Sleeping Problems: Insomnia

Approved by the Cancer.Net Editorial Board, 06/2016

Insomnia is the experience of having trouble falling asleep or staying asleep during the night. It may cause you problems during the day, such as tiredness, low energy, poor concentration, and irritability.

Most people experience insomnia at some point in their lives. However, the risk of insomnia increases with age and with serious illnesses, such as cancer.

Insomnia often causes other cancer-related conditions and symptoms—such as pain, fatigue, or depression or anxiety—to worsen. It may also decrease your ability to cope with cancer and cause feelings of isolation.

Understanding the cause of insomnia

Understanding the cause of insomnia helps your doctor find the best way to treat it. Your doctor may ask about the following factors that can contribute to sleeping problems:

  • Sleep history

    • Whether you have had a sleep disorder in the past

    • Your normal sleeping habits

      • When you go to bed

      • How long it takes to fall asleep

      • How long you sleep

      • How do you feel when awakening

    • Sleep environment, such as location, room temperature, amount of light and noise

    • Snoring

    • Change in breathing pattern when sleeping, which is often best asked of a partner

    • Exercise pattern, such as what time of day and how much you exercise

    • Restless leg symptoms

    • How is insomnia affecting you

      • Daytime sleepiness

      • Falling asleep doing normal activities

        • Driving

        • Reading

        • Working

    • Other past medical conditions that might affect sleep

      • Endocrine (hormonal) disorders, such as low or high thyroid hormone levels or diabetes

      • Heart disorders

      • Urinary problems

  • Psychological history

    • Anxiety

    • Depression

    • Concerns about the cancer getting worse or returning

    • Delirium (confusion)

    • Financial or insurance concerns

  • Physical symptoms

    • Pain

    • Shortness of breath

    • Nausea

    • Vomiting

    • Cough

    • Hiccups

    • Hot flashes

    • Itching

    • Diarrhea

    • Frequent urination

    • Any other symptoms

  • Medications

    • New medications

    • Recently discontinued medications

    • Over the counter medications

    • Medications previously used for sleep

    • Other medications or alternative therapies

    • Alcohol or drug use

    • Caffeine use

  • Recent weight changes

Managing insomnia

The goal for managing insomnia is to achieve restful sleep and improve your overall quality of life. Understanding and treating the underlying cause of your insomnia is the best way to do this. First, find potential sources of the insomnia and ask your doctor or nurse to help you manage these conditions. Non-medical problems can add to insomnia. These include financial and work concerns, family changes, fears related to the cancer worsening or recurring, among others.

Behavioral techniques are usually more effective for long-term relief of insomnia. Medications may help relieve insomnia. However, you should only use these for a short time unless other treatments don’t work.

To help find the cause of insomnia, your doctor will take a thorough history and physical exam. Depending on what your doctor finds, you may need additional testing or visits with specialists. These specialists can help determine the cause and develop a plan to manage the problem.

For ongoing insomnia, your doctor may recommend a sleep study or refer you to a sleep specialist. These specialists can find out whether you have another sleep disorder affecting your ability to fall or stay asleep. One example is sleep apnea, which is a short pause or decrease in air flow while breathing during sleep.

Relieving symptoms is an important part of your care that is provided along with treatment for the cancer. This is called symptom management or palliative care. Talk with your health care team about any problems you experience, including any new symptoms or a change in symptoms. Your oncologist may recommend that you visit a palliative care or other specialist trained to help patients manage symptoms.

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