Sleep Problems

There are several different types of sleep problems. The most common problems among people being treated for cancer are insomnia (the inability to fall asleep or stay asleep), disruption of the wake-sleep cycle, and excessive sleepiness.
 

Many people have sleep problems during cancer treatment. People who have surgery often have trouble sleeping in the hospital because of pain, as well as noise and treatment schedules. This is especially true for older patients in an intensive care setting. Women who have surgery for gynecologic cancer are likely to have sleep disrupted because of hot flashes/night sweats. For people who have sleep apnea, the condition may worsen during cancer treatments.
 

Chemotherapy and radiation therapy can disrupt the chemical balance of the body, which can affect how well you sleep. Changes in hormone levels caused by gynecologic surgery, chemotherapy, or hormone therapy may cause sleep to be interrupted. Sleep problems are more often related to other side effects of cancer treatment rather than to the treatment itself. For example, wakefulness is a possible side effect of some medications to control nausea and of corticosteroids (prednisone, dexamethasone). In contrast, opioids and other pain medications may cause excessive sleepiness. Napping and prolonged rest during the day because of fatigue or pain medications can disrupt the wake-sleep cycle and make it difficult to fall asleep at bedtime. Many factors can cause sleep problems in people with cancer, and most are not related to treatment.
 

Sleep problems can occur early on during treatment. For example, people may not sleep well immediately after surgery because of pain and the unfamiliar environment of a hospital. Sleep may be more troublesome on actual treatment days. Many people with cancer say they cope with sleep problems for many months after treatment has ended.
 

Making some simple changes in daily habits may help you to sleep better (Table 1). Your doctor may review the medications you are taking and change some of them if he or she thinks that drug interactions or side effects are contributing to your sleep problems. Your doctor may recommend a medication to help you sleep. In addition to a sleep medication such as zolipidem (Ambien), other medications have been found to help people fall sleep, including anthistamines (diphenhydramine [Benadryl], hydroxyzine [Vistaril]), benzodiazepines (diazepam [Valium], temazepam [Restoril]), and antidepressants (amitriptyline [Elavil], nortriptyline [Pamelor]). Medications prescribed to promote sleep should be taken only for a short time (less than 2 weeks) so that you do not become dependent on a drug.
 

You should talk to your doctor or nurse if you have sleep problems on a few occasions. It is important to have your sleep problems managed early on, as your body needs proper rest to tolerate treatment and to heal. Talk to your doctor before you take any over-the-counter sleep aid, as these medications may interact with other medicines you take.
 

• American Cancer Society: www.cancer.org, Getting a Good Night's Sleep May Be Challenging for a Cancer Patient
• American Society of Clinical Oncology's patient Web site: www.cancer.net, Sleeping Problems or Insomnia, Strategies for a Better Night's Sleep (article and podcast)
• National Cancer Institute: www.cancer.gov, Sleep Disorders (PDQ®)
• National Coalition for Cancer Survivorship: www.canceradvocacy.org, Sleep Problems
• Oncolink: www.oncolink.com, Insomnia