Many of us do not seem to get the proper amount of rest or sleep, even if we don't quite understand how much sleep is proper. During cancer treatment, that situation becomes more complex for a host of physiological, practical, and emotional factors. Let's try to sort them out.

Cancer affects how our body maintains energy, processes foods, and stabilizes our weight. Most cancer cells devour energy as they grow, much more than the usual healthy cell. So for most types of cancer, our body goes into energy overdrive. We can burn thousands of calories a day beyond our usual needs. This makes us tired, and we should be better primed to sleep well to help our bodies along. It rarely happens. Worrying predictably interferes with good sleep, both in depth and length, and we fail to restore our energy. At night, when the lights are out and all is quiet, everything seems worse, and our cancer fears are no exception.

Practical concerns upset our ability to sleep well. It used to be that we would be admitted the day before any planned surgery to "rest" and get a running start. No longer-- early surgeries often mean that we have to be at the hospital at 5:00 or 6:00 am, requiring a middle-of-the-night wake up call. General anesthesia makes us feel like we've sleep well, but usually during the day instead of at night. This schedule leaves us awake and often in pain during that first night, without even considering the IV lines and alarms, the urinary catheter, and oxygen. It's not easy to sleep with all the equipment plugged in. Virtually every medicine used in cancer treatment interferes with a good night's sleep, sedating us during the day. The brain recognizes many of the anti-nausea medicines (lorazepam is a classic one) as sleep medicine, taken day and night. Pain medicines in the codeine or morphine family likewise make us drowsy when she should be awake, so natural sleep is less likely to occur at night. Radiation therapy requires repeated visits, sometimes five day a week for six weeks, with lots of time traveling to and from your radiation center, sometimes early in the day or late at night. Whether radiation itself causes drowsiness is not entirely clear, though progressive investigators believe that the special proteins produced by cancer growth can be slowed down by radiation therapy. However, this effect is delayed, happening toward the end of treatment or even weeks afterwards.

So what can we do to re-introduce sleep and rest in the midst of all of these interferences? Your oncologist or advance practice nurse may suggest a sleep aid, often prescription, that can generally be used for a short few weeks at the most, and some rebound sleep problem happen when they are stopped. Many patients use their anti-nausea medications, but the same limitations apply.

What you can do - and your treatment team cannot - is follow the usual "sleep hygiene" rules that apply to us all. Adjust the temperature in your bedroom so it is comfortable for sleep, often cooler than warmer. Limit caffeine to earlier on the day and avoid exercise or heavy snacking before sleep. Use silicone ear plugs (follow directions to avoid having any pieces stick in the ear canal) or eyeshades as needed, if you cannot otherwise block out light and noise. Be a task master when it comes to schedules, getting to sleep at the same time every day, no matter how challenging the treatment schedule becomes. Although clinical trials are small, massage, gentle stretching, and relaxation techniques can help more than you'd imagine, and most cancer centers have classes set up or can refer you to someone. Relaxation and yoga are considered safe during virtually any treatment regimen, with some adjustments for individual needs, and can make a real difference in improving your sleep.

Ask your provider to schedule a Physical Medicine & Rehabilitation consult, or a Physical Therapy evaluation (depending upon your insurance coverage) to maximize your activities to stabilize both weight and sleep. Optimize your nutrition to stay as close to your ideal body weight as possible with a Nutritional Consult as well. Accredited cancer programs have these in-house or know someone in the community who understands the particular needs of patients with cancer. My book, Learn to Live Through Cancer: What You Need to Know and Do, can help you with other strategies for living with cancer.

Although we will learn more about the mechanisms of sleep problems and the best approach to sleep and rest in the future, understanding what we do now and following the best drug and non-drug methods will help restore sleep.