Getting a Better Night's Sleep, with Peggy S. Burhenn, MS, CNS, AOCNS

May 3, 2016
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In today’s podcast, Peggy Burhenn, a nurse and professional practice leader in Geriatric Oncology at City of Hope National Medical Center discusses several strategies for getting a better night’s sleep.  



ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer.

People with cancer can sometimes find it difficult to sleep well at night, either due to stress and anxiety or as a result of cancer or cancer treatment. But sleeping well can help aid in healing as well as improving overall quality of life. In today's podcast, Peggy Burhenn, a nurse and professional practice leader in geriatric oncology at City of Hope National Medical Center, discusses several strategies for getting a better night's sleep. ASCO would like to thank Ms. Burhenn for discussing this topic.

Peggy Burhenn: Hi, my name is Peggy Burhenn. I'm a clinical nurse specialist at City of Hope in geriatric oncology, and my role here is I teach nurses about caring for older adults with cancer, but I also spend a lot of time talking to patients about problems that come up as they're undergoing treatment for cancer. So one of the issues that a lot of people are concerned about is they're having trouble sleeping. So that's what I want to talk to you about today. Because when people are having trouble sleeping, it can affect many different parts of your life. Maybe you just feel cranky, or you're not yourself, or you just don't have the energy during the day to get things done you'd like to. It can also affect your treatment because maybe you don't have the energy to participate as much as you want to in your care, and your body needs sleep in order to heal.

So the first thing I would like to do, is encourage you to tell your doctor or nurse that you're having trouble sleeping. And I also, because I teach doctors and nurses, I encourage them to ask patients if they're having trouble sleeping. So you want to talk to your doctor first because sometimes trouble sleeping can be from a medical condition, and we want to make sure that there isn't a problem there that could be taken care of. So things such as pain or maybe problems breathing, sometimes even heart problems or restless legs can cause problems sleeping. And even certain medications might be causing a sleeping problem. So again, always check with your doctor first. There are other problems such as sleep apnea, which you might've heard of, where people have trouble breathing during sleep but don't always know about it, and a doctor can determine if there's a problem with sleep apnea too.

So those are kind of things you should get out of the way and make sure there isn't any medical reason that's keeping you from sleeping. But let's say you're having trouble sleeping, and you want to know, "Well, what can I do about it?" So essentially, there's three buckets of things that I think of that you can do that aren't medication. Because many times, people want to just go to medication and say, "Oh, just give me a pill. I'm having trouble sleeping." But what we know is that that's not necessarily the best thing for people. Sleeping pills have a lot of side effects, and many sleeping pills were just developed to be used on a short-term basis, like for a few nights, or a few weeks at the most, and not really ongoing for long term. So we want to find something that's going to work for you that's not a pill.

So the three things I'd like to look at are, one, sleep hygiene, two, relaxation, and then, three, if those types of things don't work, we have something called behavioral therapy. So let's start with sleep hygiene. And sleep hygiene is sort of what it sounds like. A lot of people are confused about like, what does that mean? So I'm going to clean my sleep. But when you think about something like dental hygiene, what does that mean? That means you are doing preventative work, right? To keep your teeth in the best shape. So we're going to do the same thing. We're going to do preventative work to keep our sleep as healthy as it can be.

So first, I look at what are we taking into our bodies maybe that is affecting our sleep? And caffeine is number one. I encourage people not to have any caffeine after lunch if they're having trouble sleeping as that can help. And as we age, we get more sensitive to caffeine. So sometimes, people might say, "Oh, well, I've always had caffeine all the way up to bedtime. No problem." But maybe as we get older, we're getting more sensitive to it. So just try having no caffeine after lunch. Also, remember that chocolate does have some caffeine in it too. Alcohol and nicotine can be stimulating, so we want to avoid alcohol and nicotine before bedtime as well.

Another thing to think about is light. How much light is there that you're being exposed to during the day? Our bodies like to know that, "Hey, it's light out in the daytime, and that's when I'm awake, and then it's dark at night." So try to get outside and get some natural light. Maybe go out for a walk in the middle of the day. The other thing with light is that some people don't realize that TVs and computers, they're a source of light too. So if we're watching TV or using our computers or other handheld devices at night, they emit what's called blue light, and blue light is like daylight. So your body is thinking, "Oh, it's daytime," at let's say 10 o'clock at night while you're watching TV. So it's important that we turn off our TVs and our devices probably one to two hours before we go to bed.

Activity can also affect our sleep, and it works both ways, either not enough activity during the day-- so depending on what your level of ability is, and talk to your doctor if you need some advice about this, but getting some exercise during the day. So lots of people like to take a walk. That's a very good, easy exercise that most people can do, or yoga is another good exercise, or even stretching exercises, or even chair exercises if you're not able to walk. So just depending on what your level of ability is. And then, not doing though exercise too close to bedtime. So try not do any exercise within one to two hours of going to bed because then that's sort of stimulating your body right before you go to bed.

I also like to recommend that you create a routine. If we create a routine before we go to bed, it's like training our bodies that, "Oh, this is time to go to sleep." And the routine will be different for everyone. But let's say, for example, one thing you want to do is go to bed at the same time every night and have a routine right before you go to bed. So maybe you're going to take a warm bath and then brush your teeth and feed the cat and lay down and read for 30 minutes or listen to some relaxing music, and then you're going to go to bed and then wake up at the same time every day. So that's an example of a routine that you might have, but you would create your own routine that you do every single time, so when your body goes to bed, it says, "Hey, this is the routine, and now it's time to go to sleep."

Also, it's important to remember that the bed is really for sleeping and for intimacy, but we want to avoid doing all other kinds of activities in bed. Sometimes, I talk to people who they pay the bills in bed. They do [chuckles] all their homework or whatever in bed. And we want to just reserve the bed for activities such as sleep. Other things you can do to just promote sleepiness is to make sure your room is dark. So if there's light, a night light or a glare from an alarm clock or something or a sleep partner that has a light on, try to get as much darkness as you can. If you can't, limit those lights sources. Maybe wearing an eye mask would be helpful.

We also know that most people sleep in a cool room, not cold, but cool, a little bit cooler but have a light blanket available so that you don't get chilled at night. And the room should be quiet. Now, maybe you're in an area where there's a lot of noise outside or noise inside that's keeping you up from other family members. So if you can get a white noise machine, some people find that helpful so that they don't hear the background noise. Or wear earplugs can be helpful too if you're in a noisy place. Or let's say you have to go to the hospital, you might want to bring a pair of earplugs. Another thing that can help you sleep is protein at night. So we don't want to eat a big meal right before we go to sleep, but we do want to have a little bit of protein, so maybe a cheese stick or a scoop of peanut butter or cottage cheese. Some little bit of protein that you can have before you go to bed can help and produce sleepiness in many people. So that would be another part that you could add to your routine as well.

So those are all considered sleep hygiene things. Again, sort of keeping your sleep house in order. I find that another reason that people don't sleep well is that they're worried about something. Maybe you're very anxious about an upcoming procedure or treatment, or even just day-to-day stress. I mean how many times have you just laid in bed thinking about something over and over and over again? "Oh, I should have done this," or, "I could have done that," or, "Tomorrow, I have to do this." So we all suffer from that from time to time, and relaxation can help with getting those things off your mind. Of course, another good idea is to just write down. If it's a list of something you have to do tomorrow, keep a pencil and paper next to your bed so then you can let it go.

But relaxation techniques can be really helpful for producing sleep. Some things that help people relax can be like a warm bath or a hot shower - we talked about that earlier - or other relaxing activities. So most people have a relaxing activity that they do. Maybe it's reading or prayer, meditation, even just listening to calm music. So if you have an activity like that that you'd like to participate in, that can help you relax before you go to bed. Other techniques, other things that you can do to help relax might be massage or what we call relaxation breathing where you breathe in deeply, expanding your abdomen, and holding it for several counts, and then letting it go. And do several slow, deep abdominal breaths will help relax you.

You might want to try guided imagery which is the process of thinking of pictures and using your senses through your imagination. And usually, it's guided, meaning someone walks you through it saying, "You're in a field," or, "You feel snow." It's some kind of walking you through an image. We do have some guided imagery available at our website at City of Hope. It's, if you want to try that. But there are many free guided imageries on the web that you can look for. And another technique that some guided imageries include is progressive muscle relaxation. When you relax different muscle groups, so like you relax your feet and then you relax your legs, and as you do this relaxation procedure, and then you feel more calm, and it may help you fall to sleep.

That's kind of, in a nutshell, what sleep hygiene and relaxation techniques that are used for sleep are. But for most of these to work, you have to give it a little time. You have to try most of these things for probably at least one to two weeks. And then, if you find that, "Well, none of this is really working for me. I think my problem is more serious," then I would recommend a referral to a sleep specialist or a therapist. That's experiencing what we call behavioral therapy. And all behavioral therapy is they work with you to promote sleep and kind of break that cycle that you have of getting poor sleep. And some types of professionals that offer this service are occupational therapists, social workers, nurses, or psychologists.

So if you don't know someone in your area, your healthcare provider can make a referral for you. But in the meantime, try some of these things, some of the sleep hygiene things, as well as some of the relaxation things, and I hope that soon you'll be sleeping very, very soundly. And thank you for listening to this podcast.

ASCO: Thank you, Ms. Burhenn. To learn more about getting a better night's sleep, visit And for more expert interviews and stories from people living with cancer, visit the Cancer.Net blog at

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