Cancer and sleep

To begin with honest full disclosure: I am blessed to be a world-class sleeper. With the exception of the last few months of my first marriage, many years ago, I have never had trouble falling immediately asleep and staying that way all night. I have slept at night through cancers and grief and anxiety about problems, and I am so grateful as I absolutely know that I could not cope if I could not sleep.

Getting through active cancer treatment and recovery requires rest and sleep. Without exception, cancer treatments can be exhausting, and fatigue is inevitably listed as a possible side effect of chemotherapy drugs. Adding many medical appointments to our already busy lives is exhausting, and stress makes fatigue worse.

We are often reminded that people need seven to eight hours sleep each night to stay healthy. We read that these restful hours reduce the risk of heart attacks, strokes, diabetes, and cancer. Since we already have or have had cancer, it is easy to wonder if poor sleep and not enough sleep interfere with optimal functioning of our immune systems. As if we didn't already have enough on our minds, lying awake at 1 AM and worrying that insomnia might make our cancer health worse will certainly make us more worried—and that may keep us more awake.

That is a phrase that I commonly use with patients: You have to sleep. And this not infrequently means using prescription drugs, usually Ativan or Ambien, or other chemical assistance. Many people are enthusiastic about melatonin, and, more recently, I have been hearing positive reports about marijuana-related sleep aids containing CBD or THC. CBD oils (cannabinoids from hemp plants) don't result in the high of the real stuff while THC products do. The marijuana sleep aids can be complicated because the legality varies so much state to state. In Massachusetts, both medicinal and recreational marijuana are now legal, but the systems to buy them are convoluted and inconvenient. Since marijuana is still illegal in many states, users can't travel (at least by plant) with it, and worry about even travel by car. I have several patients who depend on CBD products to sleep and make their vacation plans with crossing state lines in mind. Since marijuana is classified as a Schedule 1, controlled drug, by the FDA, there has not been testing of its efficacy or possible interactions with other medications. Most oncologists are reluctant to recommend its use for this reason and because of the illegal status at the federal level.

We all know the usual recommendations about sleep habits: keep a regular schedule of going to bed and awakening each day, no caffeine after midday, exercise regularly, don't eat too close to bedtime, turn off the electronic devices and screens for at least 30 minutes before bed. We can also drink chamomile tea or warm milk, my Mother's favorite, and listen to music or read a book that won't make it harder to turn off the light. There are recommendations about not staying in bed if you can't sleep; we are advised to get up and move to a chair or couch for a while, then return to bed. Of course a comfortable bed, a bedroom that is not too hot and not too cold, and, if we have a partner in bed, it is much better if s/he does not snore or move around too much. Hot flashes don't help. I often suggest meditation to my patients as a way to quiet our thoughts and still our bodies.

At the end of the day, we hope for a good night's sleep. If that goal is out of reach often, do talk with your doctor and, maybe, consider a referral to a sleep expert. Read about BIDMC's Sleep Disorders Clinic here.