Tips for managing Sleep Problems (Insomnia) in the Cancer Patient

Carolyn Vachani, MSN, RN, AOCN
The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 14 de febrero del 2013

What is Insomnia?

Insomnia, or trouble sleeping, is a common problem for patients with cancer. It can present as difficulty falling asleep, multiple awakenings during the night or early morning with the inability to get back to sleep. Insomnia can lead to fatigue, memory and concentration problems, mood disturbances and psychiatric disorders.

What are the causes of insomnia?

• Risk factors include: personal or family history of insomnia, depression, anxiety disorder, advanced age, and female gender.
• Causes can include: medications, recent or prolonged hospitalization, chemo, radiation, or hormonal therapy, pain, hot flashes, nausea and vomiting.
• Easily modifiable causes include: irregular sleep schedule, excessive amount of time spent in bed, napping, engaging in sleep-interfering activities in bed (TV watching or reading), and unrealistic sleep expectations.

How should insomnia be treated?

• Treat the underlying cause of the insomnia, including pain, nausea, depression and hot flashes.
• A combination of prescription medication and psychological therapy may be beneficial for short-term relief.
  • Hypnotic medications are most commonly used, but they can result in residual next-day effects, risk of dependence, and rebound insomnia when stopped.
  • These medications should not be taken for more than 2-4 weeks and do not mix with other sedating agents or alcohol.
• Over-the-counter "sleep aids" should be used with caution.
  • Many of these agents contain antihistamines, which can cause sleepiness, but may be less effective than prescription medications and may have additional side effects.
• Over-the-counter herbal products such as, melatonin, kava-kava and valerian should be used with caution.
  • Herbal products are not required to undergo the same rigorous testing as prescription medications. Their side effects and interactions with other drugs or medical conditions are not well understood.

Non-Pharmacologic Treatments

• Associate bedtime and the bed/bedroom with sleep, establish a bed-time routine and regular sleep-wake cycle.
  • Use the bed for sleep and sexual activities only.
  • No TV watching, reading or eating in bed.
• Go to bed only when sleepy.
  • If unable to fall asleep/go back to sleep after 20 minutes, leave the bedroom and return when sleepy.
• Try not to nap. When necessary, limit naps to 30 minutes and not after 3 pm.
• Use relaxation techniques, such as, deep breathing, stretching, meditation or prayer prior to bed.
• A warm bath, warm glass of milk or cup of chamomile tea at bedtime can help to induce a restful state.
• Avoid excess alcohol-it may cause initial tiredness, but then leads to fragmented sleep.
• Avoid caffeine, heavy or spicy meals, and alcohol for 4 to 6 hours before bedtime.
• Exercise (as little as 20 minutes, three times a week) can promote better sleep, although this should not be done too close to bedtime.
• Keep the sleep environment dark, quiet, cool, and comfortable.
• Reduce anxiety.
  • If having a clock nearby causes anxiety, remove it or put it where it is more hidden.
  • Be realistic about sleep requirements and managing insomnia

For more in depth information on Insomina, go to Insomnia Overview on OncoLink.