Sleeping Problems: Insomnia

Approved by the Cancer.Net Editorial Board, 04/2018

Insomnia is the experience of having trouble falling asleep or staying asleep during the night. It may cause you problems during the day, such as tiredness, low energy, poor concentration, and irritability.

Most people experience insomnia at some point in their lives. But the risk of insomnia increases with age and with serious illnesses, such as cancer.

Insomnia can often worsen other cancer-related conditions and symptoms, such as pain, fatigue, depression, or anxiety. It may also make it harder for you to cope with cancer and cause feelings of isolation.

Relieving symptoms, such as insomnia and its cause, is an important part of your care. This is called palliative care or supportive care and is provided along with treatment for the cancer. Talk with your health care team about any problems you experience, including any new symptoms or a change in symptoms. Your oncologist may recommend that you visit a palliative care or other specialist trained to help patients manage symptoms.

Understanding the cause of insomnia

Understanding the cause of insomnia helps your doctor find the best way to treat it. Your doctor may ask about the following factors that can contribute to sleeping problems:

  • Sleep history

    • Whether you have had a sleep disorder in the past

    • Your normal sleeping habits

      • When you go to bed

      • How long it takes to fall asleep

      • How long you sleep

      • How you feel when you wake up

    • Sleep environment, such as location, room temperature, amount of light and noise

    • Snoring

    • Change in breathing pattern when sleeping, which is often best asked of a partner

    • Exercise pattern, such as what time of day and how much you exercise

    • Restless leg symptoms

    • How is insomnia affecting you

      • Daytime sleepiness

      • Falling asleep doing normal activities, such as driving, reading, or working

    • Other past medical conditions that might affect sleep

      • Endocrine or hormonal disorders, such as low or high thyroid hormone levels or diabetes

      • Heart disorders

      • Urinary problems

  • Psychological history

    • Anxiety

    • Depression

    • Concerns about the cancer getting worse or returning

    • Confusion, also called delirium

    • Financial or insurance concerns

  • Physical symptoms or changes

    • Pain

    • Shortness of breath

    • Nausea

    • Vomiting

    • Cough

    • Hiccups

    • Hot flashes

    • Itching

    • Diarrhea

    • Frequent urination

    • Recent weight changes

    • Any other symptoms

  • Medications and other substances

    • New medications

    • Recently discontinued medications

    • Over-the-counter medications

    • Medications previously used for sleep

    • Other medications or alternative therapies

    • Alcohol or drug use

    • Caffeine use

Managing insomnia

The goal for managing insomnia is to achieve restful sleep and improve your overall quality of life. Understanding and treating the underlying cause of your insomnia is the best way to do this. First, find potential sources of the insomnia and ask your health care team to help you manage these conditions. One example of this would be restless legs. Restless legs can be caused by low iron in your body, a common condition in people with cancer. Non-medical problems can add to insomnia. These may include financial and work concerns, family changes, and fears related to the cancer worsening or recurring.

Behavioral techniques are usually more effective for long-term relief of insomnia. Medications may help relieve insomnia. But you should only use these for a short time unless other treatments do not work.

To help find the cause of insomnia, your doctor will take a thorough history and physical exam. Depending on what your doctor finds, you may need additional testing or visits with specialists. These specialists can help determine the cause and develop a plan to manage the problem.

For ongoing insomnia, your doctor may recommend a sleep study or refer you to a sleep specialist. These specialists can find out whether you have another sleep disorder affecting your ability to fall or stay asleep. One example is sleep apnea, which is a short pause or decrease in air flow while breathing during sleep.

Related Resources

8 Steps to a Restful Night's Sleep

Sleeping Problems: Hypersomnia, Somnolence Syndrome, and Nightmares

Podcast: Getting a Better Night's Sleep

Treating Pain with Medication