Getting enough sleep is needed for both physical and mental health.

Sleep is an important part of physical and mental health. While we sleep, the brain and body do a number of important jobs that help us stay in good health and function at our best.

Getting the sleep we need:

• Improves our ability to learn, remember, and solve problems.
• Lowers blood pressure and gives the heart and blood vessels the rest they need.
• Helps certain hormones control the following:

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  Growth.

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  The repair of cells and tissues.

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  The immune system (to fight infection).

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  Blood sugar levels (which affect energy).

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  Appetite.

Sleep has two main phases that repeat during the sleeping period.

There are two main phases of sleep, and both are needed in order to get "a good night's sleep." The two main phases of sleep are rapid eye movement (REM) and non-rapid eye movement (NREM):

• REM sleep, also known as "dream sleep," is the phase of sleep in which the brain is active.
• NREM is the quiet or restful phase of sleep. It has four stages, from light sleep to deep sleep.

The phases of sleep repeat during the night in a cycle of a non-REM phase followed by a REM phase. Each cycle lasts about 90 minutes and is repeated 4 to 6 times during 7 to 8 hours of sleep.

Sleep disorders affect normal sleep patterns.

Normal sleep patterns differ from person to person. The amount of sleep you need to feel rested may be less or more than others need. If sleep is interrupted or does not last long enough, the phases of sleep are not completed and the brain cannot finish all the tasks that help restore the body and mind. There are five major types of sleep disorders that affect normal sleep.

• Insomnia: Being unable to fall asleep and stay asleep.
• Sleep apnea: A breathing disorder in which breathing stops for 10 seconds or more during sleep.
• Hypersomnia: Being unable to stay awake during the day.
• Circadian rhythm disorders: Problems with the sleep-wake cycle, making you unable to sleep and wake at the right times.
• Parasomnia: Acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating.

Sleep disorders keep you from having a good night's sleep. This may make it hard for you to stay alert and involved in activities during the day. Sleep disorders can cause problems for people with cancer. You may not be able to remember treatment instructions and may have trouble making decisions. Being well-rested can improve energy and help you cope with side effects of cancer and treatment.

Sleep problems that go on for a long time may increase the risk of anxiety or depression.

Sleep disorders are common in people with cancer.

As many as half of people with cancer have problems sleeping. The sleep disorders most likely to affect people with cancer are insomnia and an abnormal sleep-wake cycle.

There are many reasons you may have trouble sleeping, including:

• Physical changes caused by the cancer or surgery.
• Side effects of drugs or other treatments.
• Being in the hospital.
• Stress about having cancer.
• Health problems not related to the cancer.

Tumors may cause sleep problems.

If you have a tumor, it may cause the following problems that make it hard to sleep:

• Pressure from the tumor on nearby areas of the body.
• Gastrointestinal problems (nausea, constipation, diarrhea, being unable to control your bowels).
• Bladder problems (irritation, being unable to control urine flow).
• Pain.
• Fever.
• Cough.
• Trouble breathing.
• Itching.
• Feeling very tired.

Certain drugs or treatments may affect sleep.

Common cancer treatments and drugs can affect normal sleep patterns. How well you sleep may be affected by:

• Hormone therapy.
• Corticosteroids.
• Sedatives and tranquilizers.
• Antidepressants.
• Anticonvulsants.

Long-term use of certain drugs may cause insomnia. Stopping or decreasing the use of certain drugs can also affect normal sleep. Other side effects of drugs and treatments that may affect the sleep-wake cycle include the following:

• Pain. For more information, see Pain.
• Anxiety. For more information, see Adjustment to Cancer: Anxiety and Distress.
• Night sweats or hot flashes. For more information, see Hot Flashes and Night Sweats.
• Gastrointestinal problems such as nausea, constipation, and diarrhea. For more information, see:

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  Nausea and Vomiting and Cancer Treatment

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  Constipation and Cancer Treatment

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  Diarrhea and Cancer Treatment

• Bladder problems, such as irritation or being unable to control urine.
• Breathing problems.

Being in the hospital may make it harder to sleep.

Getting a normal night’s sleep in the hospital is difficult. The following may affect your sleep in a hospital:

• Hospital environment – You may be bothered by an uncomfortable bed, pillow, or room temperature; noise; or sharing a room with a stranger.
• Hospital routine – Sleep may be interrupted when doctors and nurses come in to check on you or give you drugs, other treatments, or exams.

Getting sleep during a hospital stay may also be affected by anxiety and age.

Stress caused by learning the cancer diagnosis often causes sleeping problems.

Stress, anxiety, and depression are common reactions to learning you have cancer, receiving treatments, and being in the hospital. These are common causes of insomnia. For more information, see Depression.

Other health problems not related to cancer may cause a sleep disorder.

People with cancer can have sleep disorders that are caused by other health problems. Conditions such as snoring, headaches and daytime seizures increase the chance of having a sleep disorder.

An assessment is done for people with sleep disorders.

An assessment is done to find problems that may be causing the sleep disorder and how it affects your life. People with mild sleep disorders may be irritable and unable to concentrate. People with moderate sleep disorders can be depressed and anxious. These sleep disorders may make it hard for you to stay alert and involved in activities during the day. You may not be able to remember treatment instructions and may have trouble making decisions. Being well-rested can improve energy and help you cope with side effects of cancer and treatment.

People with cancer should have assessments done from time to time because sleep disorders may become more or less severe over time.

A sleep disorder assessment includes a physical exam, health history, and sleep history.

Your doctor will do a physical exam and take a medical history that includes:

• Side effects of your cancer and cancer treatments.
• Medicines, including vitamins, and other over-the-counter drugs.
• Emotional effects of the cancer and treatments.
• Diet.
• Exercise.
• Caregiver routines.

You and your family can tell your doctor about your sleep history and patterns of sleep.

A polysomnogram may be used to help diagnose the sleep disorder.

A polysomnogram is a group of recordings taken during sleep that show:

• Brain wave changes.
• Eye movements.
• Breathing rate.
• Blood pressure.
• Heart rate and electrical activity of the heart and other muscles.

This information helps the doctor find the cause of your sleeping problems.

Treating sleep disorders may include supportive care for side effects of cancer or cancer treatment.

Sleep disorders often occur along with cancer-related fatigue and may be related. Sleep disorders that are caused by side effects of the cancer or cancer treatment may be helped by relieving the symptoms of those side effects. It's important to talk about your sleep problems with your family and the health care team so education and support can be given. Supportive care may improve your quality of life and ability to sleep.

Cognitive behavioral therapy may reduce anxiety and help you relax.

Cognitive behavioral therapy (CBT) helps reduce anxiety about getting enough sleep. You learn to change negative thoughts and beliefs about sleep into positive thoughts and images, in order to fall asleep more easily. CBT helps replace the anxiety of “I need to sleep” with the idea of “just relax.” You learn how to change sleep habits that keep you from sleeping well. If in-person CBT sessions with a health professional are not available, video CBT sessions have been shown to be helpful. CBT may include the following:

• Stimulus control.
• Sleep restriction.
• Relaxation therapy.

• Stimulus control
  When you have sleep problems for a long time, just getting ready for bed or getting into bed to sleep may cause you to start worrying that you will have another sleepless night. That worry then makes it very hard to fall asleep. Stimulus control can help you learn to connect getting ready for bed and being in bed only with being asleep. By using the bed and bedroom only when you're sleepy, the bed and sleep are linked in your mind. Stimulus control may include the following changes in your sleeping habits:

  • Go to bed only when sleepy and get out of bed if you do not fall asleep after a short time. Return to bed only when you feel sleepy.
  • Use the bed and bedroom only for sleeping, not for other activities.
• Sleep restriction
  Sleep restriction decreases the time you spend in bed sleeping. This makes you more likely to feel sleepy the next night. The time you can set aside for sleeping is increased when your sleep improves.
• Relaxation therapy
  Relaxation therapy is used to relieve muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It is often used with guided imagery (focusing the mind on positive images) and meditation (focusing thoughts). Self-hypnosis at bedtime can also help you feel relaxed and sleepy. Relaxation therapy exercises can make it easier for stimulus control and sleep restriction to work for you.

Learning good sleep habits is important.

Good sleep habits help you fall asleep more easily and stay asleep. Habits and routines that may help improve sleep include the following:

A comfortable bed and bedroom

Making your bed and bedroom more comfortable may help you sleep. Some ways to increase bedroom comfort include:

• Keep the room quiet.
• Dim or turn off lights.
• Keep the room at a comfortable temperature.
• Keep skin clean and dry.
• Dress in loose, soft clothing.
• Keep bedding and pillows clean, dry, and smooth, without wrinkles.
• Use blankets to keep warm.
• Use pillows to get into a comfortable position.

Regular bowel and bladder habits

Regular bowel and bladder habits reduce the number of times you have to get up during the night. Waking during the night to go to the bathroom may be reduced by doing the following:

• Drink more fluids during the day.
• Eat more high-fiber foods during the day.
• Avoid drinking a lot before bedtime.
• Empty your bowel and bladder before going to bed.

Diet and exercise

The following diet and exercise habits may improve sleep:

• Stay active during the day.
• Get regular exercise but don't exercise within 3 hours of bedtime.
• Eat a high-protein snack (such as milk or turkey) 2 hours before bedtime.
• Avoid heavy, spicy, or sugary foods before bedtime.
• Avoid drinking alcohol or smoking before bedtime.
• Avoid foods and drinks that have caffeine, including dietary supplements to control appetite.

Other habits that may improve sleep include:

• Avoid naps.
• Avoid watching TV or working in the bedroom.
• Relax before bedtime.
• Go to sleep and wake up at the same hours every day, no matter how little you slept.

Hospital routines

Getting a good night's sleep in a hospital or other care facility can be hard to do. The good sleep habits listed above may help you. As a hospital patient, you may also:

• Ask caregivers to plan care so they wake you up the least number of times during the night.
• Ask for a back rub or massage to relieve pain or help you relax.

If treatment without drugs does not help, sleep medicines may be used for a short time.

Treatment without drugs does not always work. Sometimes cognitive behavioral therapies are not available or they do not help. Also, some sleep disorders are caused by conditions that need to be treated with drugs, such as hot flashes, pain, anxiety, depression, or mood disorders. The drug used will depend on your type of sleep problem (such as trouble falling asleep or trouble staying asleep) and other medicines you're taking. All of your other medicines and health conditions will affect which sleeping medicines are safe and will work well for you.

Some drugs that help you sleep should not be stopped suddenly. Suddenly stopping them may cause nervousness, seizures, and a change in the REM phase of sleep that increases dreaming, including nightmares. This change in REM sleep may be dangerous for people with peptic ulcers or heart conditions.

People Who Have Pain

If pain disturbs your sleep, treatment to relieve the pain will be used before sleep medicines are used. Pain drugs, other drugs being taken, and any other health conditions may affect which sleeping medicines are prescribed.

Older Patients

It's normal for older people to have some insomnia. Changes related to age can cause lighter sleep, waking up more often during the night, and sleeping less total time. If you are an older person with cancer who is having trouble sleeping, the doctor will look for the specific causes, such as:

• Physical health problems.
• Mental health problems, such as anxiety or depression.
• Loss of social support.
• Alcohol use (drinking).
• Side effects of medicines.
• Conditions that commonly affect sleep, such as restless legs syndrome, cramping or jerking of the legs during sleep, and sleep apnea syndrome.

Treating sleeping problems without drugs is tried first. The following may help improve sleep in older people with cancer:

• Having meals at regular times.
• Avoiding naps during the day.
• Being more active during the day.

Medicine may be used if non-drug treatments don't work. The doctor will look at all your medicines and health conditions before choosing a sleeping medicine. For some people, doctors will suggest a sleep disorder clinic for treatment.

People Who Have Jaw Surgery

People who have surgery on the jaw may develop sleep apnea, which is a sleep disorder that causes the person to stop breathing for 10 seconds or more during sleep. Plastic surgery to rebuild the jaw may help prevent sleep apnea.

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PDQ® Supportive and Palliative Care Editorial Board. PDQ Sleep Disorders. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389249]

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