Improving Sleep During and After Cancer Treatment

The benefits of sleep are clear. Getting good quality sleep nightly helps you manage stress, boost mood, and keep your immune system strong. But you may struggle to sleep while recovering from cancer. You may lie awake worrying over finances or your diagnosis. Or treatment-related effects on the body may interfere with your ability to sleep through the night.

Persistent difficulty in falling and staying asleep (insomnia) during the cancer journey is linked with higher levels of pain. It’s also associated with longer hospital stays and a greater risk of complications. Research finds that improving sleep can help you maximize your cancer treatments and quality of life.

Daniel Hall, PhD, a Mass General Brigham psychologist who specializes in insomnia and works closely with the Lifestyle Medicine Program at Mass General Cancer Center, shares strategies for improving sleep during and after cancer treatment.

The benefits of sleep when you have cancer

Getting plenty of quality sleep during and after cancer treatment can:

• Help manage the stress of living with cancer
• Improve quality of life
• Keep your immune system in fighting shape
• Lower inflammation that contributes to cancer

Cancer and insomnia

You may have insomnia if you can’t fall or stay asleep 3 nights per week for at least 3 months.

Insomnia is very common. The American Academy of Sleep Medicine reports that roughly 1 in 10 U.S. adults have it. After a cancer diagnosis, that number increases to up to 5 in 10 people.

Dr. Hall says there are many reasons why insomnia becomes more common after a cancer diagnosis. For one, older age is a risk factor for both cancer and insomnia.

Many side effects of cancer treatments — such as nausea, hot flashes, and pain — can also disrupt sleep. And financial stress and health worries tend to keep people up at night.

Coping with insomnia: 5 sleep tips for people with cancer

Cognitive behavioral therapy (CBT-I) is the gold standard treatment for insomnia, and it’s very well-tested in people with cancer, according to Dr. Hall.

CBT-I begins with an intake session with a sleep therapist. This is the time when you share details, like when your insomnia began and your bedtime habits.

Then, you participate in weekly treatment sessions for between 4 and 11 weeks. The sessions can be done one-on-one with a therapist or in a group setting. During sessions, a therapist helps you identify thoughts and behaviors that impact your sleep. Then, you learn strategies to change those thoughts and behaviors.

Dr. Hall has published research on helping cancer patients cope with insomnia. Here, he shares 5 CBT-I tips he uses with patients to help them sleep better.

1. Make time for worries.

It may sound counterproductive for better sleep, but worrying isn’t the problem. The issue is when you take your worries to bed, Dr. Hall says.

He suggests scheduling 10 minutes of worry time per day. Pick a time when you can worry without impacting your sleep. For example, after a morning walk, during a shower, or while brushing your teeth.

Patients with cancer often find that this practice becomes empowering. “It’s a way to honor the magnitude of the worry — these aren’t frivolous things people with cancer are worried about,” Dr. Hall says.

2. Use calming statements.

Scheduling dedicated “worry time” can help you manage anxiety. But worries are still bound to creep into your mind at night. When that happens, practice calming statements to stop those worries from keeping you awake.

Dr. Hall teaches patients to use these calming statements:

• “My goal right now is to get back to sleep, not to find a resolution to my questions about cancer. I can reflect on those questions tomorrow.”
• “I can take the time to rest. Everything will get done.”
• “I can be compassionate with myself when I struggle with uncertainty.”
• “I can trust my care team.”
• “Today my cancer has not recurred, which I appreciate.”
• “If my cancer returns, I will navigate it then, perhaps with greater clarity and support.”
• “If I need support or help, I can ask for it.”

“Uncertainty and fear are normal and inevitable,” Dr. Hall says. “The goal of calming statements isn’t to change that in the moment, but to get back to sleep.”

3. Practice relaxation daily.

Dr. Hall encourages patients to practice relaxation techniques during the day and before bed. This way, your body knows how to relax once it’s time to go to sleep.

Try the following relaxation techniques:

• Body scan: You focus in on all parts of your body, from head to toe, and note any sensations without judgment.
  
• Diaphragmatic breathing: This technique involves taking slow, deep inhales that expand the belly instead of the chest. Each inhale is followed by a slow exhale. Learn how to perform diaphragmatic breathing.
• Guided imagery: Guided imagery uses the imagination to create calming mental images. You might use sight, sounds, and smells to help create these scenes.
• Mindfulness meditation: Meditation is a technique that involves focusing on present thoughts, feelings, and body sensations without judgment.

4. Link your bed with sleep.

Your bed is for sleeping. But many people with insomnia see the bed as a stressful place.

You may do activities in bed that are meant for relaxation. For example, reading, listening to a podcast, watching TV, and having conversations with a loved one in bed. But those activities may actually keep you awake. “It’s not that these activities are bad or wrong, they just don’t help you sleep,” Dr. Hall says.

The goal is to teach your brain to think of the bed as a place for sleep. To do that, reserve your bedroom for sleeping only, Dr. Hall suggests.

If you wake up at night and feel alert, get out of bed, try a relaxing activity to calm your mind and body. Then, return to bed when you feel sleepy.

For cancer survivors with insomnia who wake up at night, their sleep may also be fragmented. In other words, sleep occurs in “chunks.” This interrupted sleep pattern disrupts the overall quality of sleep and limits the time you spend in deep sleep.

To address fragmented sleep, Dr. Hall recommends working with a CBT-I therapist. They can help you develop a personal sleep schedule to help your sleep become more continuous and review your progress each week using sleep diaries. 

5. Improve sleep hygiene.

Sleep hygiene refers to having a routine and an environment that promotes sleep. The U.S. Centers for Disease Control and Prevention (CDC) offers these key habits for healthy sleep:

• Avoid caffeine in the afternoon and evening.
• Avoid large meals and alcohol before bedtime.
• Don’t exercise close to bedtime.
• Go to bed and get up at the same every day.
• Keep your bedroom quiet, dark and cool.

Dr. Hall notes that sleep hygiene may not have as much of an impact on sleep as the other strategies. However, it tends to be the easiest to implement.

Sleep hygiene also gives people with cancer a sense of control. “When so many things feel outside of your control, you can adjust the temperature, put another sheet on the bed, or change the lighting in your room. That’s very empowering,” Dr. Hall says.

Sleep as lifestyle medicine

Sleep is a key part of lifestyle medicine in cancer care, along with stress management and mental health. Following a healthy sleep routine helps reduce stress and lowers the risk of depression and anxiety — and can help you stay as healthy as possible along your cancer journey.

Talk to your primary care provider or cancer doctor (oncologist) if you have sleep issues. Your health care provider can refer you to a sleep specialist for treatment.