Still can't sleep after diagnosis?

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Question from Chris UK: Since breast cancer diagnosis in 2003, my sleep has been progressively more difficult. I have tried everything I can think of but am regularly awake still at 5 in the morning. I then sleep for 1-2 hours. Sleeping tablets offer respite from this but leave me feeling tight-headed. What can I do?
Answers - Helena Schotland I think the place to start is what we call sleep hygiene: basically, some common sense tips. Things like trying to avoid caffeine after noon. Another thing is, bed is for sleeping or sex. Period. It's not for reading a book, watching TV, paying the bills, or talking on the telephone.

Editor's Note: Sleep hygiene includes the following:
  • Maintaining a regular sleep/wake schedule
  • Maintaining a healthy diet
  • Maintaining a regular exercise schedule
  • Avoiding or minimizing the use of caffeine
  • Avoiding alcohol
  • Avoiding smoking
Helena Schotland When you go to bed, turn your clock toward the wall. You don't need to see what time it is. It doesn't help you fall asleep. A lot of people are clock watchers. They'll see it's 12:03, 12:07, and get very frustrated. The other thing to do is not to go to bed until you're actually sleepy. If it's 11:30 and you're completely awake and you know you're not going to fall asleep, there's no point in going to bed. So if you go to bed, try and relax. Think of pleasant imagery, like lying on a beach in Bermuda.
Marisa Weiss, M.D. Alone or with someone else?
Helena Schotland Whatever floats your boat! If you're lying there and you can't fall asleep in, say, 20 minutes (you don't know exactly because the clock is facing the wall), don't stay there. Remember bed is for sleeping and sex, nothing else. So don't just lie there. Get up, go somewhere else. Go to a different room. Do something you find relaxing: read a book, watch TV. Don't do something stressful like getting on the Internet and typing, paying bills, rehashing things in your head. Do something you find pleasant, and then when you're drowsy, go back to bed.
Marisa Weiss, M.D. I have a great job for that—matching socks!
Helena Schotland You don't want to do housework. You want to do something pleasant that's not related to work or housework. You want to do something for yourself a little bit. So matching socks, even though it's a dull task, is still a little too much related to what we need to do during the day. Then when you're drowsy, go back to bed. If it happens again, do it again. Sometimes when people have trouble falling asleep in their room, they try somewhere else, like a guest room or a sofa in the living room, because some people have associations with their own bed. "Here I am in my own bedroom, not falling asleep again." So sometimes when they just change their setting—go to a different room or a different bed—they do better. I have some insomnia patients who actually sleep better on vacation then they do at home.
Marisa Weiss, M.D. Is there a danger in seeking another sleeping place on a regular basis, if this disrupts your intimate relationship with your partner?
Helena Schotland I think it's nice to do once in a while in a pinch. But obviously you want to try and establish good habits. Optimally, you want to sleep in your own bedroom all night with your bed partner. You want to go to bed and get up at around the same time every morning. One cup of coffee or one cup of caffeine in the morning is okay, but I try to limit it to just one. The big thing during the day is no naps. Naps are fine for people who don't have difficulty falling asleep and staying asleep. But if you are having difficulty, you want to avoid naps because your ultimate goal is to sleep in one big chunk at night; not to sleep a few hours in the day here, a few more hours there.

There's almost a sleep pressure that builds on us during the day that makes us want to go to sleep. And if you take a nap, you reduce that pressure. So you want to stay up for the entire day so you can take advantage of that natural drowsiness in the evening, so you can fall asleep and stay asleep. You want to avoid cigarettes, because nicotine is a stimulant. A stimulant is going to make you more alert, wake your brain up, and make it much harder to fall asleep. Some of my patients who are smokers and who may have insomnia wake up at 3 a.m. and have a cigarette, which is really the last thing they should be doing. Another thing to avoid in the evening is alcohol.
Marisa Weiss, M.D. Are you suggesting we should drink in the morning? :-)
Helena Schotland No, one should not have an eye-opener. I think a glass of wine—one—at dinner is fine. But you don't want to use a nightcap. And you certainly don't want to use alcohol to excess. Alcohol is a central nervous system depressant, so it makes us kind of sleepy. Initially you fall asleep more easily with alcohol than without, but as the alcohol wears off, your brain starts to wake up, so that sedative effect goes away and your brain starts to become more active. You can have a lot of sleep disruption as a result. Of course, you can have a full bladder as a result of the alcohol, and oftentimes a headache or dry mouth, and that's not exactly going to keep you sleeping well either.

The Ask-the-Expert Online Conference called Sleep Well: Healthy Habits for Good Rest featured Helena Schotland, M.D. and moderator Marisa Weiss, M.D. answering your questions about ways to improve your sleep.

Editor's Note: This conference took place in January 2007.

The materials presented in these conferences do not necessarily reflect the views of A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

A production of LiveWorld, Inc.
Copyright 2010. All rights reserved.

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