On the Side: Insomnia
A significant minority of breast cancer survivors report some level of insomnia because of the stress, treatments, and/or hormonal therapies associated with their cancer. Regardless of mood or the physical symptoms that may be troubling you during and after treatment, Ann Berger, Ph.D., R.N., A.O.C.N., F.A.A.N., wants you to know that you can learn new ways to change your lifestyle that will help you sleep at night.
Berger, Niedfelt associate professor and advanced practice oncology nurse at the University of Nebraska Medical Center, has focused much of her research on sleep disorders. “My primary interest is in trying to modify fatigue in patients as they go through cancer treatments,” says Berger.
While considerable research during the past decade has found that walking 30 minutes a day and maintaining an active lifestyle is associated with lower levels of daytime fatigue, Berger’s focus also includes what happens after the sun goes down. Her thinking has been that consideration of both daytime and nighttime factors would be more beneficial than either alone.
Breast cancer survivors experience more problems with sleep disturbances than survivors of other cancer diagnoses, she says, in part because women are more likely to have insomnia than men. Younger pre-menopausal women, thrust into menopause suddenly because of a particular treatment regimen, are most likely to have difficulty sleeping.
Berger does not recommend that patients first rush to try prescription medications that are designed to help people sleep. “The decision to try these medications should be made with a health care clinician only after carefully weighing the risks and benefits.” Nor does she recommend herbal remedies, which can interfere with chemotherapy. These can also place patients at risk for a negative reaction related to the use of these herbs or their contaminants, she says. Instead, she suggests that learning various lifestyle changes are as effective and longer lasting than medication in helping women fall asleep and stay asleep at night. Berger’s own research has identified many such tips.
For example, don’t make your bed your enemy, she says. If you cannot fall asleep within about 20 minutes, then get up. Find an already designated favorite environment conducive to your falling asleep. Put on a headset with calming music and relax. Once you feel sleepy, go back to bed. Work with your natural biological clock, which regulates your body’s sleep/wake rhythms roughly every 24 hours. By establishing a consistent routine for bedtime and waking up, you will find it easier to fall asleep at night and to avoid daytime sleepiness over time.
Relax in the evening. Enjoy a warm bath or shower. Give yourself a foot massage. “What is very interesting to me is that between about 8 and 10 p.m. every night the biological rhythm cycles (also known as circadian rhythm cycles) within our body start sending out chemical messengers to tell our body that it’s time to get ready to sleep. In our culture, however, we do things to block those chemicals. We answer e-mails, make phone calls that upset us, get on the treadmill, or watch exciting shows on TV.”
Instead of blocking those sleep-inducing chemicals, try to avoid caffeine after noon, she says. Complete physical activity within three hours of bedtime. Create a quiet environment for sleeping with no TV in the bedroom.
“Light is a strong stimulus for waking,” Berger emphasizes, so turn off the TV and the computer, and dim the lights an hour before bedtime. If you like to read in bed, clip a small light to your book, rather than turning on a bright reading light. “Do not sleep with pets.” While people agree to try many of these lifestyle changes, Berger says, they are especially reluctant to give up their pets—but pets wake people up.
“Just try it for a month,” she urges. “Find another place to keep your pets and see if you can get the sleep your body needs.”
More lifestyle interventions are described in a book Berger highly recommends called, A Woman’s Guide to Sleep Disorders, by M. Kryger, past president of the American Academy of Sleep Disorders. The book is published by McGraw-Hill.
Dr. Ann Berger wrote a chapter on sleep for “Nursing Care of Women with Cancer,” ed. K. Hassey Dow, published by Elsevier in 2006.
Dr. Ann Berger wrote a chapter on sleep for “Nursing Care of Women with Cancer,” ed. K. Hassey Dow, published by Elsevier in 2006.
This article is from the Summer 2006 issue of Lifeline.
