Sleeping Problems: Insomnia

Approved by the Cancer.Net Editorial Board, 10/2020

Insomnia is when you have trouble falling asleep or staying asleep at night. Getting enough sleep is important for your health.

When you have trouble sleeping, it can affect your daily life. You might feel tired, irritable, or like you are unable to focus. Insomnia can make other cancer-related conditions and symptoms worse, such as pain, fatigue, depression or anxiety. It can also cause or worsen other conditions, like high blood pressure. Insomnia can make it harder for you to cope with cancer and make you feel more isolated.

Relieving symptoms, such as insomnia and its causes, 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 doctor may recommend that you visit a palliative care specialist or another doctor trained to help patients manage symptoms like insomnia.

What causes insomnia during cancer treatment?

Insomnia can have many causes. Your insomnia might be caused by cancer, side effects of cancer treatment, or by another condition.

Other conditions that can cause insomnia are:

Erratic work hours, working the night shift, excessive screen time, especially in the evening, too much caffeine or alcohol, and smoking can also cause insomnia or make it worse.

Your sleep problems might be caused by a medication you are taking. This could be a medication used to treat cancer or other medication. It is important to tell your health care team about all of the medications you are taking, even over-the-counter drugs, herbs, and supplements.

Concerns about your cancer might be keeping you awake. Many people worry that their cancer will get worse or come back. Financial or insurance concerns are also common. Tell your doctor if stress and worry are keeping you from falling asleep or getting back to sleep at night.

How is insomnia diagnosed?

Almost everyone has trouble sleeping sometimes. But insomnia is a medical condition that affects your daily life. It can be treated by your health care team while you are receiving cancer treatment.

In order to understand the cause of your insomnia, your doctor will take your medical history. They will ask you a series of questions to understand your sleep habits and how they have changed. 

These questions might include:

  • What is your sleep history?

  • Have you ever had sleep problems in the past?

  • What time do you go to bed?

  • How long does it take you to fall asleep?

  • How long do you sleep?

  • How do you feel when you wake up?

Your doctor may also ask you questions about your sleeping environment:

  • Where do you sleep?

  • What is the temperature, amount of light, and the amount of noise?

  • Do you use a phone, tablet, or computer right before bedtime?

Your doctor might ask you some general questions about your health and your sleep:

  • Do you snore?

  • Do you know if you have changes in breathing when you sleep?

  • What time of day and how much do you exercise?

  • How does insomnia affect you? Are you sleepy during the day?

  • Do you fall asleep during activities such as driving, reading, or working?

Finally, your doctor may ask you about what medications you are taking and your daily habits:

  • What medications do you take, including over-the-counter drugs?

  • Have you started or stopped any medications recently?

  • Have you ever used medication to help you sleep?

  • Do you use any alternative therapies?

  • Do you drink alcohol? Do you use drugs?

  • How much caffeine do you consume?

  • Do you smoke?

These questions will help your doctor understand your routines. This can help them know how your sleep habits have changed and if there are behaviors you can change to help you sleep better.

Keeping track of your sleep in a sleep diary may be helpful for recording your sleep habits and patterns.

How is insomnia treated?

The goal for managing insomnia is to get restful sleep and improve your overall quality of life. In order to treat your insomnia, it's important to know its cause. Your insomnia might be caused by more than 1 thing.

Changes to your behavior are usually more effective for long-term relief of insomnia. Your doctor will help you find the best treatment or combination of treatments to help you sleep.

Having healthy sleep habits. This is also known as having good "sleep hygiene." There are many things you can do to help make yourself and your room more comfortable for sleeping.

  • Keep your room cool and dark.

  • Wear loose clothing.

  • Keep your bedding clean and comfortable. Use pillows and blankets to make yourself as comfortable as possible.

  • Avoid eating a big meal or drinking a lot of liquid before bed.

  • If you drink drinks with caffeine, add up how much caffeine you have each day. Avoid caffeine after mid-afternoon. You may also want to reduce your daily caffeine intake or remove it from your diet completely.

  • Exercise regularly, but avoid exercise right before bed.

  • Set a regular sleep schedule and try not to nap.

  • Only use your bed for sleeping and sex.

  • Don't watch TV or use screens, like a cell phone or tablet, in bed.

Cognitive behavioral therapy. When you have insomnia, thinking about sleeping or worrying about sleeping can make your insomnia worse. Cognitive behavioral therapy is a type of therapy that can help you reduce your anxiety about sleeping. The goal of cognitive behavioral therapy is to understand patterns in your sleep habits and how to address them.

Medication. Insomnia may be treated by medication to address the insomnia or to address the problem that is causing the insomnia. For example, restless legs is a common side effect of cancer that causes insomnia. Restless legs can be caused by low iron, so your doctor may prescribe an iron supplement pill or changes to your diet. Pain, nausea, and vomiting are other side effects that can be treated with medicine to improve your insomnia.

If other treatments and lifestyle changes do not improve your sleep, your doctor may prescribe medication to help you sleep. There are risks associated with taking these kinds of medications for long periods of time. In general, they should only be taken for 2 to 4 weeks. You will also need to avoid alcohol and some other medications while taking them. Be sure to talk with your doctor about any precautions of your prescribed medicine.

Specialist care. If you have ongoing sleep problems, your doctor may recommend a sleep study. This is a test that monitors your body's activities while you are sleeping. You may see a sleep specialist. This type of specialist can help find out the cause of your insomnia and provide additional treatment options.

Questions to ask your health care team

  • Could sleeping problems be a side effect of my cancer or treatment plan?

  • If I have sleeping problems, who should I tell on my health care team?

  • Should I track my sleeping problems? What is a sleep diary?

  • What changes to my daily habits would you recommend for better sleep?

  • Are there treatments or medications I can take to improve my 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

More Information

National Cancer Institute: Sleep Disorders

U.S. Centers for Disease Control and Prevention: Basics About Sleep