When to get help
If it takes you more than 30 minutes to fall asleep, or if you are awake in the middle of the night for at least 30 minutes and toss and turn most days of the week for at least three months, you probably have insomnia, according to zhou. “Even if a breast cancer patient doesn’t check these boxes, being dissatisfied with the quality of their sleep, or not waking up refreshed, are good reasons to consult experts to investigate what’s going on.”
Sometimes people who struggle with sleep are not even aware of it. “Other people in their lives may be aware that they aren’t sleeping well, but don’t realize the negative impact sleep loss has on well-being,” says Walsh. She notes that if you experience an increase in irritability, fatigue, depressed mood, and anxiety during the day, it may be time to seek help.
“Continued sleep disruption can contribute to the development of depression,” confirms Palesh. “If people have depression or other mental health symptoms, I would say treat insomnia symptoms early.” The general recommendation, she explains, is that symptoms that last anywhere from one to six months may go away on their own. “But there’s a scientific debate about this, and I tend to recommend that patients treat symptoms early so they don’t risk insomnia becoming chronic later on.”
Techniques that work best for insomnia
Renewing your sleep hygiene (sleeping habits) is not always enough. “The American Academy of Sleep Medicine has discouraged the use of sleep hygiene [alone], because it is not effective on its own,” says Zhou. “Sleep hygiene is rather part of a multimodal treatment called ‘cognitive behavioral therapy for insomnia’. [CBTI],’ that is advisable.”
According to all three experts, CBTI is considered the gold standard for the treatment of cancer-related insomnia. A meta-analysis published in Sleep Medicine Reviews supported CBTI in February 2021 as an effective way to improve sleep quality in women with breast cancer. And in a study published in 2022 in the journal Sleep, researchers found that CBTI plus light therapy significantly helped women with breast cancer sleep better.
Zhou says CBTI’s suite of tools teaches a patient how to approach sleep differently, from both a behavioral and cognitive perspective. And Palesh says CBTI differs from CBT for anxiety or depression because it’s a shorter series of sessions (just seven), has a stronger focus on behavior modification, and is modified to help you sleep.
“CBTI can be very effective in helping with both treatment-related and anxiety-related sleep problems,” says Walsh. “This short-term treatment is given by many social workers and other mental health clinicians and involves identifying and changing intrusive or negative thoughts.” It also uses relaxation techniques, such as guided imagery and progressive muscle relaxation. “These treatments have been shown to be even more effective than many sleep aids, although medication is sometimes used in combination with them.”
“In the short term, medications for sleep can be valuable,” Zhou adds. “An example could be shortly after a patient has been diagnosed with breast cancer. However, sleep aids are designed as short-term solutions, not long-term solutions.” Zhou believes it is essential that patients discuss an “exit strategy” with their doctor when recommending a sleep aid, with the aim of moving to cognitive behavioral therapy for insomnia in the future.
6 steps you can take to help you sleep
Follow these CBTI-informed steps to help stabilize your sleep schedule:
- Go to bed when you are tired. “I’ve yet to meet someone who can force themselves to sleep,” says Palesh, “so you want to get to know your body, learn to recognize when you’re sleepy, which is when you go to bed. Don’t use the clock to tell you telling you when to go to bed if you struggle with insomnia.”
- Wake up at the same time every day. Set your alarm for the same time each day to help your body maintain a routine rhythm.
- Take breaks when trying to sleep. “If you go to bed and can’t fall asleep within half an hour, get out of bed so you don’t form an association in your brain with bed and insomnia,” says Palesh. “Try again in half an hour.”
- Be aware of light. Light can stimulate your brain and interrupt your body’s release of melatonin. Exposure to blue light, which comes from fluorescent and LED lights and backlit electronic screens on TVs, cell phones, and computers, can also make it difficult to fall asleep and stay asleep. Avoid blue light a few hours before bedtime. Walsh and Palesh both recommend swapping TV and digital devices for relaxing activities such as reading or listening to calming music before bed. Meanwhile, starting your day with lots of light and exercise can stimulate your brain when you wake up to strengthen your sleep cycle, according to Palesh.
- Limit what you do in bed. “We just want to associate bed with sleep and sex,” says Palesh. So while reading or practicing relaxation exercises before going to bed, make sure you don’t do these things in your bed, no matter how relaxing they are.
- Establish a sleep-friendly eating routine. Do not eat or drink alcohol for two or three hours before going to bed. Also avoid caffeine in the afternoon and evening.
“These things, along with exercise and healthy eating throughout the day, can make a big difference,” says Walsh.
Palesh also says yoga can help people sleep better. But don’t be discouraged – yoga takes time to work. “It’s not like taking an Ambien,” she says. Either way, stick with it because, she adds, the breathing aspect of it will help regulate your system and ultimately help you sleep.
Acupuncture may also help, but the research to support it is still questionable. “Many people like it and it helps reduce stress and pain,” says Palesh. “People swear by it, but we don’t have enough good [scientific] proof that it will help everyone.”
But all three experts are optimistic that you can break your insomnia cycle, especially with a little help from your healthcare team. “A lot can be done,” says Walsh, “if people affected by cancer let their oncology providers help.”