Sleep Better Longer

I just finished a story for Heal on sleep and how researchers are finally looking at the problems we have sleeping both during and after cancer treatment.

The challenges to find healthy sleep come for a number of reasons, they are finding, including physical and psychological issues. What I learned is that to fix the problem, you have to start at the top and work your way down the list.

I can clearly recall lying in bed with the tears rolling into my ears while trying desperately not to wake my husband. I am a loud crier and I often was not successful.

For me, the sleeplessness was fear that I would not be here to raise my daughter. Then, during the worst of the chemo, I couldn’t sleep because there was some weird chemical battle going on in my body. I can’t describe it, but I have a feeling you understand. When treatment was over, my sleep got better, but I had those wakeful moments when I was sure it was morning and I was ready to rise for the day. Of course, it was 4 a.m. There is something about 4 a.m.

Later in my support group when I was talking about it, one of the members said, “You should have called me, I was wide awake too.”

So onward. We all just chalked it up to yet another gift of cancer. But I learned there are solutions for some of the causes. To begin with, I learned from one of the researchers that medication should be the last thing on the list and if it is used, it is for a short time only.

Because it’s hard to pin down, the numbers of cancer survivors with sleep issues ranges from 60 to 90 percent, depending on which study you are reading. No matter, it’s higher than those who have never dealt with cancer, which hovers at around 55 percent.

The reasons could be related to medication or age. Few of us have not had hot flashes that left us in a puddle when we woke. It’s when sleep is illusive for a long time that we begin using the word insomnia. Sleep is important because it gives the body time to repair and refuel. It is also critical for the waking hours. Anyone who has ever dealt with sleep deprivation understands why they use it as a mechanism of torture. You walk around in a fog unable to make a decision and when you do, it’s the wrong one.

One of the scariest things I found in my research was that the damage from inadequate sleep can raise the risk for some chronic health problems, and a study in the journal Sleep shows that "sleep efficacy, a ratio of time asleep to time spent in bed, is predictive of survival time for women with advanced breast cancer."

So let’s manage those problems. First you need to identify the when, how, and why of your problem. Circadian rhythm disruptions, the inability to sleep and wake at the right times, are a problem of shift workers. Sleep-related movement disorders such as restless leg or sleep apnea, when you stop breathing for 10 seconds or more, can both be significant physical issues to deal with. Once those are ruled out, the only approved approach to sleeplessness is Cognitive Behavioral Therapy.

CBT takes a pro who can assess why you are waking and change some behaviors to resume good sleep. For example, one therapist explained it as looking at underlying factors that precipitate sleep disturbance by learning about preexisting issues. Watching television when you wake at night is not a good way to go back to sleep, and neither is reading because both wake you more.

Another area you can work on is good sleep hygiene, a set of activities that include staying away from caffeine and spicy food at dinner and keeping the room cool and dark. Go to bed at the same time every night and wake up at the same time every morning. Some survivors say exercise helps not only with fatigue but also to help with life balance.

If you are looking for more information on complementary therapies go to https://www.ons.org/practice-resources/pep. For information about the drugs for sleeplessness, visit the NCI page on drugs at http://www.cancer.gov/about-cancer/treatment/drugs. In addition, MD Anderson Cancer Center has opened a dedicated sleep center where survivors can receive counseling and find resources. For more information go to https://www.mdanderson.org.