Insomnia and Breast Cancer
It’s normal for people to have some trouble sleeping occasionally. But insomnia is different. This common sleep disorder can make it hard for you to fall asleep or stay asleep. Insomnia can also make it hard to get back to sleep if you wake up too early, and make you feel tired when you’re up for the day.
Causes of insomnia
Cancer-related insomnia can be caused by the stress of a breast cancer diagnosis, the breast cancer itself, or certain breast cancer treatments.
Insomnia can be caused by the stress of a breast cancer diagnosis and worries about the future. Anxiety and the fear of recurrence can make it tough for some people to get a good night’s sleep.
Some breast cancer treatments, including the chemotherapy medicine Ixempra (chemical name: ixabepilone), certain hormonal therapies, and certain targeted therapies can cause insomnia, as can pain medicines that your doctor might prescribe for side effects.
Hormonal therapies that may cause insomnia include:
Targeted therapies that may cause insomnia include:
Review the medicines you’re taking with your doctor to see if any might be making it hard for you to get good sleep. You may be able to adjust the dosage or timing, or even change the medicine altogether, to see if your sleep improves.
Insomnia is a common side effect of menopause, whether your body enters menopause naturally or as the result of breast cancer treatment.
Research has yet to show if a drop in estrogen levels and other hormonal changes interfere with the sleep cycle. But the hormonal changes that come with menopause can definitely cause symptoms such as hot flashes and night sweats, depression, mood changes, and sleep apnea (when your breathing stops temporarily during sleep) — all of which can interfere with a good night’s sleep.
Treatments for insomnia
Your doctor might recommend a few different treatments to help you get better sleep.
Your doctor can recommend prescription sleep medicines for insomnia. It’s important to take them only as directed. 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 a short period of time, these prescription sleep aids also may help break the cycle of insomnia.
Your doctor might recommend combining prescription sleep medicines with cognitive behavioral therapy (CBT), especially if you have ongoing (or chronic) insomnia. During CBT, a mental health professional (psychotherapist, psychiatrist, or psychologist) helps you develop strategies for dealing more effectively with the factors that might interfere with your sleep. Ask your doctor to recommend mental health professionals in your area.
Small studies show that acupuncture, tai chi, and yoga can help ease insomnia.
It’s usually not a good idea to use over-the-counter sleep aids. 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, either. 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. Herbal supplements such as valerian and kava are also not recommended: 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.
Sleep apnea and treatments
Sleep apnea happens when your breathing stops temporarily during sleep. Central sleep apnea happens when the brain doesn’t automatically tell the muscles controlling your airway to take a breath. Obstructive sleep apnea happens when your airway is blocked, usually by the soft tissue at the back of your throat.
Sleep apnea can make you snore, gasp, or breathe heavily during sleep. As a result, you may awaken during the night or simply feel tired during the day. Hypopnea, or shallow breathing, is another form of sleep apnea. With both conditions, your oxygen supply decreases, affecting sleep quality. Obesity is a risk factor for sleep apnea.
If you’re concerned about sleep apnea, ask your doctor to refer you to a sleep specialist for an evaluation. This often involves sleeping at the clinic for a night so your sleep patterns and behaviors can be observed.
You might need a CPAP (continuous positive airway pressure) machine. This machine has a face mask attachment that you wear during the night. It uses air pressure to keep the airway open at the back of the throat.
If you don’t have access to a CPAP machine or find it too bulky or noisy, your doctor might recommend oral appliances or nasal inserts. An oral appliance helps pull the jaw or the tongue forward to keep the tongue and soft tissues from collapsing into the back of the throat and blocking your airway. You can also wear a set of adhesive inserts in your nostrils to prop them open at night and keep air flowing.
You can also try positioning your pillows to keep you on your side and off your back to help keep the airway open.
Self-help strategies for better sleep
Good sleep hygiene means following a daily routine and setting up your bedroom to get consistent, uninterrupted sleep. To improve the quality of your sleep, try some of the following tips:
Create a soothing bedtime ritual. Use your bed only for sleeping or sex. Turn off your TV and other electronic devices at least an hour before bedtime. A warm bath, light reading, meditation, or other relaxing ritual may help.
Set a regular time to go to bed and wake up, and keep it consistent, even on weekends.
Make sure your bed and bedroom are as comfortable and quiet as possible. Avoid sleeping with pets or snoring bed partners until you get back on track.
Avoid eating within three hours of bedtime. If you must eat, avoid a heavy meal, spicy foods, or lots of sugar.
Limit caffeine (soda, coffee, tea) and alcohol throughout the day. All are notorious sleep wreckers.
Stay hydrated during the day, but avoid liquids within a few hours of bedtime if you’re getting up at night to urinate.
Get regular exercise, but try to finish at least three hours before your bedtime (no 9 p.m. aerobics classes).
Try not to nap during the day. If you must, set your alarm to wake you up in 30 minutes.
Avoid nicotine, whether in the form of cigarettes, a nicotine patch, or gum.
If you wake up at night, don’t force yourself to stay in bed. Tossing and turning could make you feel even more frustrated. Get up and engage in some kind of relaxing activity, such as light reading or mindless TV, until you’re ready to go back to bed.
Keep your bedroom dark and quiet to get the best rest.
Hide the clocks in your bedroom. You won’t be as anxious about falling asleep if you don’t know the time.
Try silicone earplugs if the noise is keeping you up at night.
— Last updated on August 22, 2024 at 9:12 PM
