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Insomnia and Breast Cancer

Updated on November 15, 2021
Medically reviewed by
Mark Levin, M.D.
Article written by
J. Christy McKibben, LPN

Most people occasionally have trouble sleeping. Too much caffeine or alcohol, heartburn, or just everyday stress can make it difficult to fall and stay asleep. Insomnia is more than just occasional difficulty sleeping, though — it is a sleep disorder that can affect your mood, cause fatigue, and drain your energy.

Breast cancer is challenging enough, and insomnia can feel like its own problem entirely. As one MyBCTeam member shared, “I have been somewhat incapacitated by chronic insomnia. I know that sounds small compared to what we have gone through with cancer, but believe me, it has made me unable to function.”

Luckily, you don’t have to accept insomnia as part of life with breast cancer. You and your health care team can work together to help you get a better night’s sleep. Here, we will explore how insomnia affects people with breast cancer, including what causes difficulties sleeping and how insomnia can be managed.

What Causes Insomnia in Breast Cancer?

Many different aspects of breast cancer can contribute to insomnia.

Diagnosis-Related Stress

The emotional effects of being diagnosed with breast cancer can affect psychological well-being and physical health. A breast cancer diagnosis may bring about tension, stress, fear of the unknown, depression, anxiety, and fatigue.

There’s also the stress of breast cancer treatment. Deciding between different treatment options and all of the choices you need to make can be overwhelming and anxiety-inducing. These concerns can lead to poor sleep quality.

As one MyBCTeam member wrote, “I’m on sleeping pills, but I still can’t seem to sleep when I go to bed. I lay awake till about 4 a.m. Even though I put on a front for my husband and family, I worry every day. My anxiety is high. I think about cancer every single day — been through cancer twice already.”

Another member shared, “I had insomnia and I was STRESSED, which, in turn, made my insomnia worse.”

Cancer Medications

Many different medications used to treat breast cancer can contribute to insomnia. Pain medications, hormonal therapies, stimulants, targeted therapy, and chemotherapy can all cause sleep problems as a side effect.

Several members have shared that the hormonal therapy Arimidex (anastrozole) has caused insomnia. One member shared that they had “been taking Arimidex in the evening and is now starting to have insomnia.” Another member said, “I’ve been on Arimidex for almost two years. I take mine in the morning and still have some insomnia.”

Members have discussed the other medications that have caused difficulty sleeping. One shared that they had “been up since 4 a.m. — tamoxifen insomnia.” Another member wrote, “I finished Herceptin at the end of January, but insomnia is still going on. I guess I shouldn’t be impatient,” they added, “since we are on it for a year. May take a while to get squared away!”

Pain

Cancer pain as well as discomfort from treatment, such as nausea, can lead to trouble sleeping. As one member said: “Pain. Definitely a sleep killer.”

Hot Flashes

Breast cancer can cause hot flashes — intense flushing and sweating. These episodes can cause you to wake up suddenly with severe night sweats.

Sleep Disorders

A sleep disorder unrelated to breast cancer may be causing your insomnia.

Restless Legs Syndrome

One potential disorder that can cause insomnia is restless legs syndrome (RLS). This condition can cause substantial sleep disruptions and can keep you up late or all night. RLS causes you to move your legs when trying to sleep or rest. Your legs may feel irritated or itchy and might cause jerking motions, keeping you awake. RLS usually occurs in the evening.

Sleep Apnea

Another disorder is sleep apnea or obstructive sleep apnea. Although not necessarily directly related to cancer, sleep apnea occurs when your breathing pauses during sleep, potentially lasting up to 10 seconds. This condition may be mild to serious depending on how often these episodes of interrupted breathing occur.

Many people with sleep apnea snore. Along with causing changes in breathing patterns, snoring can wake you up during the night. Interruptions in your sleep will usually cause sleepiness and tiredness during the daytime, and you may frequently fall asleep during the day or experience involuntary naps. Sleep apnea can lead to several serious health problems, so speak with your doctor about getting tested if you or a partner notice that you’re waking up with interrupted breathing.

Managing Insomnia and Breast Cancer

Many MyBCTeam members have shared how they handle insomnia and breast cancer. Here are their tips, along with experts’ suggestions. Be sure to talk to your health care team for their advice before trying any treatment or remedy, including over-the-counter medications or supplements.

Practice Good Sleep Hygiene

Follow a set sleep routine to fight insomnia. Sticking to habits that help you get better sleep (known as sleep hygiene) can help combat insomnia.

Sleep protocols suggested to help those living with cancer fight insomnia include:

  • Restrict bed use to sleep and sex only.
  • Keep the room quiet, cool, and dark.
  • Stick to a rigid bedtime and wake time whenever possible.
  • Avoid stimulation before bedtime, especially cell phone screens.
  • Limit caffeine and alcohol consumption, especially before bed.
  • Don’t drink too much water or other liquids right before sleeping so that you don’t have to get up to use the bathroom.
  • Don’t smoke (nicotine is a stimulant).
  • Try not to nap, or avoid napping for more than one hour a day, especially after 3 p.m.
  • Cognitive behavioral therapy (CBT) before going to sleep can help. Meditation can also help you fall asleep.

One member advised making yourself as comfortable as possible when in bed: “I have a wedge pillow that helped me get through recovery. It allowed me to get semi-comfortable and get some sleep.” Other members suggest using silicone earplugs if your bedroom isn’t quiet enough for you to sleep.

Keep a Sleep Log

Recording your sleep symptoms in a log or diary alongside your breast cancer symptoms or treatment side effects, can often help you and your health care team uncover patterns of your insomnia.

Get Up

Some people find that sleep restriction helps them ultimately combat insomnia. As one member recommended, “If you can’t sleep, get out of bed. Staying in bed creates more anxiety. Sit on the couch and read a book (but not your computer). Do something else. In a few days of just tiring yourself out, your body will naturally reset.”

Stay Positive and Relieve Stress

Many members have advised taking steps to alleviate stress — especially worry about insomnia itself. Some of their tips include:

  • Relax before bed. Take a shower or warm bath, or put on calming music or sounds.
  • Get a massage from your partner or a family member.
  • Try some complementary therapies, such as guided imagery, deep breathing, and muscle relaxation exercises.
  • Practice mindfulness meditation (also known as mindfulness-based stress reduction).
  • Hide your clocks so you don’t look to see what time it is and how many hours of sleep you can get if you fall asleep soon.

Another member wrote, “It’s all about your day. Even when tired, try to pamper yourself and do meaningful things to stop the anxiety before bed, or you can become fixated on sleep.”

Take Prescription Sleep Aids

Some members find that prescription sleep aids are helpful for their insomnia. “I suffer insomnia badly at times,” wrote one member. “My doc used to give me temazepam short-term, and it helped get me back in a cycle.” Another said, “My doctor first gave me trazodone, and that didn’t do anything for my insomnia. The Ambien works wonders!”

Other medications may help with insomnia, too, so speak with your doctor about your options if you think medication is the right choice for you.

Do Cognitive Behavioral Therapy

There have been findings from some clinical trials supporting cognitive behavioral therapy as an intervention for insomnia in breast cancer. CBT is a type of psychotherapy and is an effective treatment for anxiety disorders, as well as insomnia itself.

Eat Sleep-Promoting Foods

Some foods and drinks may help you get ready for sleep. Members have recommended eating foods high in natural sleep promoters — such as tryptophan (turkey), melatonin (tart cherry juice), and magnesium (greens and whole grains) — to help induce sleepiness before bed. They have also recommended teas and tinctures that contain calming herbs, such as ashwagandha and valerian root, both of which are often used to reduce the side effects of cancer drugs.

Try Alternative Therapies

MyBCTeam members have shared many different medications, vitamins, supplements, and alternative approaches to help alleviate insomnia. Their recommendations include:

  • Antihistamines (such as Benadryl)
  • Acupuncture
  • Melatonin — Many members of MyBCTeam have benefited from this natural sleep aid. One member shared, “The only thing that ensures me a good night’s sleep is melatonin and a muscle relaxer.”
  • Cannabis or CBD (cannabidiol) oil — “Cannabis is the only thing that allows me to sleep since being diagnosed and going through chemo,” said one member. “CBD oil brought me sleep and peace,” agreed another.

Exercise

Mild to moderate exercise may help improve your mood and relieve stress. Yoga, tai chi, and aerobic exercises can be particularly stress-relieving. Try to do some physical activity, such as a 20-minute walk. It’s best to exercise more than five hours before bedtime so it doesn’t keep you up.

As one member wrote, “I try not to take naps and to do some activity. Exercise or cleaning the house — whatever uses energy. The more tired (not exhausted, that’s bad), the better I sleep.”

Find What Works for You

In many cases, a combination of approaches will help with overcoming insomnia: “On the advice of some other survivors,” shared one member, “I took a Benadryl and drank Sleepy Time tea last night to help with my insomnia. I also sprayed some lavender oil mist in my bed. Something worked.”

Another member shared their combination approach: “I use Benadryl and gabapentin,” they said. “Then, I drink a warm cup of matcha tea and try to meditate. They teach you to try and stay awake while you meditate, but it always puts me to sleep if I am doing it right.”

Another member concluded: “Bottom line, it depends on a lot of factors. Treat the mind and body — sleep should follow.”

Speak With Your Doctor

Let your doctor know if you have trouble with sleep. They may have some ideas to help you relax or otherwise address the underlying cause. The doctor may also prescribe sleep medications or recommend an over-the-counter sleep aid. If there’s a certain pain medicine that’s causing sleep problems, your doctor may be able to change that medication and find another.

When you go to your doctor, be sure you’re prepared. Write down any questions you have about your symptoms and insomnia. Keeping a journal is extremely helpful at your appointment.

Your doctor may refer you to other specialists, including a psychologist or psychiatrist, therapist, or a doctor in psycho-oncology. Be sure to follow up with any questions you have at every appointment you attend. Your quality of life matters, and your health care team is there for you.

Find Your Team

MyBCTeam is the social network for people with breast cancer. More than 54,000 members who understand life with breast cancer come together to share support, advice, and stories from their daily lives.

What treatments have you tried for your breast cancer-related insomnia? Share your experiences and thoughts in the comments below or by posting on MyBCTeam.

Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
J. Christy McKibben, LPN is a freelance writer and licensed practical nurse in North Carolina. Learn more about her here.

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