'Insomnia - being up to see the sunrise, and realise you haven’t been asleep yet'.
A topic often raised in discussions with our online visitors, whether they themselves have cancer, or they have someone they care about with cancer, is they are having trouble sleeping.
It's bad enough when life is cancer free, but an added burden when the days are filled with work, family, appointments, treatments, etc. For some, conversely, they may be feeling isolated and fed up…sleep might be considered a refuge and necessity at night, to help us get through.
I googled ‘insomnia’, and got over an incredible 14,000,000 results. Simplified , ‘Insomnia’ is a clinical term for people who have trouble falling asleep, difficulty staying asleep, waking too early in the morning, or waking up feeling unrefreshed. More than 30% of the population suffers from it…
Apparently, human beings sleep for about a third of their lives. (Whereas a python sleeps 18 hours a day, and a giraffe for 1.9 hours….?) .According to BBC webpage, Science of Sleep, ‘we have to sleep because it is essential to maintaining normal levels of cognitive skills such as speech, memory, innovative and flexible thinking. In other words, sleep plays a significant role in brain development.’
To a lay person like me, sleep means relaxing, blanking out the day, pleasant dreams, and waking up feeling re-energised. The trouble is, we tend to sleep in the dark, at night, just when fears, thoughts, niggles, pain, anxiety seem at their worst. It can be a bit of a ‘chicken and egg’ situation…anxiety causes sleeplessness, and sleeplessness causes anxiety.
Tips to help get a good night's sleep
There is a plethora of advice about how to get a good night’s rest…and seasoned insomniacs among you may well have other tips to offer. Here is a list I have adapted from various websites (drawing together the main suggestions)
- It helps to establish a regular, relaxing bedtime routine. Avoid stimulants like coffee, chocolate, and nicotine before going to sleep, and never watch TV, use the computer, smartphone, or pay bills before going to bed. Read a book, listen to soft music, or meditate instead.
- Avoid alcohol - It’s tempting to think alcohol will help you sleep, but as it’s a stimulant, it tends to help keep you awake.
- Don't eat a big meal or spicy foods just before bedtime. A small snack containing tryptophan (a natural sleep-promoting amino acid) may help, such as turkey, banana or fish. (NHS Choices webpage on Insomnia)
- Only go to bed when you’re tired. It’s tempting to just doze on the settee, but if you’re feeling that level of relaxation, it’s worth stirring, and going to bed.
- Try to make your bedroom is cool, dark, and quiet. I know it sounds common sense, but have comfortable bedding and pillows, and if you wear nightwear, ensure they're loose fitting.
- Avoid looking at the clock (easier said than done)…turn it away from you, if you can.
- Worrying can be the big issue. Keep a notepad by the bed. Write the worries down, and close the pad. They can be revisited in the morning if necessary.
- Don’t lay there getting more anxious and cross about it. If you can’t get to sleep, or are awake in the middle of the night, get up, go into another room, maybe read, or do a crossword, or listen to some music. Tell yourself it doesn’t matter, and stay there for at least half an hour, before returning to bed.
- An eye mask and ear plugs can be helpful, if outside light and noise is an issue.
- Don't use the bedroom for anything other than sleeping or sex. Tempting as it is, don't watch television, fiddle about with your laptop, eat, or text. Switch off the electronics .( I personally think lying on the bed smoothing the cat and listening to her purring, is relaxing, but haven’t found this advice on any of the websites yet…)
- Try not to ‘angst’ about the night’s loss of sleep. Sometimes it’s a case of accept it’s a ‘no sleep’ night, and tomorrow night will be better, as you’ll be more tired. Getting stressed about it, just adds to the frustration (and sleeplessness).
When to see further help
If you’re not sleeping, and it’s becoming an issue, it is worth going to see your doctor to talk things through. Short term sleep medication is sometimes helpful, but isn’t a good long term solution. Doctors are often understandably reluctant to prescribe sleeping tablets. They may suggest a low dose sleeping tablet, for a minimal length of time, as it doesn’t fix the long term issues.
You can buy 'over the counter' remedies to help with sleep, but it always wisest to check with your GP or pharmacist if you're on any other medications which they might interfere with. Many of the herbal tablets are based around Valerian...it is frequently combined with hops, lemon balm, or other herbs that also cause drowsiness. I've read that it's better if you take them for 2 -3 weeks continuously, rather than occasionally. (Royal College of Psychiatrist's webpage on 'Sleeping Well') .
Another 'regular' in the OTC medicines, often contain anti-histamines. The side effect of anti-histamines is drowsiness. It therefore follows that if you take them, you need to be careful about the effects lasting into the following morning. They can also leave you with a dry mouth and throat, and can clash with some of your other medications, so do check....
If it’s cancer symptoms, pain, discomfort, indigestion etc, then mention these to your GP, consultant, or specialist nurse, as they can be hopefully be checked out, and efforts made to help you be more comfortable so you can sleep.
Meanwhile, If you live near one of our Maggie’s Centres, it can be useful dropping in and explaining that you’re having trouble sleeping. Some of our Maggie's Centres hold sleep workshops. Talking about the underlying issues, and perhaps learning some relaxation skills, and stress management, can ease the emotional burden which may be contributing to the restless nights. You can find some relaxation and breathing exercises in Maggie's Cancerlinks, which you may find helpful. You can join in conversations here online too, and find out what helps others to cope with sleep issues.
Finally, I’ve added some links at the end of my blog, here which you may find useful. Let us know what works for you,
Original blog written by Sue Long, Cancer Support Specialist, November 2017
Difficulty Sleeping (insomnia) - Macmillan Cancer Support
Sleep Disorders – Anxiety and Depression association of America
Sleeping problems - Cancer.Net
Insomnia – NHS Choices
Sleeping well - Royal College of Psychiatrists