you cope with side effects of treatment and possibly decrease your risk of new cancers in the future.

Everyone experiences cancer fatigue differently. It may be a common side effect of this illness, but it does not have to affect your life. Talk to your doctor today. 


For more information on cancer fatigue management, watch this video presentation by our experts at OncoPower.