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.

Receiving a cancer diagnosis is certainly stressful news.  The term “stress” refers to an outside circumstance.  Behavioral health therapists use the term “distress” to label our internal response to stress.  In explaining this to my patients, I say that stress is the toxins in the  air around me.  Distress is when I breath in the toxins  The goal of monitoring and managing distress is similar to learning to use a hazmat suit and oxygen tank in a toxic environment.

Even though it is very common for those receiving a cancer diagnosis to focus on physical symptoms, medical treatments and side effects, it may surprise you to discover that you may also suffer in non-physical ways.  This is because we are not just physical beings, but have mental, emotional, psychological and spiritual aspects, too.  

Distress is an umbrella term that covers the normal thoughts and feelings that normal people have when bad things happen.  The feelings can be: sad, mad, anxious, worried, scared – and most of the time, a perplexing mosaic of these emotions.  Distressing thoughts tend to center around the fear of the unknown. “Is my treatment going to work?”  “Is it going to hurt?”  “Is it expensive?”  “Will it change how I work?”  “How will this affect my retirement?” 

A very important part of helping you in your journey with cancer is to help you monitor and manage your distress levels –  just as you would monitor any other side effect.  There are two primary reasons why this is so important.  First reason: as distress levels rise, quality of life sinks.  But by working on lowering distress levels, you will improve your quality of life.  When a disease process is usurping the controls you normally have, one of the most important methods to reclaim control is using the tools you do have to manage distress levels.  

The second reason to manage distress levels is because when you feel less distress, you tend to heal better. This is because your mind and your body are really one unit – connected in a myriad of ways we don’t completely understand.

Basically there are three tool boxes that you already have to draw from to help manage your distress levels.  The first one is your internal resources: your psychological strengths, your intellect, your resiliency.  Internal resources are the resources that you have built into your brain during previous times of crisis.  Sometimes these were minor changes you made to handle small crisis and you recovered in hours or days.  Cancer tends to be a major crisis and many patients tell me that it is the worst thing that has ever happened to them.  This will usually mean that distress levels are higher than they have ever been.  This also means that it may take more time to successfully manage.

The second toolbox which provides your resources to manage your distress levels is your support system. This includes your friends family and community.  These are the people who call, send cards, bring casseroles, and when you have a bad day, listen. Many times cancer patients voice surprise by the number of people that rally around them.  (As well as the people who don’t know what to do and seem to move a little farther away.)  I encourage people to realize that the bigger the crisis –  the bigger the team needs to be.

The third toolbox for dealing with crisis and distress is your medical team.  Many patients are surprised to learn that they may need several doctors, nutritional specialists, physical therapists, and behavioral health support.  Many patients also find relief from the distress by seeking out relaxation therapies, massage, yoga etc.

CAN I REALLY MANAGE MY DISTRESS LEVEL?

Clinically speaking, the simple answer is yes!  You have done this before in other situations.  I am not going to tell you it’s easy, but I will tell you patients consistently improve the quality of their life by initiating steps which lower distress.  Even though at the beginning of the process, it may seem overwhelming, let me suggest three questions to begin lowering your distress level, and thereby improving your quality of life.

First, ask yourself, what internal resources have I used in the past when I’ve been in difficult or negative situations?  Usually in discussing this question with patients, I remind them that the wrench I use on my mower can be used on my motorcycle, and on my automobile.  Even if being diagnosed with cancer is the most difficult and most distressing situation you have ever been in, the tools that you have learned to use from other life experiences can also work in this situation.

Second, what things do I need from my support team and who do I need to add to my support team?  It is not unusual for new situations to call for new team members and new behaviors.  The more specific you are with identifying your needs, the easier it is for your team to help you meet those needs.  Many people on your support team will not know what support you need until you tell them.

Third, what do I need from my medical team?  Your medical team is likely to have more members than you might have imagined or have used in the past.  Take a look at all the departments and providers that are available at your treatment site.  It is not unusual  to add providers and services.  That is part of the rationale behind OncoPower: to add value to your treatment plan.

With Halloween approaching, most people are stocking up on chocolate bars, fruity chews, and other candy to hand out to trick-or-treaters. Though a delicious holiday tradition, many cancer patients are wondering: do these sweet treats do more harm than good? 

What is Sugar and Why Do We Need It?

Sugar is a kind of simple carbohydrate, which means it is digested quickly by the body.  Sugar is in obviously sweet things like soda pop, candy, and baked goods, but is also in healthy foods like fruits, vegetables and whole grains.  Every cell in the body, including cancer cells, uses carbohydrates as a main energy source.  Your body doesn’t store many carbohydrates, which is why you need to consume them every day.

Why Do Some People Say Sugar Causes Cancer?

As of this writing, there is no evidence to say that sugar directly causes cancer.  However, there is an indirect link between sugar and cancer.  A diet that is high in sugary foods leads to weight gain and obesity, which leads to high inflammation in the body.  Obesity and inflammation have both been strongly linked to 13 kinds of cancer and in the US, excessive weight is the second largest modifiable risk factor to developing cancer behind smoking. Obesity and excess fat in the body also leads to abnormal levels of specific hormone and signaling molecules, which may have cancer-causing effects.

Because cancer cells use carbohydrates for energy to grow, some people think if they cut out all sugar from their diet then the cancer will shrink and die.  If curing cancer was this easy, there would be no need for chemotherapy drugs! This doesn’t work because your whole body, not just cancer cells, needs carbohydrates in order to make energy. If you don’t eat enough sugar and carbohydrates, your body will break down fat and muscle to make sugar. This tissue breakdown leads to weakness, fatigue, and even malnutrition.  Foods like carrots, strawberries, oatmeal, and milk all contain natural sugars but also contain healthy things like fiber and antioxidants which can be cancer-fighting. It isn’t healthy to get rid of all these foods from your diet, especially when many cancer patients have a hard time eating enough food as it is.

How Much Should You Eat?

Many recommendations for sugar and carbohydrates intake are written in ‘servings per day’ or ‘grams per day’. This level of detail can be confusing to follow in your day-to-day life, but on the nutrition facts label the most important thing to avoid is too much ‘added sugar.’ This is the kind that manufacturers put in foods to make it addictively sweet, and can be a range of things, from the much demonized ‘high-fructose corn syrup’ to ‘brown rice syrup’ but it all means the same thing – sugar.  Overall, you should be limiting the amount of artificially sweet foods and choosing more naturally sweet foods. The American Cancer Society, along with many other trusted sources, suggests following an eating pattern similar to the one below, both to prevent and treat cancer:

  • Include:
    • Whole grains like brown rice and oatmeal, which contain slow-to-digest carbohydrates that keep you fuller longer
    • Fruits and vegetables that are brightly colored, to provide vitamins, minerals, and antioxidants to keep your immune system working properly
    • Lean proteins such as fish, chicken, eggs, nuts & seeds, beans, and soy to keep your muscles strong
    • Healthful fats like olive, canola, or avocado oil to provide additional energy and keep you satisfied
    • Drink plenty of water to stay hydrated and flush out toxins 
  • Avoid or limit:
    • High sugar foods such as soda pop, candies, and cookies since they provide a lot of energy but very little nutrition 
    • Fatty or fried foods like french fries, steak, cream, and butter as these can lead to high inflammation and are not good for your heart

Sugar is delicious but not very nutritious, especially for cancer patients who need to get the most impact out of every bite.  Do you have specific questions about what changes you should make to your diet to enhance your cancer care? Join OncoPower and reach out to our Registered Dietitians on the app. We look forward to giving you personalized nutrition advice, it’s a treat that can be enjoyed year-round!