Insomnia

Patient Education Quick Reference Guide

What is Insomnia?

Being able to sleep and to get good sleep is very important to the human body. Sleeping gives your body time to rest and build up your strength. From time to time, we all have trouble sleeping, but having a “bad night” every once in a while is different from having a sleep problem that occurs every night.

Insomnia is a sleep problem. It includes difficulty sleeping and the feeling that you slept poorly or you did not sleep well. When you have insomnia you may have trouble falling asleep, or you may be able to fall asleep but are not able to stay asleep (waking up many times during the night). You may wake up too early in the morning, or you may not feel refreshed after a night’s sleep. Insomnia may be a disease by itself, but it may also be a symptom of other problems.

It is thought that up to 60 million Americans have insomnia. It is also thought that up to 50% of patients with cancer have insomnia at some time. Not being able to sleep, or not getting good sleep for any length of time can make you moody and forgetful. You may have trouble concentrating and paying attention. You may also feel like you have no energy or motivation and feel very tired. If you are trying to cope with the diagnosis of cancer, insomnia can make the physical, mental and emotional stress worse. It can make it difficult for you to make decisions or have the energy to complete the planned treatment.

Symptoms of Insomnia

You may have insomnia if you have any of the symptoms listed below and they have been present for three or more weeks.

• It takes 30 minutes or more to get to sleep after “lights out”.
• You wake up frequently during the night.
• It takes 30 minutes or more to get back to sleep after you wake up at night.
• You wake up very early in the morning and can’t get back to sleep.
• You wake up feeling tired and not refreshed by sleep.
• You are unable to function normally during the day, especially if you have trouble concentrating
• You feel irritable due to lack of sleep.
• You have signs or symptoms of anxiety, depression, restless leg syndrome or sleep apnea.

Management of Insomnia

Be sure to tell your doctor or healthcare provider if you are having difficulty sleeping. Let them know if this is a problem that you had before you were diagnosed with cancer. Bring a list of all medications that you are taking with you to each appointment. In addition, if you follow the suggestions listed below your sleep may improve:

• Set up a daily routine that works for you during treatment. If you are able, keep your regular daytime schedule for work, rest, meals, treatment, exercise, and any other daily activities.
• Exercise regularly in the early part of the day. Exercising too close to bedtime can cause difficulty sleeping. In addition, fatigue increases as the day goes on.
• Limit the amount of nicotine, caffeine, and other stimulants you take in. If you have to take stimulants, don’t take them in the afternoon or evening.
• Avoid drinking alcohol near bedtime.
• Drink warm, caffeine-free drinks such as warm milk or decaffeinated tea before going to bed.
• Only go to bed when you feel sleepy.
• Go to bed when you feel ready to go to sleep – do not watch TV, read, eat, or talk on the phone while you are in bed.
• Set up a relaxing bedtime routine, such as a warm bath, a light bedtime snack, or 10 minutes of reading.
• If you get into bed and cannot get to sleep, or if you wake during the night and you cannot get back to sleep for 15 minutes or more, get out of bed and go to another room. Do something relaxing (like reading or deep breathing) until you feel sleepy again, and then go back to bed. You may need to do this two or three times during the night.
• Get up at the same time every day, even on weekends, and even if you didn’t sleep much the night before.
• If you need to rest during the day, try to do this earlier in your day. Try to limit your rest periods to 20-45 min, even if you are tired.
• Keep a notebook or diary of the times you go to bed, the times you wake up, the amount of coffee or caffeine you drink/eat, the amount of alcohol you drink, when you take your medicines and when and for how long you exercise. This kind of sleep log may help figure out if there are any particular sleep or behavior patterns that may be contributing to your insomnia.
• If you find yourself worrying at night, try to plan another time of the day to write down your worries and possible solutions.
• If you are having symptoms such as pain, nausea, or muscle cramps, be sure you tell your doctor or healthcare provider.
• If you take any over-the-counter medications to help you sleep (Unisom, Benadryl, Tylenol PM), be sure to let your doctor or healthcare provider know what you are taking, how much and how often. Note: you should discuss with your doctor or health care provider before using them if you have an enlarged prostate (BPH) or glaucoma.
• Your doctor or healthcare provider may recommend prescription medications to help you sleep. Make sure that you take them exactly as directed and tell you doctor or healthcare provider is you are having any problems with the sleep medications.

Medications

There are a number of different types of medications available to treat insomnia. They include:

• Benzodiazepines (frequent use can cause dependency), such as:
• Flurazepam (Restoril)
• Clonazepam (Klonopin)

• Antidepressants, such as:
• Trazodone (Desyrel)

• Others (these have not been widely studied in patients with cancer), such as:
• Eszopiclone (Lunesta)
• Ramelteon (Rozerem)
• Zolpidem (Ambien)
• Zaleplon (Sonata)

These medications have several side effects in common. They include:

• Sedation (tiredness)
• Confusion
• Decreased coordination
• Decreased speed of thought
• Forgetfulness Visual changes

Complementary and Alternative Medecine for Insomnia

There are some mind-body techniques, manipulative and body based approaches, and energy based therapies that may help to treat your insomnia. These include:

• Biofeedback
• Hypnosis
• Meditation
• Guided imagery
• Music therapy
• Progressive muscle relaxation
• Yoga
• Chiropractic medicine
• Massage therapy
• Acupuncture
• Biofield therapy (including Reiki, Qigong, and Therapeutic Touch)
• Electromagnetic therapy

Finally, always tell your doctor or healthcare provider about any therapies (complementary or alternative) that you are currently using or considering using, including all over-the-counter products you are taking, including dietary supplements or vitamins, herbal medicines and homeopathic remedies.

Additional Information:

American Cancer Society
National Cancer Institute