Many people have difficulties sleeping from time to time. Common sleep problems include difficulty falling or staying asleep (insomnia), over-sleeping and having nightmares. There are many possible reasons for sleep problems, including stress, side effects of lymphoma treatment and pain.
The emotional impact of having lymphoma
Having lymphoma is stressful, even when you are in remission (no evidence of disease). You may experience physical tension and worrying thoughts when you are trying to sleep. You might be fearful about what is happening to you or anxious about an upcoming hospital visit.
It’s important to find ways of managing stress that work for you. What works best depends on why you can’t sleep and on who you are as a person. Some people find relaxation techniques helpful, eg breathing exercises and meditation.
In some cases, a problem-focussed strategy might help. Break down a problem and come up with a plan to address it. Speak to a member of your medical team if you are struggling to sleep because of stress.
It is natural to experience feelings of sadness and anxiety from time to time. Sometimes, however, people feel very low a lot of the time over a long period. Depression is very common for people with cancer and it can affect your sleep. You might feel restless, wake early or sleep a lot of the time. Being affected by depression does not mean that you are unable to cope. If you think you might be affected by depression, talk to your medical team. There are various treatments and sources of support that can help.
Side effects of lymphoma treatment
Some treatments for lymphoma may disrupt your sleep.
You might feel too alert and energetic to sleep if you are on steroid treatment. You should take your steroids first thing in the morning, when your steroid levels are naturally higher. Speak to your medical team for advice on when to take your steroid medication.
Anaemia (shortage of the red blood cells that carry oxygen around your body) can cause tiredness. You might want to sleep more than you usually would if you are anaemic. Some people recommend you rest when you feel your body needs rest, but exercise when you have the energy to do so. It is also important to eat well and drink lots of fluids.
You might experience pain because of the lymphoma itself or as a side effect of your treatment. Relaxation can be very difficult if you are in pain. Speak to your doctor or clinical nurse specialist (CNS) if you are in pain. They might prescribe pain relief medication or suggest other ways to help manage your pain.
Talk to your medical team if you have problems sleeping. There are many things you can try to get a more restful night. What works partly depends on the cause of your sleep problems and partly on you as a person. You may find generic advice helpful.
Establish a sleep routine
Help to set your body clock. Studies show that exposure to natural light during the day can improve your quality of sleep.
Take an hour or so to wind down before you get into bed. Do something soothing in this time, such as having a warm bath, reading a book or listening to music.
At night, keep your room dark – light slows the production of melatonin (a hormone that regulates sleep). This includes minimising your exposure to blue light, which disrupts your body clock and sleep rhythm. Blue light is given off by mobile phones, laptops, iPods and similar devices. Some e-readers give off blue light, although researchers report that the original Kindle does not. Many devices now allow you to switch off the blue light so it is worth checking the settings to see if yours does too.
As far as possible, try to go to bed and get up at around the same time each day. This helps to get your body into a rhythm.
Avoid stimulants before going to bed
Some foods and drinks are stimulants (substances that increase alertness) and may make you feel more awake. It is a good idea to avoid stimulants before going to bed.
Stimulants to avoid around bedtime include:
- caffeinated drinks, eg tea, coffee, coke, alcohol
- foods rich in tyramine, eg cheese, pork, aubergine and tomatoes
- foods rich in tyrosine, eg spinach, eggs and cottage cheese
- sugary foods, eg chocolate, cakes and biscuits.
- warm, milky drinks
- herbal teas, eg camomile
- starchy (carbohydrate) snacks eg non-sugary cereal or oatcakes
- foods rich in tryptophan, eg nuts, tuna and bananas
- foods rich in magnesium and calcium eg nuts, seeds and wholegrains.
Take care of your sleep environment
Make sure your room is comfortable with some air flow. It should be neither too warm nor too cold. Light can wake you so keep your room as dark as possible while you are trying to sleep. Thick (blackout) curtains help to block out natural light and street lamps. Ear plugs can drown out noise that is beyond your control. Some people find that essential oils (eg lavender) help them to relax and prepare for sleep. You can buy essential oils in pharmacies and supermarkets.
If you can’t sleep once you are in bed
Lying in bed unable to sleep can be frustrating. If you cannot sleep after 20–30 minutes, it may help to get up and do something relaxing until you feel sleepy enough to go back to bed.
Some people find that breathing techniques help to calm their mind. You can find examples of breathing techniques on NHS Choices. The Mental Health Foundation also has information about getting a good night’s sleep.
Your doctor can help you to understand the cause or causes of your sleep problems and advise you accordingly. It may help to keep a sleep diary over a period of time (eg 1 week) to note the time you go to bed each night and the time you get up in the morning. You also record how easily you fell asleep, the number of hours you slept, how many times you woke during the night and how refreshed you felt the next day. Alongside this, you keep a note of your caffeine intake each day, physical activity, and any medication taken.
You can find an example of a sleep diary on NHS Choices.
If you experience insomnia, your doctor may prescribe medication such as benzodiazepines or ‘Z medicines’ (Zopiclone or Zolpidem). Sleeping tablets may help you fall asleep, but should only be used in the short-term. They lose effectiveness over time and can be highly addictive.
If you wish to take a natural or other over-the-counter sleeping remedy, discuss this with your doctor. They might advise you against taking such medicines. Some, for example, may react with chemotherapy drugs.
It is important to seek advice for ongoing sleep problems; feeling well-rested can greatly improve your general wellbeing.