Sleep Problems

Treating sleep problems

Sleep problems can be very different for each person. Start by describing your symptoms to your health care team. This helps them figure out the best way to treat your problem.

Your health care team might suggest that you meet with a sleep specialist. A sleep specialist may be able to help you figure out why you’re having trouble sleeping. Ask your health care team about a referral, if needed.

Below are some common ways to treat cancer-related sleep problems. You might need to use more than one way to help with your sleep.

Cognitive behavioral therapy (CBT)

Thinking or worrying about sleeping can make your sleep problems worse. Cognitive behavioral therapy (CBT) is one way to help you feel less anxious about sleep. The goal of CBT is to recognize your sleep habits and patterns and then find ways to manage them.

Relaxation

There are many ways to relax, calm your thinking, and wind down before bed. Relaxation methods can help you fall asleep, stay asleep, and go back to sleep if you wake up during the night.

Some examples of relaxation methods are:

• Focused breathing
• Meditation
• Mindfulness
• Progressive muscle relaxation
• Music therapy
• Hypnosis
• Guided imagery 

You might be able to learn these methods on your own. But if you’d like help, ask your cancer care team for resources or a referral to a sleep specialist.

Learn more about mindfulness and other relaxation methods.

Managing medicines

Sometimes, medicine is used to manage sleep problems. Your health care team can help you decide if this is right for you.

Other types of medicine can cause sleep problems. This includes steroids and hormones, and some medicines for pain, seizures, anxiety, and depression.

Don’t make any changes to your medicines without first talking to your health care team. Tell them about any medicines you are taking.

Treating side effects

The side effects of your cancer or cancer treatment might cause sleep problems. Many of these side effects can be managed, and this might help you sleep.

You might sleep better if these cancer-related side effects are well managed:

• Pain
• Depression
• Anxiety
• Peripheral neuropathy
• Nausea and vomiting
• Hot flashes and sweating

Learn more about treating cancer-related side effects.

Sleep apnea

Cancer and cancer treatment are not usually the cause of sleep apnea, but many people with cancer have sleep apnea for other reasons. This needs to be treated to prevent other problems.

A continuous positive airway pressure device (CPAP) is the usual treatment for sleep apnea. A CPAP helps you breathe while you sleep. Tell your cancer care team if you have, or think you might have, sleep apnea.

Tips for managing sleep problems

There are many things you can do to help manage your sleep problems.

Bedtime routine

It’s important to have good habits before bedtime. (This is often called sleep hygiene.) Examples of good sleep hygiene include:

• Keep a schedule. Try to go to sleep and get up at the same time each day.
• Have a relaxing bedtime routine. This includes activities like a bath, reading, meditation, calm music, or breathing exercises.
• Try a sleep or meditation app. There are many helpful apps to choose from.
• Avoid screens. Don't watch TV or use screens in bed, or for 30-60 minutes before you sleep.
• Get a backrub or foot massage. Ask your partner or caregiver for a gentle backrub or foot massage near bedtime.
• Keep the clock out of sight. Try not to look at the clock when you are awake at night.

If you can’t fall asleep within about 20 minutes, or if you wake up and can’t go back to sleep, it’s time to try something new. Get up and go to a different part of your home. Stay in a darkened room and do something relaxing, like reading a book. Don’t go back to bed until you feel sleepy again.

Eating and drinking

What you eat and drink before bed can also affect your sleep.

• Avoid big evening meals. Try not to eat a big meal or drink a lot of liquid before bed.
• Stick to light snacks. If you need to eat before bed, have a light snack with some protein, like cheese or peanut butter.
• Try a warm drink. Warm, caffeine-free drinks like heated milk or decaf tea might help you relax. 

Sleep location

It can also help if you set up your room for a good night’s sleep. 

• Manage lights, noise, and temperature. If possible, keep your room dark, quiet, and at a comfortable temperature.
• Wear comfortable clothes. Loose, comfortable clothing can sometimes help you sleep.
• Think about your bedding. Keep your bedding clean. Use pillows and blankets to make yourself as comfortable as possible.
• Only use your bed for sleeping and sex.

Daytime routine

What you do during the day can make a big difference in how you sleep at night.

• Get sunlight in the morning. Try to spend time in bright daylight early in the morning.
• Avoid caffeine after mid-afternoon. You can also try cutting back on caffeine or not drinking it at all.
• Avoid tobacco, nicotine, and alcohol. Avoid tobacco, nicotine products, and alcohol too close to bedtime. Or avoid them completely.
• Set your “to do” list aside. If worry or anxiety makes it hard for you to sleep, try writing a “to do” list before bed.
• Schedule a “worry time.” Set aside “worry time” earlier in the day.
• Avoid daytime naps. If you need to nap, keep it to 30 minutes or less. Try to only nap once per day.
• Get physical activity every day. It’s best to do this in the morning or afternoon.
• Avoid exercise close to bedtime. Try not to exercise within 3 hours of bedtime.
• Stretch daily. If you have restless leg syndrome, daily stretching exercises might relax your muscles. 

If you need help figuring out what physical activity or stretches to do, talk to your cancer care team. They might be able to help you find an exercise routine. Or they can refer you to a physical therapist to learn stretches that relax your muscles.

Tracking your medicines

• Review your medicines. Review all your medicines with your health care team. Some of these can affect your sleep.
• Prescription sleep medicines. These may include medicines classified as antidepressants, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics. Some are only recommended for short-term use, while others can be used long-term.
• Over-the-counter sleep aids. Be sure your doctor knows about the supplements and herbals you may use or want to try.
• Cannabis (marijuana) products: Cannabis is being studied for its possible benefits in helping to manage sleep problems from cancer and its treatment. But cannabis has risks and can be harmful in certain situations, forms, and doses.

Tracking your sleep

Sometimes it helps to keep track of your sleep habits so you can figure out patterns and problems.

• Keep a sleep diary. Record the times you sleep and wake up, including naps.
• Write down what works and doesn’t work. Write down anything that keeps you from falling or staying asleep (like side effects or worries). Also record anything that helps you sleep better.
• Ask your partner for clues. If you have a partner, ask them if they notice anything unusual when you are asleep.

When to ask for help

Call your health care team if you:

• Sleep very little or can’t sleep at all during the night
• Have trouble staying awake during the day
• Think you might have sleep apnea or restless leg syndrome