Many people have trouble falling and staying asleep from time to time, but insomnia is more than just occasional difficulty sleeping. It’s a sleep disorder that can affect your mood, cause fatigue, and drain your energy.

Breast cancer and its treatments can be challenging enough, and insomnia related to your treatments 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 as you go through breast cancer treatment. Read on to explore how insomnia affects people with breast cancer, causes of sleep difficulties, and how to manage it.

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How Breast Cancer Treatment Causes Insomnia

Many different treatments for breast cancer can contribute to insomnia. Chemotherapy, hormone therapy, radiation, and surgery for breast cancer can all cause sleep problems.

Chemotherapy

Sometimes, chemotherapy side effects can include insomnia. Sleep studies have shown that people undergoing chemotherapy for breast cancer often sleep lighter and experience less deep or rapid eye movement (REM) sleep.

Certain chemotherapy drugs can make it difficult to fall or stay asleep. When insomnia is a side effect of chemotherapy, it’s often because fatigue from the chemo makes you want to take naps during the day. This then makes it harder to fall asleep at bedtime.

Endocrine Therapy

Insomnia may also be a side effect of hormone therapy for breast cancer, also called endocrine therapy. These treatments interfere with your body’s production of the hormones estrogen and progesterone.

When these hormones fluctuate abnormally, sleep disturbances can result. While just 20 percent of the general population has sleep problems, up to 60 percent of people undergoing endocrine therapy for breast cancer do. You may also have symptoms associated with menopause, including hot flashes and night sweats, which can contribute to trouble sleeping.

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

Members have discussed other endocrine therapies that have caused difficulty sleeping. One shared that they have “been up since 4 a.m. — tamoxifen insomnia.” Another member said, “I finished Herceptin at the end of January, but insomnia is still going on.”

Radiation Therapy

“Does anyone have trouble sleeping after radiation?” asked a MyBCTeam member. “I have not been able to sleep well at all.” Another member answered, “I have not been able to sleep since I started radiation. Thought maybe it was just me. I feel like I am in a haze.”

Insomnia may not be as common a side effect of radiation as it is for chemotherapy or hormone therapies, but it can happen. Like chemotherapy, radiation therapy can make you very tired. This tiredness can lead to daytime napping, which might interfere with your ability to get a good night’s sleep.

Breast Cancer Surgery

After breast cancer surgery, you might have trouble sleeping because of pain or discomfort. Pain medications prescribed after a mastectomy, including opioids, may also contribute to sleep issues in some people, despite helping others with sleep after surgery.

How Insomnia Connects to Fatigue, Pain, and Mood

Sleep problems often come with other problems related to breast cancer treatment.

Stress and Mood Changes

The emotional effects of going through breast cancer treatment can affect your physical health as well as your psychological well-being. Understanding different treatment options and all the choices you need to make can be overwhelming and anxiety-inducing. These concerns can contribute to poor sleep quality.

As one MyBCTeam member said, “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. I think about cancer every single day — been through cancer twice already.”

Pain

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

Poor sleep can also contribute to the pain you experience from breast cancer or cancer treatments. Studies show that people who experience insomnia or other sleep disturbances have worse pain outcomes after breast cancer surgery.

Fatigue

Fatigue from treatments like radiation and chemotherapy can lead to more trouble sleeping at night. Like pain, fatigue and insomnia can become a cycle.

Fatigue during the day makes it hard to sleep at night, and insomnia at night leads to more fatigue during the day. These effects can continue long after you complete breast cancer treatment.

Evidence-Based Treatments for Breast Cancer-Related Insomnia

Many MyBCTeam members have shared how they’ve been handling insomnia and breast cancer. Here are their tips, along with suggestions from researchers. Be sure to ask your healthcare team for their advice before trying any treatment or remedy, including over-the-counter medications or supplements.

Cognitive Behavioral Therapy for Insomnia

Evidence suggests that cognitive-behavioral therapy (CBT) may be an effective intervention for insomnia in breast cancer. CBT for insomnia, or CBT-I, combines more traditional behavioral therapy with mindful sleep hygiene practices to help you get a better night’s sleep.

CBT-I is currently considered the gold-standard treatment for insomnia in both young and older adults, including those undergoing breast cancer treatment. In many cases, CBT-I is as effective as sleep medications (but without the side effects), and its effects can outlast your time in therapy.

Sleep Hygiene

Sticking to habits that help you get better sleep (known as sleep hygiene) can help anyone combating insomnia. Sleep hygiene is a key part of CBT-I, but you can also adopt sleep hygiene habits on your own.

Helpful tips for sleep hygiene include:

• Use your bed for sleep and sex only.
• Keep the room where you sleep quiet, cool, and dark.
• Stick to a strict bedtime and wake-up time whenever possible.
• Avoid stimulation before bedtime, especially from cell phone or tablet screens.
• Limit caffeine and alcohol, especially before bed.
• Don’t drink too much water or other liquids right before sleeping to avoid having 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.

One MyBCTeam member recommends 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.

Medications and Sleep Aids

Some members find that prescription sleep aids are helpful for their insomnia, especially if other strategies haven’t improved sleep. “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.”

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

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.

One member shared, “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.”

Talk to Your Doctor About Sleep Problems

Let your doctor know if you have trouble falling asleep at night or staying asleep throughout the night. They may have some ideas to help you relax or otherwise address the underlying cause.

Your oncologist may also prescribe sleep medications or recommend an over-the-counter sleep aid. If there’s a certain pain medicine or cancer treatment that’s causing your sleep problems, your doctor may be able to adjust your plan.

When you see your healthcare provider, be 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 with experience in oncology psychology. Be sure to follow up with any questions you have at your appointments. Your quality of life matters, and your healthcare team is there for you.