Key takeaways
- Disturbed sleep is a common side-effect of cancer treatment and can take many forms, including poorer sleep quality and reduced total sleep time
- A diet focusing on gut health naturally supports sleep, while reducing caffeine and focusing on specific nutrients might also be helpful
- Research shows that physical activity benefits sleep quality; finding something you like doing and getting into a routine is key
- Basic sleep hygiene behaviours like cutting down screen time, having a warm bath and reading before bed can help you to relax and sleep well
Many people living with or beyond cancer say that they experience disturbed sleep. Some studies estimate that 30–50% are affected, while others say it could be as much as 95%. Disturbed sleep can take the form of poorer sleep quality, difficulty getting to sleep, staying asleep, early waking and reduced total sleep time. It can lead to feeling fatigued and can affect someone’s quality of life.
While the causes of disturbed sleep after cancer treatment are not fully understood, what you eat and the physical activity you do, can have a positive influence, while psychological support can help you understand the relationship between sleep, and your lifestyle and emotions. In this article, three Perci professionals – dietitian Jo Cunningham, physiotherapist Hannah Leach and psychologist Dr Lucy Davidson – share how they support members experiencing disturbed sleep.
What causes disturbed sleep in those living with or beyond cancer?
The causes of sleep disturbance in those living with or beyond cancer are not fully understood, but are most likely due to a combination of factors. This can include the effects of the cancer itself, the effects of cancer treatment, the stress associated with a cancer diagnosis and cancer treatment and other side-effects, such as pain and fatigue, and other medical conditions.
Supporting sleep with diet and nutrition
Jo Cunningham, Registered Dietitian, Perci Health
Studies have shown that just two nights of reduced sleep quality and quantity can have a negative impact on the environment in our gut, known as the ‘microbiome’. Just as we find it hard to function when we’re tired, so do our gut microbes. This means that we’re more likely to experience digestive issues when we’re tired. And it works the other way around as well: when our digestive system isn’t functioning well, sleep may be affected. If you look after your gut microbes, they can look after your sleep.
Inside lots of plants are chemicals called polyphenols, which have been shown to improve sleep quality as well as quantity. My advice is to try to eat a diet rich in plants, with lots of colour and variety. Each day will be different, but try to aim for the following:
- 2–3 pieces of fruit (spread the intake throughout the day)
- 5–7 types of vegetables/salad (e.g., 3 at lunch and 4 at dinner)
- 3 types of wholegrains (wholewheat pasta, quinoa, buckwheat, oats)
- 1–2 portions of nuts (or nut butters) and seeds
- 1–2 types of legumes (e.g., beans, chickpeas and lentils)
- Herbs and spices
I always get asked about whether supplements can help with sleep. When it comes to supplements, personalised advice is key, so I would always recommend working with a dietitian who specialises in cancer. Always look at diet first, as what you eat feeds your microbes while most supplements don’t. Key nutrients to support sleep can be found in nuts and seeds. Vitamin D also has a role in sleep quality.
While my approach is always about what to include in your diet, caffeine is something you might want to think about reducing. Our DNA can affect our response to caffeine, so everyone’s response to it is a little bit different. Caffeine can stay in our bodies for up to six hours, so going caffeine free after lunch is a general rule that most people will find helpful. And remember that green tea, chocolate and some fizzy drinks contain caffeine.
I often remind my clients that your body clock is just that: a clock. It follows a regular rhythm. So, as well as getting up and going to bed at a similar time each day, try to eat at regular times, too, and not too late in the day. If we eat late, our bodies focus on digestion rather than rest and relaxation, which negatively influences our sleep and wake cycles and, therefore, our sleep quality. Finally, try to stick to that routine at the weekend, especially if you’re finding that your digestion is disrupted at the start of the week.
Ask Jo: Will melatonin supplements help me sleep?
Melatonin isn’t readily available in the UK, and the evidence behind it isn’t conclusive. Instead you could experiment with Epsom salt baths and magnesium body rubs, which also provide you with a relaxing ritual before bed.
Supporting sleep with physical activity
Hannah Leach, Physiotherapist, Perci Health
Research shows that physical activity benefits sleep quality. Generally, the more energy you use during the day, the better you’ll sleep, however things can get a bit complicated if you’re experiencing cancer-related fatigue. Exercise can help you to feel better, and therefore sleep better, but people often don’t feel they have the energy to start. Part of my job is helping them to kick off that positive cycle.
One of the first things we’ll do is talk about your symptoms and why you’re not sleeping. If you’re experiencing pain or breathlessness, there are things we can do to support this. For instance, we might talk about sleep position or the airflow in your bedroom. I find that people often don’t like being on medication to help them sleep, and can find these approaches useful. When exercise becomes part of a routine over time, it can really help with sleep.
Whether you’re struggling with sleep or other cancer-related side-effects, we’re always aiming for about 150 minutes of activity each week. Walking is a really good way to work towards that goal, especially if you live in a busy household; an early evening walk is a great way to start winding down. You can start off slowly and build your minutes up over time. Yoga, depending on the type, can be very relaxing. It is something you can do on a chair in your bedroom, for just ten minutes before you get into bed. Joining a group exercise class can really help to keep you motivated and feel less isolated. It’s all about finding the right exercise for you.
Ask Hannah: How long will it take for exercise to benefit my sleep?
Physical activity can provide immediate benefits, improving mood and sleep, however research suggests it can take around six months for changes to happen in our brains. That’s why it’s important to be consistent and motivated with your exercise habits and routines. Finding something you enjoy doing is key!
Supporting sleep with sleep hygiene
Dr Lucy Davidson, Psychologist, Perci Health
Sleep is often one of the first things I explore with a patient, as it can have such a huge impact on someone’s day-to-day life, and their ability to cope with cancer and its side effects. For someone living with or beyond cancer who is struggling with sleep, it’s important for me to take a comprehensive history. Some people in this situation have experienced sleep disturbances before, yet functioned quite well, but it’s become really problematic for them after cancer treatment when they need good sleep to aid their recovery. In this situation, I’ll use my training to look at longer-term strategies to support their sleep, as well as implementing what’s known as ‘sleep hygiene’.
Sleep hygiene is all about creating an environment and routine that supports good sleep. Can you cut down screen time in the evening? Can you have a warm bath before bed or a warm decaffeinated drink? Can you read a book or listen to an audiobook as a way to relax? Is your bedroom cool and dark? Too often people wake in the night and reach for their phone, which just activates the brain and actually prevents getting back to sleep. Setting a regular sleep pattern and sleep hours can also really help. At times this sleep pattern requires careful planning, for example, working towards gradually increasing hours of sleep in someone who struggles to sleep through the night.
I also help my patients to look at sleep in the context of their whole day. For some patients, napping in the day will be problematic and impact their sleep quality at night. For others, I work to help them realise that having a sleep in the afternoon isn’t a failure; in fact it can be a great strategy if they are struggling with energy throughout the day. An example of this would be a mother with young children. Resting before they return from school gives them a boost of energy to help with the after-school and evening routine. Increasingly, evidence is pointing to the benefits of short daytime sleeps, but education around the ideal duration and time of the day is helpful.
Ask Lucy: Are sleeping pills beneficial?
Sleeping pills can be helpful for some, if used in the correct way. I would always encourage trying over the counter sleeping pills before getting a prescription dosage. Often patients aren’t educated in how to take them. I always recommend taking them to pre-empt a bad night of sleep. They’ll be ineffective if taken when you wake up at 2am, as you will then struggle to get up the next day. It is also better not to use them in an ad hoc way. Taken nightly for several nights in a row is a much more effective way of resetting your sleep rhythm. Some patients worry about dependency, but taken for a short period in this way is like a reset, if waking in the night has become habitual. It doesn’t mean you will need them long term.
While disturbed sleep is experienced by many people living with or beyond cancer, the right support can make all the difference. Our Cancer Nurse Specialists have extensive experience in many aspects of cancer, as well as treatment side-effects, and can refer you to the Perci professionals who can make a difference.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
Büttner-Teleagă, et al., ‘Sleep Disorders in Cancer – A Systematic Review’ International Journal of Environmental Research and Public Health 18, no. 21: 11696, 2021, https://doi.org/10.3390/ijerph182111696
‘Cancer Survivorship’, Dynamed.com, 17 Aug 2023, https://www.dynamed.com/approach-to/cancer-survivorship#GUID-F31EF729-45CF-4E84-82C5-9C981184C1DB
‘NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Survivorship Version 1.2023’, nccn.org, March 2023, https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf
‘Sleep Disorders, Fatigue, and Cognitive Function in Cancer Survivors: A Plenary Session’, jnccn.org, June 2023, https://jnccn.org/view/journals/jnccn/21/5.5/article-p1_3.xml