Difficulty sleeping (insomnia) and cancer

Insomnia is when you have difficulty falling asleep and staying asleep at night, and waking up too early in the morning. 

Most people will experience insomnia at some point during their lives. It can be due to lots of different reasons. Some things that can cause insomnia when you have cancer include: 

• symptoms caused by the cancer (such as pain or sickness)
• side effects of treatment 
• worry, anxiety or depression 

If you often have insomnia, it can interfere with everyday life. You may feel very tired, and have low energy. You might also have poor concentration, and irritability, and may feel you cannot cope.

Symptoms caused by the cancer

If you feel sick, have pain or other symptoms caused by the cancer and it’s affecting your sleep, let your doctor know. They can prescribe medicine and treatment to help.

Treatments that can affect sleep

The following treatments may affect your sleep.

Cancer drugs

Some cancer treatments such as targeted cancer drugs can cause insomnia. Ask your pharmacist or doctor if the drug you are taking can affect your sleep.

Steroids

You may be taking steroids as part of your cancer treatment. Steroids can cause sleep disturbance. It can help if you take them in the morning.

Anti sickness drugs 

Some anti sickness drugs can make you feel restless. If this happens, tell your doctor as you might be able to have a different type.

Hormone treatment

If cancer or its treatment has affected your hormone levels, or you are taking certain hormone drugs, then you may experience hot flushes and sweats. These can interfere with your sleep. Talk with your doctor if hot flushes are a problem for you.

Radiotherapy 

The side effects of radiotherapy can affect people in different ways. This depends on where you have your radiotherapy, For example, if you have radiotherapy to your bladder you may find that you need to wee more often during the day and night.

Worry, anxiety or depression

A cancer diagnosis can cause many different feelings including worry and anxiety. This is natural and can be hard to cope with.

Worry can disrupt your sleep. You may be worrying about the disease, treatment or disruptions to family and work life. You might find that thoughts run over and over in your head.

You might feel depressed and find that although you are managing to fall asleep you wake in the middle of the night unable to get back to sleep again.

If you really can't sleep it's best not to lie there. Try getting up and do something quiet such as reading or doing a crossword or a jigsaw until you feel tired. Then try again. You might find it helpful to write down your thoughts and worries in a diary.

Talking to someone 

Talking through your worries can help. If you don’t want to talk to family or friends, then you might find counseling helpful. Speak to your GP, hospital doctor or specialist nurse about a referral for counselling.

What can help?

There are things you can do to try to help improve your sleep.

• Make sure you turn off mobile phones, tablets and TV at least 2 hours before going to bed.
• Try to be physically active during the day.
• Have a regular bedtime routine.
• Try to avoid napping during the day.
• Try to avoid caffeine 6 hours before you go to bed as it can keep you awake. Also try to avoid nicotine and large meals within 2 hours of going to bed.
• Try to avoid alcohol as it can affect sleep quality.
• Do something relaxing before you go to bed, for example, listening to relaxing music, reading a book or having a bath.
• Make sure the temperature in the bedroom is not too hot or cold.
• Meditate, practice mindfulness or try deep breathing at bedtime.
• Minimise noise and light in the bedroom.
• Try to avoid checking or watching the clock during the night.

Treating and managing insomnia

If you are worried about disturbed sleep then do talk to your doctor or specialist nurse. They may ask you to keep a sleep diary or fill in a questionnaire. These can often help them understand the cause of your insomnia and work out a treatment plan.

Your doctor may recommend counselling or cognitive behavioural therapy to treat insomnia.

Cognitive behavioural therapy for insomnia (CBT-I) 

CBT aims to help you change how you respond to certain situations or emotions. It helps you understand your thought patterns and how they affect how you feel. 

This therapy also teaches you how to calm your body and mind. It helps you to control your feelings, think more clearly and generally have a more positive outlook. 

There is a type of cognitive behavioral therapy for insomnia. It's also known as CBT-I. It is a programme that focuses on your thoughts and feelings that may be affecting your sleep.

Speak to your doctor or specialist nurse about CBT-I. It is usually provided in a series of sessions. These might be in person with a therapist or by using an app specifically designed to provide this.

Relaxation techniques 

Relaxation techniques such as mindfulness, meditation and breathing exercises can help you to feel calmer and cope with worries and anxieties. This in turn could help you to relax and sleep. Research has shown that listening to music to help you relax can improve sleep patterns.

You can read about meditation and other mindfulness based techniques in our complementary therapies section. 

Several organisations produce CDs and podcasts to help improve sleep. There are also apps and websites available, such as Headspace and Sleepio.

Sleepio is available free to people with cancer or those affected by cancer. It’s a digital self help programme. It aims to help you manage sleep problems and insomnia using CBT.

Penny Brohn is a cancer charity. They offer advice and support to cancer patients and focus on complementary therapies, nutrition and relaxation techniques. They have a selection of meditation CDs.

Sleeping tablets

If you’re finding it very difficult to sleep then your doctor might prescribe sleeping tablets. You usually only take these for a short amount of time. This is because sleeping tablets can have side effects.  

Doctors often recommend other ways to treat insomnia before prescribing sleeping tablets. Speak with your doctor if you think you need sleeping tablets. They can talk it through with you.

There are several types of sleeping tablets and they work in different ways. Your doctor or pharmacist will explain to you how they work and the possible side effects.

Examples of sleeping tablets include:

• zolpidem 
• zopiclone
• temazepam 
• lorazepam

Side effects of sleeping tablets

These side effects usually wear off during the day. They include:

• dizziness, feeling light-headed or sleepy
• finding it hard to concentrate - 'foggy feeling'
• clumsiness

You shouldn’t drive or operate machinery if you feel tired, dizzy or unable to concentrate.

It’s possible to develop a tolerance to sleeping tablets or become dependent on them. 

Tolerance to a drug is when the effects of the drug don’t seem to work anymore, and it feels like it is no longer helping. You may need a higher dose to get the same effect. After a while, the higher dose of the drug will start to have less effect, although the side effects of the drug can get worse. 

Dependence on a drug is when you get withdrawal symptoms if you suddenly stop taking it. Withdrawal symptoms can include: 

• feeling anxious
• inability to sleep
• a jittery, restless feeling

Your doctor will only prescribe a small amount of sleeping tablets and then review how you are feeling.

Melatonin

Melatonin is a hormone that occurs naturally in the body and helps with the control of our sleep patterns. As we get older the amount of naturally occurring melatonin in the body decreases. 

Melatonin is available as a tablet also known as Circadin. Taking melatonin can help you sleep. Doctors prescribe this for people over the age of 55 as a short term solution for sleep problems. 

Other remedies

You can also buy herbal tablets and other remedies to help promote sleep. These can be bought over the counter in pharmacies. Some of these may be helpful in the short term. However, it is possible to develop a tolerance to these so that over time they become less effective. 

Talk to your pharmacist for advice. It's important you tell them of any other medicines you are taking before you start any over the counter treatments to help you sleep.

Complementary therapies

Acupuncture

Studies have looked at acupuncture to see if it might help with insomnia in people with cancer. There are mixed results. It did appear to help some people, however more studies are needed in order to know how beneficial it might be. 

Reflexology

Reflexology is a complementary therapy that applies gentle pressure to the feet or hands to stimulate energy pathways in the body. It can bring about a state of deep relaxation. Some studies have looked at whether it might help with sleep in cancer patients. It did appear to help relax some people however more studies are needed.

Cancer Research UK nurses

Cancer chat

Talking to people who have had similar experiences can help. Cancer Chat is our fully moderated forum where you can talk to others affected by cancer, share experiences, and get support. Cancer Chat is free to join and available 24 hours a day.