Sleep and Wakefulness

After breast cancer treatment, many women have changes in their sleep habits.  Some want to sleep all the time, while others have trouble sleeping.  Most complain of fatigue.  Good habits that promote a good night sleep often help.  Keep in mind that what works for some individuals may not work for others, and it may take several months before you notice an improvement.  Here are a few tips that may help you improve your sleep:

  • Go to bed and wake up about the same time every day.  This sets your body’s internal clock so it will be ready for sleep when you are, and you will feel more rested when you are awake.
  • Make sure your bedroom is as pleasant, comfortable, dark and quiet as you can. Try using dark shades over the windows, using a fan to keep your room cool, and cutting off the television and other electronics off at least 30 minutes before you plan to sleep. This will help your mind to slow down and begin to go into a restful state.
  • Start relaxing pre-sleep rituals, such as a warm bath, a light bedtime snack or 10 minutes of reading.  This will allow you to unwind and send a “signal” to your brain that it’s time to sleep.
  • Avoid being around bright light before bedtime.  Light signals your body to wake up.
  • Exercise regularly in the morning or afternoon, not at night because exercise causes a temporary rise in endorphins, which can keep you awake.
  • Maintain regular times for meals, taking medicine, doing chores and other activities.  This helps keep your “internal clock” running smoothly.
  • Avoid caffeine, nicotine and alcohol in the late afternoon and evening. Caffeine and nicotine can delay your sleep, and alcohol may interrupt your sleep later in the night.
  • Avoid drinking liquids before going to bed. This will cause your bladder to become full, prompting you to go to the bathroom during the night. Waking up to use the restroom will not allow your body to stay in a state of deep sleep.
  • Avoid exciting or stressful mental or physical activities close to bedtime.
  • Don’t watch TV, eat or read in bed.  Use your bed only for sleep and sex. This way your bed will be associated with sleep.
  • Don’t take over the counter medications, including natural herbs and remedies, for sleep without talking to your healthcare provider.

Take a walk in the morning and evening. This can help send signals to your brain that stimulate melatonin production, your body’s own sleep hormone, and promote healthy sleep patterns.

  • Take prescription pain medicines as directed.  Pain keeps you awake and fatigue worsens pain.  You must break the cycle by taking your medicine before your pain becomes too bad.
  • If you take naps, try to do so at the same time every day.  However, sleeping too much during the day can make getting to sleep at bedtime harder.  So, don’t take a late afternoon or early evening nap.  If you find yourself very tired in the afternoon, take a walk, instead of a nap.
  • Take a deep breath and just relax when you go to bed.  Feel your muscles relax.
  • Try relaxation techniques before going to bed. Visit  American Cancer Society website for relaxation techniques ( )
  • Think about a pleasant experience once you’re in bed; repeat it to yourself over and over. Think about positive thoughts following each letter of the alphabet (A is for Amazing, B is for Beautiful …through Z)
  • Don’t stay in bed tossing and turning.  If you can’t go to sleep after 30 minutes get up and take part in a quiet activity until you are relaxed and ready for sleep.
  • Keep a sleep/wake journal/diary if you have tried the above interventions without success.  This may help you identify things that are keeping you awake.

When Do You Need to Seek Help?
Poor sleep can be a sign of other problems such as insomnia, sleep apnea or depression.  If you continue to have sleep problems, or if being sleepy interferes with the way you feel or function during the day, talk to your doctor or nurse.  Bring your sleep diary with you to help them decide the best ways to help you sleep.

Useful websites:
Living Beyond Breast Cancer: Guide to Understanding Insomnia and Fatigue
Sleep disorders and management
American Cancer Society: Fatigue
National Sleep Foundation