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Difficulty Sleeping (Insomnia)

Insomnia refers to the experience of having difficulty falling or staying asleep, and as a result being unable to obtain adequate sleep over a prolonged period of time. This can lead to fatigue, irritability and inability to concentrate and carry out activities during the day. Many people with serious illnesses like cancer experience insomnia. If left untreated, insomnia can aggravate other cancer and treatment-related conditions (e.g. pain, fatigue), and cause increased difficulty in coping with cancer. It is therefore important to seek treatment promptly if you develop insomnia.

  

What you need to look out for

  • Difficulty falling asleep
  • Difficulty staying asleep
  • Waking up too early and unable to get back to sleep

  

Causes of Insomnia

  • Physical discomfort or uncontrolled symptoms
  • Medications or foods (e.g. corticosteroids, caffeine beverages)
  • Excessive day time sleeping (e.g. due to cancer or treatment related fatigue) leading to difficulty in falling or staying asleep at night
  • Psychological problems (e.g. anxiety, depression)
  • Stress or worrying (e.g. health, finances, work or family)
  • Other medical conditions affecting sleep (e.g. restless legs syndrome, urinary problems, hyperthyroidism, sleep apnoea)
  • Poor sleep habits (e.g. excessive media consumption, late night strenuous exercise)

  

How it can be treated

The treatment for insomnia depends on its cause. Your doctor will ask you more questions and do a physical examination, to identify the reason and decide on the treatment for your insomnia. For instance, if uncontrolled pain is keeping you up at night, your doctor will manage the pain to allow you to sleep better. If stresses like finances or work are the cause of your insomnia, your doctor may refer you to the medical social worker or counsellor who can assist you to cope better with these issues. You may also be advised on lifestyle modifications (see “What you can do” below) to promote a more regular sleep pattern.

If your insomnia persists despite treating the cause, your doctor may prescribe medications to help you sleep better (e.g. lorazepam, diazepam, zolpidem). You should use these medications only at the advice of your healthcare provider, as inappropriate use can lead to undesirable side effects.

  

What you can do

Here are some tips to help you cope better with insomnia:

  • ​Take your medications as prescribed
  • A sleep diary to keep track of the times you are asleep/ awake, and things that may have led to your insomnia may be useful if you are unsure of what causes it
  • Go to sleep and wake up at the same time each day so that your body’s internal clock can settle into a regular sleep-wake cycle
  • Keep your room dark when you sleep
  • Use the bed only for sleeping and not when doing other activities (e.g. watching television, playing electronic games or reading)
  • Light exercises during the day can help to relieve stress and improve sleep
  • Engage in activities that is stress-relieving for you (e.g. meditation, listening to relaxing music, singing, cooking etc.)
  • ​Avoid taking naps for more than 1 hour
  • Avoid eating or exercising within 2 hours of bedtime
  • Avoid or reduce late night use of screen devices e.g. phones, tablets, televisions
  • Avoid or reduce engaging in serious or stressful conversations e.g. health, family, work, finances, late at night
  • Reduce your caffeine intake, and avoid caffeine in the evening
  • If you are on corticosteroids, try to avoid taking it in the evening. Discuss with your doctor or nurse on changing the timing that you take the corticosteroids, if it is causing insomnia


When to call your cancer care team

Please inform your doctor or nurse if you are feeling very distressed from being unable to sleep, your insomnia persists despite treatment, or if you experience any side effects from the medications prescribed to help with your sleep.

If you have any questions regarding the above information, please call the Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

The above contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers.