Many people affected by cancer have difficulty sleeping and this can have a real impact on their daily life, affecting their ability to concentrate at work and feel motivated throughout the day.
There are many factors that can affect sleep, such as a poor sleep routine or an uncomfortable bed, but people affected by cancer also have to manage side-effects of treatment and concerns around prognosis, among many other things.
Lisa, 45, was diagnosed with a rare form of breast cancer in early 2015. Now, in remission for almost a year, she told HuffPost UK how her cancer journey affected her sleep and how she’s still struggling to this day.
Before her diagnosis, Kim, who is a head and neck cancer nurse specialist for Macmillan Cancer Support, said she was a good sleeper.
But she soon went from averaging seven to eight hours per night to lying awake with insomnia - that potent mix of being utterly exhausted, but unable to sleep a wink. Now, a year into remission, her sleep is still badly affected.
“At worst, I managed just two hours sleep in about three or four days,” she told The Huffington Post UK. “My body was exhausted but my mind wouldn’t shut off... It’s frustrating not being able to sleep, you know your body needs that rest but it’s still not getting it.”
Lisa initially thought her prognosis was “really poor”, due to a lack of resources and study papers on her cancer, which is called neuroendocrine carcinoma.
“We thought I was going to die,” she told HuffPost UK. “We convinced ourselves.”
But it wasn’t until Lisa learned that she might be able to overcome her cancer that she started to have trouble sleeping.
“I slept better when I thought that [death] was going to happen. I’d resigned myself - nothing could be done and I was more settled,” she revealed. “Once knew that I might be able to cure it, I felt uncertainties and ups and downs as to what might happen in the future.”
Lisa underwent surgery, chemotherapy and radiotherapy to remove the cancer, and said “my treatment regime got imprinted in my body clock”.
She was given steroids alongside her chemotherapy, which stimulated her and left her “clock watching all night”.
Lisa was in and out of hospital for her treatment for various reasons, and said that due to the regular checks and medication, her sleep was disrupted.
She’s tried all sorts including mindfulness, a pre-bed phone-free sleep routine and gentle exercise, but none seem to have a lasting impact.
“I think I do have to remind myself that I am still recovering, I expect myself to do more than I should be doing,” she said. “Living with and beyond cancer means the side effects from treatment are long-term effects.”
If you’re having problems sleeping, Macmillan Information Nurse Specialist Kim Hardwick has put together some helpful tips for you.
Of course, these might not work for everyone so do speak to your doctor or call Macmillan’s helpline for more tailored advice.
Lack of physical activity
If you’ve just had treatment you may feel sore, or fatigued, suffer from low energy and other side effects. Exercise may be the last thing on your mind but a lack of physical activity can affect your sleep.
If you’ve recently had treatment and you are struggling with low energy levels or side effects, it’s still important to do as much physical activity as you feel able to do whilst staying safe. Even a short daily walk or a bit of gentle gardening can help to build stamina and improve the quality of your sleep.
Medication
Many medicines for cancer and some other illnesses can cause sleeplessness. Not everyone who takes these will have problems sleeping, as medicines affect people in different ways. You can discuss the possibility of your medicines affecting your sleep with your doctor or specialist nurse, as they may be able to give you suggestions. For example, it can help to take medicines that make you very alert (such as steroids) in the morning. On the other hand, if some of your medicines cause drowsiness, it may be more helpful to take these at bedtime. But it’s important to check with a member of your healthcare team before making any changes to your medicine timings.
Some other medications don’t cause sleeplessness directly but prevent you from sleeping due to other side effects. Many of the hormonal therapies for breast and prostate cancer can cause hot flushes and sweats, which can keep you awake at night. Your doctor or specialist nurse may be able to offer some help and advice with these side effects so that you’re able to sleep. Or read our Macmillan’s information about managing hormonal symptoms for some tips.
Emotional distress
Being diagnosed with breast cancer can naturally cause feelings of worry and anxiety, which can stop you being able to sleep. Many people find they stay awake, going over and over the same thing in their mind.
If you wake at night and are worrying about things, write them down. There’s probably nothing you can do about them immediately, but if you note them down, you can then work through them during the day with support from relatives, friends, or your doctor or specialist nurse. Many people find that their fears and worries are reduced simply by telling someone else about them.
However, if you are finding your emotional distress is overwhelming your life, then it’s important to speak to your GP about getting some help.
Physical pain and discomfort
You might feel pain and discomfort if you’ve just had surgery or if you are experiencing side effects from radiotherapy or chemotherapy. This can keep you up at night. Simple breathing and relaxation exercises may be very useful in reducing anxiety and stress and take your mind of the pain. They can also reduce muscle tension. Many people with cancer and their relatives find that these simple methods relax them and give them a sense of calmness.
Almost anyone can learn relaxation techniques. You can learn them at home using a CD, tapes or podcasts, or you may be able to join a group. Lying flat can be uncomfortable for people who are breathless or in pain, but many relaxation exercises can be done sitting up or using pillows for support.
Some hospitals and support groups offer relaxation sessions. You can ask if they are provided at your hospital.
Sleeping for too long during the day
If you’re staying up late or not sleeping well in the night due to physical pain or worry you may find yourself sleeping for longer during the day. This can knock your sleep cycle off kilter so you get too much sleep in the day and therefore can’t sleep at night. Having a good sleep pattern and regular bed time routine is really important when you are going through cancer and treatment. Reading in bed, having a hot drink and brushing your teeth can let your brain know that it’s time for bed.