Discussion – 


Difficulty Sleeping and What You Can Do About It

It can be hard to get enough restful sleep when you’re living with cancer. From the emotional toll, cancer can take to sleep-interfering side effects of treatment, many people with cancer find that getting much-needed rest isn’t always easy. The tips below will help you better understand the range of sleep-wake difficulties and how cancer contributes and suggest some easy-to-implement solutions that can help you get more soothing sleep.

What is sleep-wake difficulties? 

Although people sometimes refer to a range of sleep problems as insomnia, insomnia is a specific type of sleep difficulty characterized by difficulty falling asleep, staying asleep, or getting enough restful sleep despite the adequate opportunity. To be diagnosed with insomnia, the sleep difficulty must cause daytime fatigue and happen at least 3 times a week for three months. While some people coping with cancer may meet the criteria for insomnia, many have more short-term sleep difficulties. In addition, some people coping with cancer have other specific sleep difficulties like sleep apnea, REM sleep disorder, or circadian rhythm disturbances which often require help from a sleep specialist.

What causes sleep difficulties? 

Sleep trouble is a common experience when coping with cancer. Common causes of sleep difficulties in people with cancer include:

  • Mental health problems and emotional distress (like anxiety, depression, worries, and fears)
  • Short-term, or transient sleep, interferences (which commonly happen during a hospital stay, or when medical devices or nighttime medications are needed)
  • Side effects of treatment (like pain and nausea)
  • Medications that cause daytime drowsiness and therefore difficulties with night-time sleeping
  • Some cancer treatments
  • Stimulant medications that cause alertness
  • History of sleep disorders

Why is addressing sleep difficulties important? 

Getting adequate sleep is important for both your physical and emotional health. Poor sleep can be detrimental to anyone’s overall well-being — and this is especially true for people who are living with cancer. Lack of sleep can cause a wide range of emotional and physical complications for people with cancer, including:

  • Cognitive impairments: trouble concentrating, difficulty with memory, delayed response time, and/ or greater likelihood of making errors at work and at home
  • Mood disturbances: increased anxiety or depression, irritability, low energy, and/ or decreased sex drive
  • Daytime sleepiness: drowsiness that feels out of your control and that could be powerful enough to cause you to fall asleep in dangerous situations, like while driving a vehicle.
  • Decreased quality of life: quality of life concerns when sleep quality is affected over a long period of time
  • Weakened immune system: lack of sleep over time can make you more likely to catch common viruses and makes your body less capable of fighting them off
  • Decreased heart health: short sleep duration for prolonged periods has been associated with heart problems like hypertension and high cholesterol

What to do 

There are many things you can do to improve your sleep. Here are a few strategies. You can try several of them and see what works for you.

Track your sleep to further understand your patterns 

A sleep diary is a place to record various important details each morning about your sleep the night before. Creating and maintaining a sleep diary can help you (and your doctor or therapist) understand what thoughts and behaviors may be interfering with your ability to fall or stay asleep.

To create a sleep diary, record the following every morning for one week:

  • Time you fell asleep
  • Time you woke up
  • Approximate time it took to fall asleep once you were in bed
  • Any medications or supplements taken before bed
  • Any stressful or recurring thoughts
  • What you did right before bed
  • If and how often you woke up in the middle of the night
  • How rested you felt in the morning (you can measure this on a scale of 1-10, with 10 being fully rested)

While it may seem impossible, sleep experts recommend you stop clock watching. When recording in your sleep diary, document approximate times based on your best guess. Clock watching contributes to sleep difficulties. Your diary can help you understand the details of your sleep difficulties and where you may want to intervene.

Practice good sleep hygiene 

Having good sleep hygiene means having an environment and daily routine that promotes restful sleep at night. Consider some of the options below to improve your sleep hygiene:

  • Get regular exercise (if approved by your doctor) with a goal of 20 minutes a day
  • Set a routine that includes a consistent wind-down process (like a warm bath followed by reading for 15-30 minutes), as well as a set bedtime and waketime. Routines can help your body create sleep patterns and rhythms according to the cadence you set for yourself.
  • Limit caffeine beyond 250mcg per day and only consume caffeine before noon
  • Limit eating and exercise beginning 2 hours before your established bedtime
  • Limit naps and dozing during the day and evening

To promote better sleep hygiene in your bedroom environment, try to:

  • Minimize nighttime disturbances (like electronics)
  • Make your bedroom as dark and quiet as possible (consider a white noise machine or a fan)
  • Avoid clock watching
  • Reserve the bedroom for only sleep and sexual activity

Explore Cognitive Behavioral Therapy (CBT) 

Cognitive Behavioral Therapy (CBT) targets behaviors and thoughts that may be contributing to your sleep difficulties. CBT for insomnia (CBT-I) is specifically for diagnosed insomnia and has been found to increase total sleep time, sleep quality, and quality of life for people coping with cancer. It requires careful analysis of a sleep diary, attention to sleep behaviors, and thoughts related to not getting enough sleep. It is most successful if done under the guidance of a sleep expert, but some of its components can be taught by an Iris mental health therapist — schedule an online visit below for additional support.


In some cases of insomnia, you might consider taking certain medications and supplements that are intended to promote restful sleep. Before adding any medication or supplement to your daily routine, discuss options with your doctor. Some of these medications can be very helpful but also have their potential side effects.

You may also be currently taking medication that affects your sleep. For example, steroid medications often taken by cancer patients are a common cause of sleep disturbances. Discuss your medications with your doctor to see how best to take them to minimize their impact on your sleep. In some cases, changing the time of day when you take your medications can help reduce their negative impact on sleep.


Copyright © 2023 OncoHealth. All rights reserved. All materials on these pages are the property of OncoHealth. The information and other content on this website are for information purposes only. If you have any questions about your diagnosis or treatment, please seek the advice of your physician or other qualified health care provider(s).

Reviewed by the Iris Clinical Editorial Board
This article meets Iris standards for medical accuracy. It has been fact-checked by the Iris Clinical Editorial Board, our team of oncology experts who ensure that the content is evidence based and up to date. The Iris Clinical Editorial Board includes board-certified oncologists and pharmacists, psychologists, advanced practice providers, licensed clinical social workers, oncology-certified nurses, and dietitians.


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