Why Do Cancer Patients Have Trouble Sleeping?

The stresses and physiological changes caused by cancer and its treatments are almost a perfect recipe for insomnia. Drug side effects, stress and anxiety, physical pain and discomfort, oddly timed hospital routines and other factors may all contribute to insomnia in cancer patients.

Sleep disorders interfere with a good night's sleep and can make it difficult for a person to stay alert and involved in activities during the day. 

The five major types of sleep disorders that affect normal sleep include: 

• Insomnia
  • Inability to fall asleep and/or stay asleep
• Sleep apnea
  • Abnormal breathing during sleep in which breathing stops for 10 seconds or more
• Hypersomnia
  • Inability to stay awake during the day
• Circadian rhythm disorders
  • Problems with the sleep-wake cycle (circadian rhythm)
• Parasomnia
  • Undesirable physical events (movements or behaviors) or experiences (emotions, perceptions, dreams) that occur during sleep

Sleep disorders can affect as many as half of all patients with cancer. 

Causes for sleep problems in cancer patients include: 

• Physical changes caused by the cancer or surgery
  • Pain 
  • Pressure from the tumor on nearby areas of the body
  • Gastrointestinal problems
    • Nausea
    • Constipation
    • Diarrhea
    • Inability to control bowels
  • Bladder problems 
    • Irritation
    • Inability to control flow of urine 
  • Tiredness
  • Fever  
  • Cough
  • Breathing problems
  • Itching
• Side effects of drugs 
  • Corticosteroids
  • Hormone therapy
  • Sedatives and tranquilizers
  • Antidepressants
  • Anticonvulsants
• Side effects of treatments
  • Pain
  • Anxiety
  • Night sweats or hot flashes
  • Gastrointestinal problems 
  • Bladder problems
  • Breathing problems
• Being in the hospital
  • Hospital environment
    • Uncomfortable bed or pillow
    • Room temperature
    • Noise
    • Sharing a room with a stranger
  • Hospital routine
    • Sleep is interrupted when doctors and nurses come in to check on patients or give drugs, other treatments, or exams
• Stress about having cancer
  • Stress, anxiety, and depression are common reactions to a cancer diagnosis and treatment
• Other health problems not related to the cancer

Sleep disorders are diagnosed with a patient history and physical exam. Tests or procedures that may be used to diagnose sleep disorders or to rule out other underlying conditions include: 

• Daily sleep log
• Sleep study (polysomnography)
• Record of activity and movement with a monitor or motion detector, generally worn on the wrist throughout the day and night (actigraphy)
• Home sleep apnea testing 
• Home devices that monitor breathing, oxygen saturation, position, and heart rate
• Melatonin sampling 
• Core body temperature measurements 
• Hormone tests
• Electrocardiogram (“ECG”) 
• Computerized tomography (CT) scan 
• Pulmonary function tests
• Magnetic resonance imaging (MRI) of the brain

Treatment for sleep disorders in cancer patients may include:

• Supportive care for side effects of cancer or cancer treatment
• Cognitive behavioral therapy (CBT) to help reduce anxiety and help patients relax
  • Stimulus control: using the bed and bedroom only when sleepy, so the bed and sleep are linked 
  • Sleep restriction: decrease the time you spend in bed sleeping so patients are more likely to feel sleepy the next night
  • Relaxation therapy: used to relieve muscle tension and stress and control pain, and can make it easier for stimulus control and sleep restriction to work 
  • Good sleep habits to help patients fall asleep more easily and stay asleep
    • A comfortable bed and bedroom
    • Regular bowel and bladder habits
    • Diet and exercise
    • Avoid naps
    • Avoid watching TV or working in the bedroom
    • Relax before bedtime
    • Go to sleep and wake up at the same hours every day, no matter how little you slept
• Medications
  • Sleep medicines may be helpful for short periods
  • Medications also be used to treat conditions that disrupt sleep that need to be treated with drugs, such as hot flashes, pain, depression, anxiety, or mood disorders