From symptoms related to the cancer or its treatment to medications to emotional changes, and more, let’s look at the many ways in which cancer can lead to insomnia.
Since it is helpful to understand causes before discussing treatments, let’s begin by outlining some of the causes and risk factors for insomnia in people with cancer. These include the biochemical changes associated with the growth of a tumor, cancer treatments, symptoms related to cancer and cancer treatments, as well as sleep routine and coexisting medical conditions.
While there is little that can be done directly for this cause of insomnia (other than treating the cancer) it is a reminder that often many causes of insomnia and fatigue work together to cause symptoms. Controlling those causes over which people do have some control becomes increasingly important.
Steroids, such as dexamethasone, often cause a state of hyperarousal for a few days, which in turn may be followed by a greater need for sleep. People with cancer may wish to work with their healthcare providers to schedule their chemotherapy infusions and does of steroids earlier in the day to help reduce this cause of insomnia. Small changes such as this can sometimes lead to large changes in how you feel.
Pain Nausea and vomiting Peripheral neuropathy Cough Shortness of breath Hot flashes Itching Diarrhea
Sometimes, taking the time to look at each of these symptoms individually, and making sure they are being optimally addressed, can make a significant difference in insomnia. For example, if hot flashes are causing significant sleep disruption there are a number of options (both medication and non-medication) that could reduce these symptoms, and hence, improve sleep.
Stress and the release of stress hormones also plays a role, and this stress can persist throughout life following a diagnosis of cancer. First, there is the stress of diagnosis, followed by the fear of recurrence or progression if a cancer is stable, or the fear of death if a cancer continues to progress or recurs. Managing stress (which requires stepping back and analyzing what you are most stressed about) can have a significant impact in controlling insomnia.
Sleep apnea is a common condition marked by short periods of apnea (literally, no breath) during the night. You may associate sleep apnea with snoring, but there are many surprising signs of sleep apnea to keep in mind as well. Thyroid problems are common in general and may occur in relation to cancer, chemotherapy, immunotherapy, and more. If other causes don’t seem to be adding up to cause your insomnia, ask your healthcare provider about this possibility. It’s thought that hypothyroidism is greatly underdiagnosed in the United States.
Noting that other medical conditions may be leading to your insomnia is very important, as it can be easy to dismiss any symptom as being due to the cancer. Again, elucidating the causes of insomnia sometimes requires stepping back enough to look for non-obvious factors.
It’s not just the physical environment that can be noisy. Thinking about your fears, about discussions with friends or family members who have upset you, or trying to write a to-do list in your mind, can lead to “noisy thoughts” that keep you up as well.
Excess time spent in bed, or napping for an extended period of time in the late afternoon, can make it difficult to fall asleep at night. Having unrealistic sleep expectations may also be a factor in insomnia. If your body is healing from cancer treatments you may require more sleep—but not necessarily an entire day spent in bed.
