Saturday, November 13, 2010

Sleepless in Cancer Land

I didn't realize how sleeplessness is a common side effect of cancer treatment.  After months and months of insomnia, I thought it was just me.  I've always been a "night owl" but this is ridiculous.  In my first two months of treatment, I think my inability to fall asleep at a reasonable hour was from anxiety and worry and over thinking.  When I switched to the twelve weeks of Taxol, and every treatment came with chemo crack (decadron), the insomnia through the whole weekend was drug induced and the worst I've ever had.

It would continue into the next week, and by the time I'd finally start sleeping better, it was chemo Friday again and the whole cycle would start over.

I thought it would gradually go away after finishing the Taxol, but it hasn't.  I think lately it's been a combination of pain management and now my body is used to this pattern.  Most of those nights during chemo I couldn't fall asleep till three or four a.m., wake up at nine or so, up for several hours, then have to nap mid day.  I'd be up again for several hours, then need to nap before dinner.  The whole routine repeated each day.

In the weeks after chemo it felt like it was getting better, but the whole thing started again the night of my surgery, when except for tiny cat naps I was up the whole night and into the next day, not sleeping until we got home late in the afternoon.

By the time I saw The Good Witch yesterday, and after the despondent night I had Thursday, I realize my sleep deprivation had really gotten the best of me and was out of control.

It felt so good to nap yesterday, what felt like a productive nap, and last night I fell asleep just before midnight and did not wake up this morning until 5:30 a.m.  That is really good for me lately.

The Good Witch had mentioned some of the studies regarding this and I found several on the Internet, many of which also reported in breast cancer survivors, dysfunctional sleep patterns continued long after treatment was over because of crashing into menopause.

I found the article below on the Network of Strength (NOS) website, which is where my favorite message board is found.


A significant minority of breast cancer survivors report some level of insomnia because of the stress, treatments, and/or hormonal therapies associated with their cancer. Regardless of mood or the physical symptoms that may be troubling you during and after treatment, Ann Berger, Ph.D., R.N., A.O.C.N., F.A.A.N., wants you to know that you can learn new ways to change your lifestyle that will help you sleep at night.

Berger, Niedfelt associate professor and advanced practice oncology nurse at the University of Nebraska Medical Center, has focused much of her research on sleep disorders. “My primary interest is in trying to modify fatigue in patients as they go through cancer treatments,” says Berger.

While considerable research during the past decade has found that walking 30 minutes a day and maintaining an active lifestyle is associated with lower levels of daytime fatigue, Berger’s focus also includes what happens after the sun goes down. Her thinking has been that consideration of both daytime and nighttime factors would be more beneficial than either alone.

Breast cancer survivors experience more problems with sleep disturbances than survivors of other cancer diagnoses, she says, in part because women are more likely to have insomnia than men. Younger pre-menopausal women, thrust into menopause suddenly because of a particular treatment regimen, are most likely to have difficulty sleeping.

Berger does not recommend that patients first rush to try prescription medications that are designed to help people sleep. “The decision to try these medications should be made with a health care clinician only after carefully weighing the risks and benefits.” Nor does she recommend herbal remedies, which can interfere with chemotherapy. These can also place patients at risk for a negative reaction related to the use of these herbs or their contaminants, she says. Instead, she suggests that learning various lifestyle changes are as effective and longer lasting than medication in helping women fall asleep and stay asleep at night. Berger’s own research has identified many such tips.

For example, don’t make your bed your enemy, she says. If you cannot fall asleep within about 20 minutes, then get up. Find an already designated favorite environment conducive to your falling asleep. Put on a headset with calming music and relax. Once you feel sleepy, go back to bed. Work with your natural biological clock, which regulates your body’s sleep/wake rhythms roughly every 24 hours. By establishing a consistent routine for bedtime and waking up, you will find it easier to fall asleep at night and to avoid daytime sleepiness over time.

Relax in the evening. Enjoy a warm bath or shower. Give yourself a foot massage. “What is very interesting to me is that between about 8 and 10 p.m. every night the biological rhythm cycles (also known as circadian rhythm cycles) within our body start sending out chemical messengers to tell our body that it’s time to get ready to sleep. In our culture, however, we do things to block those chemicals. We answer e-mails, make phone calls that upset us, get on the treadmill, or watch exciting shows on TV.”

Instead of blocking those sleep-inducing chemicals, try to avoid caffeine after noon, she says. Complete physical activity within three hours of bedtime. Create a quiet environment for sleeping with no TV in the bedroom.

“Light is a strong stimulus for waking,” Berger emphasizes, so turn off the TV and the computer, and dim the lights an hour before bedtime. If you like to read in bed, clip a small light to your book, rather than turning on a bright reading light. “Do not sleep with pets.” While people agree to try many of these lifestyle changes, Berger says, they are especially reluctant to give up their pets—but pets wake people up.

“Just try it for a month,” she urges. “Find another place to keep your pets and see if you can get the sleep your body needs.”

More lifestyle interventions are described in a book Berger highly recommends called, A Woman’s Guide to Sleep Disorders, by M. Kryger, past president of the American Academy of Sleep Disorders. The book is published by McGraw-Hill.

Dr. Ann Berger wrote a chapter on sleep for “Nursing Care of Women with Cancer,” ed. K. Hassey Dow, published by Elsevier in 2006.

This article is from an article that first appeared in Lifeline.
Duncle Dody, I thought of you when I read the part about "Don't sleep with pets."  Of course not, unless you're Duncle Dody and the pets are two hot dogs and you have a king size bed for all of you!
I am going to give all the recommendations a try.  I don't want to take a sleeping pill, but know I need to get this sleep thing under control.  It's affecting my usual optimistic and cheerful coping abilities, and I'm sure must be interfering with my healing.
As part of my commitment to get to bed earlier, I need to write my blog earlier too.  It's a challenge though, as my creative juices always flow late at night.  I have never been a morning person, unless it's morning from the other side of midnight!
For most of my life I've been one of those people who "burn the midnight oil" which I don't think is a bad thing in itself, if you are sleeping through the night and sleeping in the next morning.  Even before my diagnosis, I would regularly not go to bed till one a.m., and would wake between seven and eight the next morning.  Even earlier when the boys were little and needed help before school.
I know I have not been getting the sleep I've needed for years now.  It really started when I switched from working a day time office job, to serving nights in a restaurant.  It was a great schedule because I could participate in all of the kids stuff at school, but when you don't get home from work until midnight or later, it takes at least an hour or two to wind down.
Getting more sleep and better sleep is definitely part of the healthy life style changes I've needed to make in my life, more than ever now.
I don't even remember the last time I got eight hours sleep.
I'm shooting for six.   That would be a welcome miracle!
I started my stretching exercises today, and was able to walk my fingers up the wall so that my hand was as high as my fuzzy head. I did this several times, without much discomfort. When I tried to go higher, my inner arm felt so tight, like a rubber band was inside it and stretched as far as it would possibly go. It also hurts to pull on the sutured area under that arm where my lymph nodes were removed. My skin there is still very tight and so is the left breast. My right breast is already starting to soften up and not so leather like.

This evening I've been in more pain and discomfort than usual on my left side, and had to take my pain med right at the four hour mark. I guess from finally stretching out that arm. I took a hot bubble bath and it helped some.

Sleep tight and Nighty night.

1 comment:

Beneath the Eaves said...

I have been away working on my REPLY and had to catch up on your blog. Thanks for all the info on the sleepless nights. Really interesting. I guess it is part of our new normal. Hang in There.

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