What causes insomnia?

Poor sleep following a cancer diagnosis can be attributed to more than just the obvious cause of anxiety, worry and stress. Poor sleep can be a result of the treatment itself, such as steroids or hormone therapy or pain and discomfort following surgery.

Sleeping poorly can also have knock on effects – feeling tired all the time, worsening of fatigue, feeling too tired to manage everyday tasks or leave the house, not looking after yourself well, being irritable, increased sensitivity to pain and other symptoms, difficulty with relationships, poor concentration and many more.

Sometimes poor sleep becomes a habit even after the original root cause has been resolved or stopped. Here are some practical steps you can take to break the poor sleep habit.  

• Avoid napping during the day, or if you do keep it to no more than 45 minutes.
• Avoid alcohol late at night. It may help you fall sleep initially but it will disrupt your sleep later on in the night.
• Avoid smoking late at night. Nicotine is a stimulant, people who smoke take longer to fall asleep, wake up more frequently, and often have more disrupted sleep.
• Avoid meals with a lot of refined carbohydrates which give sugar ‘highs’ and ‘lows’ especially late in the evening.
• Experiment with your caffeine intake, you may need to stop drinking caffeinated drinks in the evenings, from late afternoon, or cut them out altogether. For some people caffeine stays in their bloodstream for several hours. Remember caffeine is present in most fizzy drinks and in chocolate.
• Avoid exercising at night. Moderate exercise on a regular basis, such as swimming or walking, can help relieve some of the tension built up over the day. Tai chi and yoga may be helpful in the early evening. But make sure you don’t do vigorous exercise, such as running or the gym, too close to bedtime, as it may keep you awake.
• Avoid going to bed until you are feeling sleepy.
• Try to go to bed and wake up at the same time every day to help your body’s circadian rhythm.
• Make sure your sleeping environment is comfortable (not too hot or too cold and not too noisy or bright).
• Invest what you can in comfortable bedding. Is your mattress too soft or too hard, do you need an extra blanket for when the temperature drops, do you need extra pillows?
• Ensure darkness and switch off any electronic devices with screens or flashing lights (such as chargers).
• Build in a relaxing routine before bed. Have a bath, read a book or listen to relaxing music.
• Use aromatherapy oils such as Lavendar or Ylang Ylang, you can sprinkle these on your pillow, in your bath or use an aromatherapy diffuser. Check for sensitivity before adding to your bath or furnishings.
• Only use your bedroom for sleep.
• If you’re still wide awake after 20 minutes, get up and do something relaxing such as reading a few pages in a book. Try again when you’re feeling drowsy.
• Get any thoughts about tomorrow out of your head by writing them down. To do lists, reminders, text messages about errands can all be picked up in the morning rather than running around in your head.
• Drink a cup of herbal tea. There are several herbal teas such as chamomile, sleep-easy, night-time, which may be helpful. Herbal teas are usually too dilute to cause any serious drug interactions, but be careful if you are drinking them regularly or in a potent brew and check with a healthcare professional. Green and white tea contain caffeine so limit/avoid these.

If you’ve tried all these without success, there are a number of complementary therapies that people sometimes find helpful. There is very little reliable consistent research data available to help people make evidence-based decisions, and insomnia is a very individual thing with different approaches helping different people.

It is generally advisable to weigh up the risks and benefits of any complementary approach you are considering (including the cost, the potential side effects and how quickly you might expect to see benefits) and give anything that seems to weigh up positively for you a try.  Bear in mind that insomnia is not something that usually has an overnight solution and may take weeks or even months to gradually improve.

A few more tips to combat insomnia

Relaxation techniques
If practised regularly during the day, these can be very useful if used again at bed-time or if you wake during the night. Try listening to a relaxing CD (e.g. music or guided relaxation, meditation, mindfulness or imagery) or MP3 using headphones before going to sleep or if you wake at night and can’t get back to sleep. Be prepared to try a few to work out what suits you. The Penny Brohn shop has several CDs and resources to get you started. 

CBT (Cognitive Behavioural Therapy)
Many forms of CBT which help reframe thoughts and behaviours around sleep have been shown to be useful. An online resource Sleepio designed by Professor Colin Espie in Scotland, can provide supported CBT via web and email over several weeks for a weekly subscription and anecdotally has achieved impressive results. 

Homeopathy
Homeopathic remedies like coffea and passiflora are safe to take with other medication. They are cheaply available without a prescription from large chemists or specialised homeopathic pharmacies. Ideally, homeopathic remedies should be matched to your individual detailed symptoms so other remedies may be helpful (there are various books you can consult to match your symptoms to the remedies) and you may get better results after consulting a homoeopath who will take a full history and individualise your choice of remedy. 

Herbal remedies
Herbal remedies (tinctures or tablets) have more evidence to support them, but may cause problems with interactions if you are taking any other medication. Chamomile, Valerian and Hops may be worth considering. Always consult your GP to find out about the safety of taking herbs in your situation. The National Institute of Medical Herbalists has a useful information line. 

Melatonin
Melatonin is a chemical we make in our brains which regulates our sleep/wake cycle. For some types of insomnia, doctors (still mainly specialists rather than GPs) can now prescribe this on the NHS and in the US it is widely available over the counter and has a very good safety record. As with herbal supplements, there is a risk of interaction with other medicines and products, and as melatonin is powerful anti-oxidant it may interfere during radiotherapy and some forms of chemotherapy. 

Complementary Therapies
Complementary therapies like acupuncture, homeopathic consultations, reflexology, shiatsu, healing and massage can also be very supportive and it may be worth finding an experienced and well-regarded practitioner in your area and trying 3-4 sessions of something you feel interested in.

It is important to remember that sleep problems are usually caused or made worse by several things, so having a plan which involves changes in several areas (e.g. physical activity, diet, breathing and relaxation, CBT and complementary therapies,) may have the best chance of success.

If none of the above is improving your sleep, then go to your GP as maybe there is an underlying problem (for example depression or a hormonal problem) that needs addressing before your sleep problems can improve.

You can also find further information about insomnia on the NHS Choices website.

Article by Dr Catherine Zollman