For nearly half of people with cancer, falling asleep is an ongoing challenge. Dr. Amane Abdul-Razzak, medical director of the Intensive Palliative Care Unit at the Foothills Medical Centre and a palliative care consultant at the Tom Baker Cancer Centre, works with the Complex Cancer Management Service to help cancer patients with issues that affect their quality of life. Here, she touches on why cancer can cause sleep issues and what to do about it.
Q: What are some common sleep challenges that arise for cancer patients?
The most common types of sleep issues would be in the insomnia camp, which may be experienced as difficulty falling asleep, waking up in the middle of the night and having difficulty falling back asleep, or waking up earlier than desired.
Q: Why do people who have cancer often encounter problems sleeping or resting?
There are multiple reasons. Pain or other symptoms such as cough caused by cancer can interfere with sleep. In addition, mood issues such as depression or anxiety are common in patients with cancer and cancer-related fatigue —which is this overwhelming feeling of tiredness that doesn’t improve with rest. These can lead to daytime sleepiness and nighttime sleep disturbance. Lastly, medication, such as the hormonal therapies used in treating cancers, can cause hot flashes that lead to sleep disturbance. Steroid therapies, too, can cause high cortisol levels, which can interfere with sleep.
Q: What kind of help should patients seek when dealing with cancer-related sleep issues?
Firstly, look at the underlying causes: are medications, pain or other symptoms such as cough or nausea triggering the issue? If mood is an underlying issue, a patient can ask their oncologist for a referral to a service that can help. Sleep medications may be helpful in the short term, but it’s best to treat the underlying depression and anxiety if these exist. Counselling is a key part of treating moods.
Q: What are some practical things a patient can do at home to improve sleep?
Strategies could include avoiding stimulants like caffeine or nicotine close to bedtime, avoiding stimulating TV shows or bright screens like smartphones or computers, and avoiding clock-watching — all of which can cause a little bit more anxiety. There are meditations and white-noise apps that can help people as part of their relaxation, or relaxing music. Sometimes a fan in your room can help, too, as having a higher body temperature or hotter environment can interfere with sleep.
Q: Any final advice on bedtime routines to adopt or other tricks to try?
Even simple things like earplugs and eye covers can help with stimulus control. And adopting a really relaxing bedtime routine, such as having a bath, reading a book or stretching, can help.
