How Cancer Survivors, Patients Can Better Optimize Sleep

Sleep disorders, such as insomnia, are approximately twice as likely to occur in cancer survivors than the general population.

However, survivors and patients with cancer can take certain steps to improve their quality of sleep, explained Natalie Solomon.

Solomon, who is a clinical assistant professor in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine in California, gave an overview of how survivors can optimize sleep during the 13th Annual Joining Forces Against Hereditary Cancer Conference.

‘Don’t Chase Sleepiness’

She related sleep effort to a child’s finger trap toy, where the user puts their fingers in each end of the tube.

“The harder you pull, the more stuck you are …. The way to actually get out of one of those things is to stop trying,” Solomon said. “Sleep is a bit like that — the harder we try to force ourselves to sleep, the harder sleep becomes. So one of the keys to falling asleep is to actually stop trying …. Don’t chase sleepiness. Rather, wait for sleepiness to come find you.

In practice, waiting for sleepiness can mean not getting into bed too early, or getting out of bed and doing something else if someone wakes in the middle of the night and has difficulty falling back to sleep.

Solomon mentioned that patients on active cancer treatment may find it more difficult to fall asleep on the days they get their therapy — especially if their regimen involves steroids, which could be activating.

“My recommendation is that for those nights, (don’t) try to force sleep, but rather rest,” she said. “You can pass the time as you would on a long flight; rather than make yourself sleep, you can actually do things that are restful, knowing that sleepiness will reset, but it might not be present that night.”

Survivors should also wait until they are sleepy (which is different than being tired) before going to bed, according to Solomon.

“Sleepiness is that feeling of your eyes getting heavy and you feel like if you lay down, it’s likely that you would drift off to sleep,” Solomon said.

Use the Bed for the 3 S’s

If someone is in bed struggling to sleep, they may start to feel frustrated or desperate, and when this happens multiple times, they may start to associate the bed with negative feelings — something Solomon called “conditioned arousal.”

“Over time, the bed becomes associated with, and can even cue feelings of, frustration, panic or distress,” Solomon said. “We really want to protect our relationship with our beds.”

To do that, Solomon recommends only using the bed for the three S’s: sleep, sickness and sexual activity.

Solomon also recommended implementing a “wind down time” to transition from the daytime to nighttime. This can include taking a shower, reading or watching a relaxing television show.

Cancer survivors can also schedule “worry time,” as Solomon said that thoughts can oftentimes become more catastrophic at night.

“The recommendation here is actually to give your worries a little bit of your attention during the day, it could be talking to a friend or provider or journaling,” Solomon said. “One of the things I recommend is writing down your top three worries for the day … when that worry shows up a night, remind yourself that this isn’t the best thinking time anyway … thoughts are more catastrophic at night, so think about this tomorrow in the clear light of day.”

Avoid the Clock

Whether sleeping or resting, Solomon said that survivors should avoid looking at the clock, as that, itself, could be very activating.

“I’m sure many of us, myself included, have had the experience of seeing the time, and starting to do some math: how long have I been awake? How long have I been asleep? How long until my alarm goes off?” Solomon said. “We really want to try to protect our curious minds and rather think in terms of, ‘this window is protected for resting, whether I’m awake or asleep.’”

Even after a difficult night’s sleep, survivors should set their alarms to the same time every day.

“Even if you miss some sleep in the short-term (perhaps you would have been able to sleep more), it actually keeps the signal for your circadian clock. If your circadian clock is really strong, it makes it more likely that you can get good sleep in the future,” Solomon said.

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