Insomnia During Cancer: How to Sleep Better

Dr. Boris Wydoff

Insomnia during cancer can develop even before treatment begins or appear during chemotherapy. If you cannot fall asleep at night, try not to make your anxiety worse or force yourself to lie in bed for hours. Find out what is interfering with your rest, tell your oncologist, and gradually establish a calming evening routine. There are several ways to support better sleep without interfering with your prescribed treatment.

Can cancer cause insomnia?

Yes, sleep problems often accompany cancer and its treatment. Some people have trouble falling asleep, while others wake up during the night and cannot get back to sleep. Sometimes a person sleeps for several hours but wakes up feeling exhausted, as though they have not rested at all.

Insomnia during cancer does not, by itself, indicate whether the disease is progressing or improving. Sleep quality is affected by emotional well-being, physical discomfort, medication side effects, and changes to daily routines. Sometimes several factors contribute at the same time.

Some people already have sleep problems before receiving their diagnosis. After treatment begins, these problems may become more noticeable because of anxiety, changes in how they feel, and regular visits to medical facilities. That is why it is important to consider not only nighttime awakenings but also the circumstances in which they occur.

Sleep problems should not be dismissed as something minor. Restful sleep is essential for maintaining energy, emotional balance, and everyday activity. When someone does not get enough sleep for a long time, it can become harder to concentrate, manage familiar tasks, and cope with emotional stress. Lack of sleep can also make anxiety and low mood worse.

Why is insomnia more common during cancer?

There can be many different reasons. Sometimes a person who used to sleep well starts waking up because of anxious thoughts after receiving a diagnosis. They worry about their loved ones, the future, test results, and upcoming procedures. Even severe tiredness does not always make it easier to fall asleep when thoughts keep returning to the illness.

Physical factors also come into play during treatment. Doctors identify several common causes:

• Pain and discomfort. If pain gets worse at night, it can be difficult to find a comfortable position and sleep peacefully.
• Treatment side effects. Some anticancer drugs and other medications can change a person's usual sleep patterns.
• Urinary problems. Frequent urges to urinate may force someone to get up several times during the night, interrupting their rest.
• Diarrhea. Frequent trips to the bathroom can prevent uninterrupted nighttime sleep.
• Hospital stays. An unfamiliar environment, noise, lighting, and medical procedures can disrupt familiar routines.
• Emotional stress. Fear of treatment and waiting for test results can keep anxiety going even after a person gets into bed.

Sometimes sleep problems begin after a change in the treatment plan. It is helpful to keep track of when nighttime awakenings started and whether they coincided with a new treatment cycle or a medication change. This information can help your healthcare professional understand what is happening.

Do not stop taking a medication on your own, even if you suspect it is keeping you awake. Your oncologist can assess whether it may be contributing to insomnia and consider possible treatment adjustments if needed. Also tell your doctor about pain and other uncomfortable symptoms that interfere with your nighttime rest.

How can you tell insomnia from ordinary fatigue?

After a difficult day or a course of treatment, a person may feel extremely tired. But fatigue and insomnia are not the same thing. With fatigue, the body needs rest. With insomnia, a person has difficulty actually falling or staying asleep, even when they want to sleep and are trying to do so.

Sleep problems commonly show up in the following ways:

• taking a long time to fall asleep after getting into bed;
• waking up repeatedly during the night;
• waking up too early in the morning;
• feeling that sleep has not restored your energy;
• daytime sleepiness and difficulty concentrating;
• irritability, anxiety, and a worsening mood.

It is also worth paying attention to loud snoring accompanied by pauses in breathing. If family members notice that someone snores loudly during sleep and then stops breathing for a while, they should tell the doctor. These observations need a separate assessment because poor sleep may be caused by something other than insomnia.

Not every nighttime awakening means there is a sleep disorder. For example, someone may wake up because of pain, the need to use the bathroom, or noise, and then fall asleep again quickly. Even when complaints sound similar, the underlying causes can be very different.

You do not need to diagnose yourself based on the number of times you wake up. Your doctor will assess your symptoms, general health, and medications and may recommend additional tests if necessary. Sometimes a sleep study is needed to record brain activity, breathing, and heart rate.

What can you change in your diet and lifestyle?

When you have cancer, your diet should take into account your health, the specifics of your treatment, and your medical team's recommendations. There is no need to make sudden dietary changes, fast, or follow detox programs. During treatment, it is especially important to get enough energy and nutrients.

There are several things you can pay attention to in your daily routine.

Avoid eating a heavy meal just before bedtime. A large, late dinner may increase digestive discomfort. If you feel hungry in the evening, discuss suitable food choices with your healthcare team. Pay particular attention to your diet if you have a poor appetite, nausea, or other treatment side effects.

Maintain a calm routine. Try to go to bed and get up at approximately the same time every day. Regularity helps maintain a familiar sleep-wake schedule. After a poor night's sleep, avoid completely changing your routine the following day.

Reduce evening stimulation. Before bedtime, it is better to avoid distressing news, difficult conversations, and prolonged phone use. Emotionally stressful programs and bright screens can make it harder to relax.

Save physical activity for daytime. Walking or gentle exercise can help you maintain your usual level of activity. Regular movement is worth including in your routine, taking your health and your doctor's recommendations into account. Intense exercise immediately before bedtime may make it harder to relax.

Prepare your bedroom. Ideally, your room should be quiet and dark. Your bed should be comfortable, and light from the television, clock, and other devices should not irritate your eyes.

If you cannot fall asleep, you do not need to lie in bed for hours forcing yourself to sleep. You can get up briefly, sit quietly in dim lighting, and return to bed when you start feeling sleepy.

At the same time, do not try to solve every problem simply by changing your habits. If pain, medication side effects, or other physical problems are causing nighttime awakenings, those issues need to be addressed directly. Your doctor can suggest additional ways to support you based on your treatment.

What do I recommend to support sleep during cancer treatment?

I always pay attention to habits that affect how a person feels in the evening and how well they sleep at night. In my books, I connect sleep care with overall lifestyle, nutrition, and the condition of the nervous system. Below are my naturopathic views and observations, which I suggest considering only as a complement to medical care.

My first recommendation is not to fall asleep with the news playing or after difficult conversations.

I believe that ending the day with distressing programs and unpleasant conversations is a bad habit. In my experience, people who spend the entire evening exposed to emotionally upsetting information may find it harder to settle down and rest. This is especially true for people undergoing cancer treatment, who already have plenty of reasons to feel worried.

I recommend setting aside the evening for peaceful activities. There is no need to keep reading medical news, searching for frightening predictions, or discussing the most difficult questions right before bed. This does not mean hiding your worries from loved ones. If fear becomes constant and interferes with daily life, it is important to seek professional support.

My second recommendation is not to leave your main meal until late in the evening.

In my books, I write that a stomach occupied with a heavy dinner makes it harder for the body to move into deep recovery. I associate late meals with an additional burden on digestion and believe that the main meal should not be postponed until just before bedtime.

However, I am not advising people undergoing chemotherapy to restrict their food intake or go hungry. If you have a poor appetite, nausea, or weight loss, you need to discuss your eating schedule with your healthcare team. Getting enough nutrition during treatment is more important than following any general naturopathic rules.

My third recommendation is to consider the vegetable juices I use in my approach.

In my books, I describe three vegetable blends that I associate with supporting the nervous system, low energy, and insomnia. The first consists of carrots, celery, parsley, and spinach. The second combines carrots and celery with their leaves. The third combines carrots, lettuce, and spinach.

I consider these blends part of my naturopathic approach to nutrition. In my experience, vegetable juices can be one way to add variety to the diet. However, I do not describe them as a treatment for insomnia or cancer.

During chemotherapy, it is especially important to consider food safety and the risk of infection. Freshly squeezed juices should be discussed with your oncologist in advance, including their ingredients and preparation methods. If your doctor does not allow you to eat raw foods, you should not follow this recommendation.

My fourth recommendation is not to treat constant nighttime awakenings as a lack of self-discipline.

I believe persistent insomnia deserves attention, especially when a person wakes up feeling anxious and cannot get proper rest. We should not blame all sleep problems on bad habits or a lack of willpower.

That is why I recommend avoiding spending the entire evening in front of the television or computer. At the same time, doctors take a broader view of insomnia: they assess pain, medication effects, anxiety, breathing during sleep, and other possible causes. I believe we need to care for the whole person, not just the nighttime symptom.

My observations and recommendations do not replace treatment from an oncologist. Their purpose is to support everyday self-care and help people pay closer attention to their habits. Before using any herb or supplement or changing your diet, tell your oncologist. Never stop or replace prescribed medications with naturopathic remedies.

What should you avoid during chemotherapy without your doctor's approval?

During anticancer treatment, even familiar natural foods and herbal supplements need to be approached carefully. Some substances can affect the concentration of medications in the body and change how well treatment is tolerated.

You should be particularly cautious with the following foods and products:

• St. John's wort. It can change the concentration of certain anticancer drugs and affect how they work.
• Grapefruit and grapefruit juice. Interactions with certain medications can change their concentration in the blood.
• High doses of antioxidants. Using them during chemotherapy or radiation therapy without your oncologist's approval is not recommended.
• Concentrated herbal products and extracts. A high concentration of plant substances is not the same as eating ordinary foods and may create additional risks.

Ordinary fruits and vegetables are not prohibited. You do not need to remove them from your diet without a medical reason. Restrictions mainly concern certain foods that interact with medications, concentrated supplements, and herbal extracts.

Do not start taking sedatives, sleeping pills, herbal blends, or dietary supplements on your own. Even products sold without a prescription can interact with anticancer treatment. Discuss them with your oncologist or clinical pharmacist first.

Fasting and detox programs are also not suitable ways to deal with sleep problems during treatment. They can further weaken someone who needs to maintain adequate nutrition.

When should you see a doctor?

When you have cancer, it is important to distinguish between situations that require immediate medical attention and symptoms that can be discussed at a scheduled appointment.

When to seek urgent medical attention

During chemotherapy, a temperature of 38 °C or higher, or chills, may indicate an infection when your immune system is weakened. In this situation, contact your oncologist or medical team immediately. Do not try to bring down the fever on your own and wait for your condition to improve.

Urgent medical assessment is also necessary if you experience any of the following:

• sudden shortness of breath or difficulty breathing;
• chest pain, especially if it starts suddenly;
• swelling, pain, or a feeling of warmth in one leg;
• vomiting that continues for more than a day, or being unable to drink;
• blood in vomit or stool;
• black stools;
• fainting or severe dizziness;
• a rapid heartbeat, especially when accompanied by weakness or shortness of breath.

If you have severe difficulty breathing, chest pain, fainting, or a sudden worsening of your condition, call emergency services. Do not wait for your next scheduled appointment.

When to make a routine appointment

Schedule a consultation if you repeatedly have trouble falling asleep, nighttime awakenings become frequent, or daytime fatigue interferes with your usual activities. It is especially important to tell your doctor if the problem started after a new course of treatment or a change in medication.

Do not put off talking to your oncologist if anxiety prevents you from resting, pain gets worse at night, or you frequently have to get up because of bladder or bowel problems. These conditions need separate assessment and may sometimes require additional supportive treatment.

Your doctor may recommend cognitive behavioral therapy for insomnia, relaxation techniques, or a consultation with a sleep specialist. In some cases, sleeping medication may be considered for a limited period. The choice depends on the type of sleep problem, your overall health, and the other medications you take.

It is helpful to prepare a list of questions in advance: What might be disrupting your sleep? Which side effects should you pay attention to? Which ways of supporting sleep are suitable for your treatment plan? You can also keep a sleep diary, noting when you fall asleep, nighttime awakenings, how you feel, and any treatment changes. These notes will help your doctor identify patterns and assess how your condition is changing.

To learn more about how I approach this subject, visit the page "Oncology".

Boris Wydoff — naturopath and author, Ph.D. in nutrition. For over fifty years I have helped people restore health through nutrition, cleansing and the power of the mind — in Europe, America and Asia. About the author →

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