It all started when I found out I had cancer. Suddenly, I found myself tossing and turning at night, unable to sleep. I slept fewer and fewer hours each night, and I was constantly waking up.  I researched insomnia and tried all the recommended ‘sleep hygiene’ tips. Still, sleep was elusive.  I’m not the only cancer patient who suffers with insomnia. It turns out many patients and survivors struggle to get adequate sleep.

I recently spoke with sleep expert Dr. Michael J. Breus, aka ‘The Sleep Doctor (Learn more at the Sleep Doctor) , about cancer patients and insomnia. Dr. Breus says sleep problems are extremely common for cancer patients and yet typical sleep hygiene practices are not enough to help cancer patients get quality sleep.

Why Does Sleep Matter?

In our hectic society, it seems few of us are getting enough sleep. The average adult needs 7 to 10 hours of sleep per night. If we get fewer than 6 hours of sleep per night, our physical and mental health will be affected.

How Does Our Sleep Get Disrupted?

Our bodies have internal ‘circadian clocks’ which keep us on a 24-hour schedule. This circadian clock, along with an internal ‘sleep homeostasis’ mechanism, controls our sleep/wake cycles. However, the circadian clock is easily disrupted, causing changes in our normal sleep patterns. Traveling through different time zones, for example, can disturb the circadian clock. Circadian rhythms are also altered by exposure to artificial light at night. Blue light emitted from the screens of our computer devices is the worst offender and can wreak havoc with our sleep.

There are many other ways our sleep can be negatively affected. Stimulants, such as caffeine, and medications can cause insomnia. People with depression and/or anxiety also frequently suffer from disruptions in sleep. Since sleep affects our mood, insomnia can cause a vicious cycle: the depression leads to insomnia and then the insomnia makes the depression worse.

Why is Insomnia Bad for your Health?

We all know that when we do not get enough sleep, we don’t feel particularly well. Evidence shows that beyond being annoying, insomnia is bad for our physical health. Not getting enough sleep is linked to heart disease (Read the study here ) and type II diabetes. Insomnia is also linked to inflammation within the body, with some forms of cancer (Read the study here ) and other significant illnesses.  The risk of developing some cancers has been linked to night time light exposure. Women who work the night shift have much higher rates of breast cancer than those who work daytime hours. (Ready study here )

How Common is Insomnia in Cancer Patients?

Unsurprisingly, many cancer patients suffer from insomnia. It makes sense, after all, as a cancer diagnosis is frightening and anxiety-provoking. According to one study of nearly 1000 cancer patients, about half suffered from insomnia. Somewhat surprisingly, 18 months later, 38% of respondents still reported having insomnia. (read study here ) Unfortunately, many oncologists do not ask their patients about their sleep so many cancer patients suffer in silence.

What is the number one factor contributing to insomnia in cancer patients?

Dr. Breus believes that one of the most important contributing factors to cancer patients’ insomnia is ongoing extreme stress. “Stress is the biggest problem across the board for all cancers,” he explains. The stress is physical, emotional and financial in nature and it does not always disappear even when the patient is in remission.

Thus, the key to helping cancer patients sleep is helping to reduce their stress. Dr. Breus recommends combining stress-reduction programs with typical sleep hygiene recommendations, which include things like sticking to a regular bedtime and staying off of devices that emit blue light prior to bedtime.

Dr. Breus’s Top Tips to Banish Insomnia

1. Figure out what the best time is for you to go to bed and wake up and maintain that schedule. In     particular, stick to your wake up time. If you get up at 6:00 am during the week, then get up at 6:00 am on the weekend.

2. Stop consuming all caffeine by 2:00 p.m.

3. Stop alcohol three hours before going to bed. Alcohol prevents you from entering the deeper stages of sleep.

4. Exercise for at least 20 minutes per day. There is no better way to improve the overall quality of your sleep.

5. Hydrate and get exposure to direct sunlight every morning. Getting sunlight in the morning can help restore the body’s circadian clock.

6. MInd-Body Practices, such as yoga or meditation. Research demonstrates the helpfulness of these practices for stress reduction among cancer patients. (Read more about these findings here: Learn more here )

7. Cognitive Behavioral Therapy (CBT) also yields positive results. CBT is a short and intense form of therapy which focuses on the patient’s thoughts and behaviors. For insomnia, CBT typically works by reframing negative thoughts that have developed surrounding sleep. It also includes things such as sleep scheduling and relaxation therapy. (To  learn more about CBT and insomnia, click here:  Click here for more info )

What About Sleeping Pills?

“Many cancer patients are already taking so much medication they aren’t eager to add more to the mix,” says Dr. Breus. However, sometimes medication is warranted. Dr. Breus cautions against taking over-the-counter melatonin. He explains, “Melatonin is not regulated by the FDA. There is no way to know what is in the pills you are buying. In addition, most of the time, the manufactured dosage is not correct. Usually people only need 0.5 mg of Melatonin and the bottles come in doses that are 3 or 5 mg.”

As for other medications, Dr. Breus believes there is a place for them when prescribed by a knowledgeable medical professional. He recommends patients speak with their doctors about sleep medications if other methods have failed to help.

Putting it all Together for a Great Night’s Sleep

Do your body and mind a favor and work towards getting 7-9 hours of quality sleep each night. Exercise, do some yoga, and get up at the same time each day. Check your caffeine intake, especially later in the day. Don’t eat a large meal or drink alcohol close to bedtime. Get some direct exposure to sunlight early in the day. If your insomnia is persistent, seek help from a Cognitive Behavioral Therapist. Finally, make sure your physician is aware of your sleep issues.

About The Sleep Doctor

 Dr. Breus is a clinical psychologist who specializes in treating sleep disorders. He has appeared on a number of television shows and is on the advisory board for the Dr. Oz show. His website (The Sleep Doctor) is a treasure trove of information on all things sleep related.  I would like to extend a special “thank you “ to Dr. Breus for taking the time to share his expertise with Project Purple.