For persistent sleep problems, you may wish to seek help from a professional accredited sleep therapist or clinic. Many hospitals now have these services available; you also can search for one through the Sleep Foundation.
For chronic (or ongoing) insomnia, cognitive behavioral therapy (CBT) may be helpful. Sometimes known as “talk therapy,” CBT involves meeting with a mental health professional (psychotherapist, psychiatrist, psychologist) for a limited number of structured sessions. This person can help you develop strategies for dealing more effectively with the emotions, stress, or other factors that may be interfering with your sleep. Ask your doctor for the names of mental health professionals her or she would recommend in your area.
Another option is sleep medications, sometimes used in addition to CBT. Examples include:
- Rozerem (chemical name: ramelteon): This prescription sleep aid is generally preferred because it can be used long-term and does not appear to pose a risk of dependence. It functions like the sleep hormone melatonin.
- Ambien (chemical name: zolpidem) or Lunesta (chemical name: eszoplicone): Taken from time to time over the short-term, these prescription sleep aids also may be helpful in breaking the cycle of insomnia.
It’s usually not a good idea to use over-the-counter sleep aids (Unisom, Simply Sleep, Tylenol PM, ZzzQuil). Most contain diphenhydramine, which can make you feel sleepy at first but tends to disrupt the stages of sleep. Diphenhydramine can also interfere with the effectiveness of tamoxifen. Over-the-counter melatonin products generally aren’t recommended for everyday use: You can’t trust that the dosage matches what’s on the label, and many of these supplements can raise melatonin levels much higher than they should be. Neither are herbal supplements such as valerian and kava: Kava has been linked to the risk of liver damage, and the long-term effects of valerian aren’t well-understood. Persistent insomnia really does require treatment by a medical professional.
For sleep apnea
If you’re concerned about sleep apnea, talk to your doctor. He or she can refer you to a sleep specialist for an evaluation. This often involves sleeping at the clinic for a night so that your sleep patterns and behaviors can be observed.
The main treatments for sleep apnea are:
- Weight loss (if you’re overweight): For practical advice and information about how to lose weight and maintain a healthy weight, visit Breastcancer.org’s sections on Nutrition and Exercise.
- CPAP (continuous positive airway pressure) machine: This is a machine with an attached face mask that you wear during the night. It uses air pressure to keep the airway open at the back of the throat.
- Oral appliance or nasal inserts: Some people find the CPAP device too cumbersome and noisy. One alternative is a plastic oral appliance you wear that helps pull the jaw or the tongue forward. This prevents the tongue and soft tissues from collapsing into the back of the throat and blocking the airway. Another is a set of adhesive inserts worn in the nostrils to prop them open at night and keep air flowing.
- Positioning aids: Pillows or other devices that keep you on your side and off your back can help keep the airway open.
“You need adequate sleep to perform basic everyday functions plus anything above and beyond. Need to recover from the anxiety of the breast cancer experience? Stressed to meet major deadlines at work? Dizzy from the merry-go-round of demands at home? Want to think clearly, speak well, be one of the living? Need to revive your flattened spirit? Sleep is your first priority — good, high quality, solid sleep to revive your energy, focus, resources, motivation, and will to live your life fully.”
— Marisa Weiss, M.D., president and founder, Breastcancer.org
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