Disturbed Sleep


What is disturbed sleep (insomnia and hypersomnia)?

Disturbed sleep is a change in your usual sleep pattern. It can range from insomnia (inability to either fall or stay asleep) to hypersomnia (inability to stay awake). It is estimated that nearly half the people with cancer have sleep disturbance.

Sleep problems may include any or all of the following:

  • Difficulty falling asleep (more than 30 minutes to fall sleep).
  • Difficulty staying asleep (having nighttime awakenings lasting 30 minutes or more).
  • Waking up too early.
  • Non-refreshing or poor quality sleep.
Hypersomnia is different from fatigue. You may have hypersomnia if you are sleeping more than 10 hours per night and still sleep during the day.

How do people describe disturbed sleep?

Disturbed sleep is often described as excessive fatigue or sleepiness. People who have it say that they have no desire to do anything, even activities that used to bring great pleasure. Not wanting to see or talk to friends or family is also a result of disturbed sleep. Disturbed sleep can change the way you think and feel about things.


What causes disturbed sleep?

Worrying about the diagnosis and treatment can make sleep difficult. Other sleep disturbances include: pain, itching, hot flashes, night sweats, depression, and noisy environments.


What can I do about disturbed sleep?

Here are some tips you may find helpful. These tips to help you deal with disturbed sleep will depend upon whether you have insomnia or hypersomnia.

ACTIVITY

  • Establish a nighttime routine. Go to bed and get up at the same time each day.
  • Use your bed for sleeping only.
  • Go to another room when you are unable to fall asleep.
  • Maintain a quiet, comfortable, and consistent bedroom temperature.
  • Have someone give you backrubs or a foot massage.
  • Get some exercise every day, such as walking. Try to exercise 20-30 minutes 4-5 times a week. Exercise at least 3 hours before bedtime.
  • Try taking a warm bath an hour before going to bed.
  • Limit napping to no more than 30-45 minutes of rest time.
  • Try to avoid waking up once asleep.
  • Ensure your pain is well controlled.
  • Avoid watching television in the bedroom.

DIET

  • Do not eat heavy or large meals closer than four hours before going to bed. If you are hungry, eat a snack with warm milk at bedtime.
  • Avoid drinking caffeinated drinks after noon, such as colas like Mountain Dew®, hot cocoa, chocolate, diet sodas, tea, or coffee.
  • Do not drink alcohol.
  • Avoid tobacco products altogether. Nicotine is a stimulant.

MEDICATIONS

  • Carefully follow the directions of prescribed sleep medication.

PSYCHOLOGICAL

  • Try a radio, fan, or mood music (nature sounds, ocean waves, etc.) to filter out noises.
  • Listen to a relaxation tape at bedtime.
  • Try to deal with problems or worries during the day, before bedtime.
  • Practice relaxation, meditation, or guided imagery.
Here are some tips for helping people with hypersomnia (sleeping more than 10 hours per day):
  • Get some exercise every day, such as walking.
  • Drink a few cups of coffee, tea, cola, or caffeine every day.
  • Do not drink alcohol.
  • Go to bed at the same time each night.
  • Use distraction to avoid boredom.
  • Do activities that will keep you moving, such as swimming or gardening.
  • Get up at the same time every morning.
  • Avoid sweets and foods high in sugar.
  • Avoid eating peanuts, which are high in tryptophan.
  • Avoid dairy products.

How is disturbed sleep managed?

In addition to the strategies listed above, there are procedures and treatments that your healthcare team may recommend to help you sleep. It is very important that your healthcare provider has a list of all your current prescriptions, over-the-counter medications, vitamins, minerals, and any herbal remedies that you are taking. Keeping a journal of all the medication, remedies, and other treatments that you have tried for your sleep disturbance will also be helpful.

Common medications for sleep include:

  • Hypnotics
  • Benodiazepines
  • Antihistamines
  • Antidepressants
Complementary therapies include:
  • Expressive therapy
  • Expressive writing
  • Massage therapy
  • Muscle relaxation
  • Mindfulness-based stress reduction (MBSR)
  • Yoga
Examples of exercise include:
  • Check with your healthcare provider before starting any exercise program to make sure it is right for you.
  • Complete moderate exercise (brisk walking 20-30 minutes, four to five times a week) at least 3 hours before bedtime.
  • Participate in strength and weight training.

What can my family members and friends do to help me with my disturbed sleep?

Ask family members and friends to:

  • Help create a quiet environment.
  • Just listen to you.
  • Help you with relaxation exercises, controlled breathing exercises, or visualizing pleasant scenery.
  • Remind you to take your medications and when to call your healthcare provider.

How can I talk with family members and friends about my disturbed sleep?

Here are some ideas that may help you talk to family members and friends:

  • Try to describe how your disturbed sleep is affecting you.
  • Ask your family members and friends for ideas to deal with your disturbed sleep.
  • Ask your family members and friends how your disturbed sleep is affecting them.
  • Be open and honest with your family and friends about your sleeping difficulty.

What should I report to my healthcare provider about my disturbed sleep?

If you experience any of the following symptoms, report them to your healthcare provider:

  • Unmanaged pain, overwhelming fatigue.
  • Nightmares.
  • Confusion.
  • Waking too early in the morning.
  • Not being able to get back to sleep after waking.
  • Waking up frequently during the night.
  • Having sleep disturbances for 3 weeks or more.
  • Experiencing sleep problems caused by sadness for 2 weeks or more.
  • Inability to carry out daily activities.

What should I discuss with my healthcare provider about my disturbed sleep?

If you are experiencing disturbed sleep, you should discuss the following with your healthcare provider at your next appointment:

  • Do you recommend that I take a medication for my sleep disturbance?
  • Will my sleep improve once my treatment is finished?
  • Where can I learn more about relaxation techniques and guided imagery?
  • Is it safe for me to take herbal supplements for sleep?
  • What type of exercise is safe for me to do?
  • Do you recommend massage therapy for me? Will it hurt me?

Where can I get more information?

For more information, contact the people or organizations at the numbers or websites listed below:

References

  • Berger, A., Parker, K., Mccaughan, S., Mallory, G., Barsevidk, A., & Beck, S., Et Al. (2005). Sleep/wake disturbances in people with cancer and their caregivers: state of the science. Oncology Nursing Forum, 32 (6), 98-126.
  • Davidson, J.R., Maclean, A.W., Brundage, M.D., & Schulze, K. (2002). Sleep disturbance in cancer patients. Social Science Medicine, 54(9), 1309-21.
  • Garci, G. (2005). Pathogenesis and management of cancer-related insomnia. Journal Of Supportive Oncology, 3 (5), 349-358.
  • Koopma, C., Nouriani, B., Erickson, V., Anupindi, R., Butler, L.D., Bachmann, M.H., Sephton, S.E., & Spiegel, D. (2002). Sleep disturbances in women with metastatic breast cancer. Breast Journal, 8(6), 362-70.
  • Kvale, E., & Shuster, J. (2006). Sleep disturbance in supportive cancer care: a review. Journal Of Palliative Medicine, 9 (2), 437-450.
  • Mills, M. & Graci, G.M. (2003). Sleep disturbance. In C.H. Yarbro, M.H. Frogge, & M. Goodman (Eds.), Cancer Symptom Management, 3rd Ed. (Pp. 111-134). Boston: Jones And Bartlett.

Supportive evidence-based practice

  • Berger, A., Parker, K., McCaughan, S., Mallory, G., Barsevidk, A., & Beck, S., Et Al. (2005). Sleep/wake disturbances in people with cancer and their caregivers: state of the science. Oncology Nursing Forum, 32 (6), 98-126.
  • Lee, K., Cho, M., Miaskowski, C., & Dodd, M. (2003). Impaired sleep and rhythms in persons with cancer. Sleep Medicine Reviews, 8, 199-212.
  • Page, M.S., Berger, A.M., & Johnson, L.B. (2006). Putting evidence into practice: Evidence-based interventions for sleep-wake disturbances. Clinical journal of oncology nursing, 10(6), 753-767.

Return to top