You would hope that if you are constantly fatigued sleep would come easily. Many people with advanced cancer say it does not always work that way. They have trouble falling asleep and staying asleep (also called insomnia) and do not feel rested if they do manage to sleep.

It is normal to have problems sleeping during this challenging time in your life. Difficulty sleeping may be caused by fear and worry about cancer and treatment, side-effects from treatment, and being less active during the day.

Sleep is an important part of the healing process and not being able to do so can be distressing. If you can’t sleep within 30 minutes of going to bed, get up and do something not too stimulating (eg. quiet reading, listen to music) until you feel sleepy again. “Clock watching” may cause more distress and contribute to not sleeping.

What may help

Talk to your Doctor

The underlying reason for your poor sleep may be treatable, or your doctor or nurse may be able to offer you appropriate prescription medicines.

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It is very important that you let your health care team know about all the medicines you take including over-the-counter medicines, as these may interact with medicines he or she may have suggested to help you sleep.

Write down what you want to tell you doctor:

Keep a record of your sleep pattern, including what you are eating, drinking and doing during the day and just before bed. When did you start not sleeping well? When do you go to bed? Do you fall asleep immediately? When do you wake up? What wakes you up? Share this record with your doctor and health care team so you can come up with a plan to help you sleep.

Write down what you want to ask your doctor:

What can be done to help you sleep? Ask your doctor about medicinal and non-medicinal strategies to help you sleep. If you are prescribed a sleeping medication, ask the doctor: How long will it take to work? How often should I take it? Should I take more medication if I can’t sleep? Are there other options if the medication doesn’t work? What are the possible side-effects of the medication? How can the side-effects be managed? Who will I continue seeing about my sleep problems (eg. doctor or palliative care nurse)?

Talk to others

If anxiety, stress or worry about yourself or those close to you are disrupting your sleep, talking to your family, friends or a trained professional (such as a counsellor or a psychologist) may make a difference.

Relaxation

Some people who have trouble sleeping find relaxation techniques, such as meditation, deep breathing exercises, muscle relaxation, yoga or self-hypnosis, useful. Your doctor or nurse may know where you can learn these techniques and where to find self-hypnosis tapes. Also, your community health centre may have a list of relevant services.

Try to deal with things that may be worrying you earlier in the day and plan more relaxing activities for the late afternoon.

Exercise

Regular exercise is also a good way to reduce anxiety and improve sleep quality. However, vigorous exercise right before bed should be avoided as it promotes wakefulness.

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  • Try to go to bed and get up at a similar time every day.
  • Establish a regular, relaxing bedtime routine.
  • Avoid caffeine-rich beverages and alcohol before bed.
  • Avoid eating a heavy meal before bed.
  • If you have a nap, make it no longer than 30 to 40 minutes.
  • Some people find drinking warm milk with honey or decaffeinated teas before going to sleep helps.

Life, Hope & Reality was developed and written by Afaf Girgis, Claire Johnson, and Sylvie Lambert with funding from the NHMRC and Cancer Council NSW.

Last updated 30 August 2015