Hello chemo! Goodbye sleep!
Just when you want to collapse into bed and grab some rejuvenating sleep it appears that you have completely lost the knack! Many people find that chemotherapy causes sleep problems and can destroy the concept of a good night’s sleep so you are not alone.
There is a reason sleep deprivation has been used for years as a torture method – it is really hard to function without it and lack of sleep can compromise both physical and mental health. During chemotherapy sleep problems can be a real issue. I know they were for me so here are a few hints and tips that may help.
At the Beginning
Right from the start of this journey you may have noticed that your quality of sleep has changed. You no longer wake up feeling refreshed and it may be hard hauling your body out of bed in the mornings.
At this stage that may be largely due to the worry and the stress of the diagnosis and upcoming treatment. Believe me, there is plenty of that!
It is worth starting to look at things that can help try and get you back on track, including –
- Relaxation Techniques
- Sleep Hygiene
- Alternative Therapies
Relaxation Techniques for Sleep Problems
There are many relaxation techniques that would be suitable to use at bedtime. Not all of them suit everybody so you may need to do a bit of trial and error.
- Progressive Muscle Relaxation – this is a technique that involves holding each muscle group tense for 5 seconds, breathing deeply for 10 seconds then moving on to the next muscle group while you are sitting comfortably or lying in bed.
- Humming – this can have a calming effect (not necessarily on your partner, so you may need some alone time in order to practice this).
- Sound – Typically soothing noise such as a calm ocean or the gentle music. These are available as apps on your phone so that you could listen to it with headphones as you fall asleep.
- Breathing Exercises – such as those that are practiced in yoga. Breathing slowly in, holding your breath then breathing even more slowly out again.
These are just a few but if you haven’t yet tried them yet then do – they won’t do you any harm and just may help!
Exercise and Sleep Problems
Regular exercise is well recognised to improve quality of sleep and this situation is no different. It makes sense. If you can completely relax your body and mind and physically tire yourself at the same time its got to work hasn’t it?
The amount of exercise needed will vary amongst us and there can be such a thing as overdoing the exercise – like the idea of children being ‘overtired’ so there’s no need to go wild. A short walk everyday for example will help increase the feel good chemicals in the brain (the endorphins) and encourage sleep. Exercising itself will also help our minds and bodies deal with stress so the benefit for sleep is two fold – you will end up going to bed feeling less stressed so your brain has less to mull over and to wake you up with in the early hours.
Sleep hygiene is the name used to describe getting your sleep habits into a good pattern. With everything that has been on your mind you may be out of kilter in terms of the time you go to bed and grabbing naps etc
For good sleep hygiene there are things that should be avoided, for example:
- Watching an exciting film just before bed – this can cause adrenaline, your flight or flight hormone, to surge round your body making it impossible to relax.
- Using an electronic device just before bed – the blue light that radiates from these can interfere with your body’s melatonin (the chemical that regulates your day/night rhythm and sleep patterns) and hence disturb your sleep patterns.
- Taking an afternoon nap. Although this may feel like a good idea or even a necessity at the time by catching up on sleep during the day you are even less likely to be able to sleep well at night. There is also the risk you can end up in a cycle of napping and not sleeping which can be hard to break.
- Too much caffeine. You may, like me, grab tea and coffee through the day and, of course, this is even more likely if you’re tired. The problem with this is caffeine is a stimulant and caffeinated drinks including colas and ‘energy’ drinks consumed later on in the day and into the evening will prevent the brain from switching off. It is worth looking at how much caffeine you have through an average day and perhaps swapping in some decaffeinated versions especially after 4 in the afternoon.
- Alcohol. This should be avoided for 4-6 hours before bedtime. At first it can seem that alcohol can help you sleep but as the levels of alcohol in your bloodstream fall there can be a stimulant effect which wakes you up.
- Heavy meals or spicy food just before bed.
- Exercise just before bed. As discussed on the whole exercise is a good thing which can help sleep but not within two hours of going to bed.
For good sleep hygiene there are some things which may help, such as:
- Try and go to bed at the same time every evening whatever else is happening.
- Set your alarm for the same time every morning and get up regardless of how much sleep you have had that night.
- Make sure your room is a comfortable temperature – slightly cooler is better.
- Have comfortable bedding (now might be the time to treat yourself to a new duvet or mattress topper!)
- Try to avoid using the bedroom as an office or recreation room. Let your brain realise this is the room where you sleep.
- Try having a light snack before bed – warm milk or foods rich in ‘tryptophans’ may help.
- Practice relaxation techniques like yoga before getting into bed.
- Make sure you have a good pre bedtime regime – take a bath or read for a while.
- Try not to take your worries to bed with you – sometimes it can help to devote some time to these worries earlier on in the evening and then leave them alone (this may take some practice).
- If you don’t fall asleep within half an hour, get up and go and read in another room until you feel sleepy. don’t lie there tossing and turning. This also applies if you wake up in the middle of the night and can’t get back to sleep – get up and read, have a bath or do something else that is quiet and relaxing – don’t watch television or drink caffeine!!
Counselling and Sleep Problems
Counselling is often helpful during this time of your life – big changes are happening – the actual cancer diagnosis and then the trauma of treatment, in particular, chemotherapy.
You may find that there is some free counselling available to you via your cancer centre so it is worth checking if you have not already been told about this.
You may not feel you need counselling but it is often beneficial to go along for a session to talk through things and there may be more than you were aware of to talk about. This is particularly true for insomnia.
A counsellor can chat through issues which are bothering you and may be preventing sleep and this may help. There is also the option of cognitive behavioural therapy or CBT to try and change your brain’s behaviour towards trying to get to sleep.
Counselling is becoming more popular for insomnia as professionals are tending to steer away from the prescribing of sleeping tablets (as per the NICE Guidelines)
I am no expert on alternative therapies but I appreciate the fact that you may find them helpful. My view as a doctor would be that as long as they do no harm, do not interfere with your cancer treatment and don’t cost you a fortune go ahead and see what’s for you.
There are various modes of therapy people try from the basic lavender on your pillow (you may, like me, have been given a lot of lavender products when starting out on this journey!) to hypnosis and reflexology.
If you are at the end of your tether check with your oncology team and then have a look, see what’s out there and what appeals to you.
The Biggie – Menopause and Sleep Problems
The biggie for a lot of women with breast cancer is the, often very sudden, onset of menopause. For me this coincided with my second chemo treatment for some it occurs once on the longer term drugs such as tamoxifen which are designed to decrease oestrogen levels.
The menopause is a charming ‘pick ‘n’ mix’ of symptoms. Amongst them are night sweats and also insomnia (not necessarily linked to night sweats).
Of course, in the scenario of an oestrogen positive tumour Hormone Replacement Therapy cannot be used and there is some evidence that complementary therapies (Oil of evening primrose, red clover etc) because they contain plant oestrogens may not be a wise choice either. Always check with your oncologist.
There has been a small study (published in the American journal ‘Menopause’ in 2016) which showed that the group of women treated with acupuncture reported 29% fewer hot flushes and night sweats after 6 months (roughly 20 sessions of acupuncture).
Beware the Addiction Trap
Of course there still are sleeping tablets which may be helpful to you – Short Term. They should never be a long term solution.
During the months you are actually undergoing chemotherapy medication may be right for you. Some of the ‘hypnotics’ can also reduce anxiety and so can be useful to aid sleep the night before a treatment (eg lorazepam). This is especially the case if you are on steroids with your chemo – in this instance I found the odd sleeping tablet very helpful in combatting the steroid induced insomnia.
Bear in mind the more any of these medications are used – whether they are benzodiazepines or the more modern so called ‘Z’ drugs the less effective they become.
Guidelines from the National Institute of Clinical Excellence (NICE) aim to generally reduce the use of sleeping tablets.