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Cancer
Information
Insomnia
 
 
I can't sleep, doc!

Insomnia is a common problem generally in our community, but it seems to be especially common in people undergoing chemotherapy and other forms of cancer treatment.
The reasons are multiple, and include:


  • Anxiety and stress related to the illness, unknowns about the future, concerns about the side-effects of treatment, relationships with family and friends, issues at work, and financial and business concerns resulting from the unplanned interruptions associated with medical treatment.

  • The direct effects of medications. The main culprit is dexamethasone which is used to prevent nausea and vomiting. Dexamethasone is a corticosteroid. It makes you mildly “high”, causing pressure of speech, a desire to be constantly doing things (clear out the shed, do all the cupboards, paint the kitchen in the middle of the night!), excessive eating and food craving, and insomnia.

  • Altered sleep hygiene. Symptoms such as pain or nausea may have led to broken sleep and a disturbance to normal patterns of sleeping and waking times – a bit like “jet-lag”.

  • Physical symptoms preventing sleep, like pain, nausea or diarrhoea.

  • Lack of physical exercise.




Tips in managing insomnia

  • Don’t panic! No-one has ever died of insomnia! Everyone’s sleep requirements are different and vary considerably from time-to-time and with age. People over 60, for example, need far less sleep than 20-year-olds. It may be quite normal for you only to have 6 hours sleep per night.

  • Go to bed later.

  • Avoid sleeping or dozing off in the daytime.

  • Use bed only for sleeping. Do not read or watch television in bed. If you cannot sleep after 15 minutes or so, get up and sit in another room to watch television, read, listen to music, sew or whatever, and try again one hour later.

  • Exercise. Even a gentle walk each day will help. Preferably this should be first thing in the morning.

  • Avoid stimulants like coffee, tea and cola drinks after about 7 pm at night. All contain caffeine. Other stimulants include nasal decongestant sprays and “cold-and-‘flu” preparations.

  • Keep regular habits, going to bed and rising at approximately the same.

  • Sit quietly in a darkened room for 30-60 minutes before retiring. Listening to gentle music and/or reading, talking quietly on the phone, or playing solitaire, other card games, chess or scrabble are all preferable to watching television.




The use of sedatives
A simple sedative is hot milk with a little brandy or whisky added.
Some find the use of melatonin helpful, and it is safe in patients with cancer and in patients taking chemotherapy. The dose is 3 mg taken as close as possible to midnight. It helps to reset the biological clock which is normally affected by light and darkness.




Sedative-hypnotic medications (“sleeping tablets”)

As a last resort, sedative-hypnotic medications may sometimes be prescribed by your doctor for short periods to help restore the sleep cycle. They should never be used for prolonged periods as they suppress normal “rapid-eye-movement”sleep which is important in refreshing the brain and in the restorative processes of normal memory mechanisms. Regular use also rapidly leads to the development of tolerance: the drugs are then no longer effective. It may also result in rebound insomnia.
All sedative hypnotics have side effects including unsteadyness on the feet, which may produce night-time falls, bad dreams, headaches, memory disturbance, and morning “hang-overs”. Occasionally lowered blood pressure may occur. The sedatives that your doctor may prescribe for short periods include temazepam (“Normison”), lorazepam (“Ativan”), oxazepam (“Serepax”) and zolpidem (“Stilnox”).
Sedative-hypnotics should never be taken within 12 hours before using machinery or driving. They must always be used strictly on your doctors instructions, and never with alcohol, which may significantly potentiate their activity and could lead to respiratory suppression and coma. NEVER TAKE A FRIEND’S OR RELATIVE’S SLEEPING TABLETS. There may be important interactions with your other medications, particularly those used for pain control and the control of nausea.




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