Primrose Foundation



Contributing to excellence in breast care services at Derriford Hospital NHS Trust


Thursday 30th March 2017

National Sleep Day zzzzzzzzzzzzz

Sleeping Well Dr Catherine Zollman About 30-50% of people who’ve been diagnosed with cancer will have sleep problems at some point. Sometimes they’re caused by cancer treatments like steroids or hormone therapy, sometimes by pain or discomfort or disruption of your daily routines, and sometimes by stress, worry, depression or anxiety. Sleeping poorly can have other knock on effects -feeling tired all the time, worsening of fatigue, feeling too tired to look after yourself well, being irritable, increased sensitivity to pain or other symptoms, difficulty with relationships, poor concentration and many more. Sometimes poor sleep becomes a habit even after the original cause has stopped. There are many simple practical steps you can take to get back in the habit of good sleep -this is often called having good sleep hygeine. . Avoid napping during the day .Limit alcohol and cigarettes late at night . Get help and support with any ongoing stresses if possible. .Avoid meals with a lot of refined carbohydrates which give sugar “highs” and “lows”,especially late in the evening. . Experiment with how much caffeine you have; you may need to avoid it in the evenings, from the afternoon onwards, or exclude it completely. In some people caffeine can last for several hours in the bloodstream .Avoid exercising at night, although exercise during the day may help you sleep(see below) . Avoid going to bed until you are feeling sleepy .Try to go to bed and wake up at the same times every day to help get your body into a routine . Make sure your sleeping environment is comfortable (not too hot, cold, noisy or bright) .Ensure darkness and switch off any electronic screens or gadgets . Try to relax before bedtime, a warm bath may be helpful. Some aromatherapy essential oils can aid relaxation try Lavender or Ylang Ylang add a few drops to bath water as long as you have checked for sensitivity first. .Only use your bedroom for sleep .If you're still wide awake within 20 minutes, get up and do something relaxing such as reading a book until you feel drowsy again. If you’ve tried all these without success, there are a number of complementary therapies that people sometimes find helpful. There is very little reliable consistent research data available to help people make evidence based decisions, and insomnia is a very individual thing with different approaches helping different people. It is generally advisable to weigh up the risks and benefits of any complementary approach you are considering (including the cost, the potential side effects and how quickly you might expect to see benefits) and give anything that seems to weigh up positively for you a try, bearing in mind that insomnia is not something that usually has an overnight solution and may take weeks or even months to gradually improve. Here are some of the things that may be worth considering. Relaxing physical activity like Tai Chi or yoga may be helpful in the early evening. Taking more strenuous physical activity during the day may also be helpful (providing it is not too close to bedtime) as it can lead to physical tiredness which may aid sleep at nighttime. Vigorous exercise too close to bedtime can make insomnia worse. Relaxation techniques, especially if practised regularly during the day, can be very useful if used again at bedtime or if you wake during the night. Try listening to a relaxing CD (e.g. music or guided relaxation, meditation, mindfulness or imagery) or MP3 using headphones before going to sleep or if you wake at night and can’t get back to sleep. Be prepared to try a few to work out what suits you. The Penny Brohn shop has a number of CDs and resources to get you started. Many forms of CBT (Cognitive Behavioural Therapy) which help reframe thoughts and behaviours around sleep have been shown to be useful. An online resource designed by Professor Colin Espie in Scotland, can provide supported CBT via web and email over several weeks for a weekly subscription and anecdotallyhas achieved impressive results. Homeopathic remedies like coffea and passiflora are safe to take with other medication. They are generally cheaply available without a prescription from large chemists or specialised homeopathic pharmacies. Ideally homeopathic remedies should be matched to your individual detailed symptoms so other remedies may be helpful (there are various books you can consult to match your symptoms to the available remedies) and you may get better results after consulting a homeopath who will take a full history and individualise your choice of remedy. Herbal remedies (tinctures or tablets) have more evidence to support them but may cause problems with interactions if you are taking any other medication. Chamomile, Valerian and Hops may be worth considering. Always consult your GP to find out about the safety of taking herbs in your situation. The National Institute of Medical Herbalists has a useful information line. Melatonin is a chemical we make in our brains which regulates our sleep/wake cycle. For some types of insomnia,doctors (still mainly specialists rather than GPs) can now prescribe this on the NHSand in the US it is widely available over the counter and has a very good safety record. As with herbal supplements, there is a risk of interaction with other medicines and products and as melatonin is powerful anti oxidant it may interfere during radiotherapy and some forms of chemotherapy There are a number of herbal teas such as chamomile, sleep easy, night time etc which may be helpful. Herbal teas are usually too dilute to cause any serious drug interactions but be careful if you are drinking them very regularly or in a very strong brew and check with a healthcare professional. Green and white tea contain caffeine so limit/avoid these. Complementary therapies like acupuncture, homeopathic consultations, reflexology, shiatsu, healing and massage can also be very supportive and it may be worth finding an experienced and well regarded practitioner in your area and trying 3-4 sessions of something you feel interested in. You can also find further information about insomnia on the NHS Choices website. It is important to remember that sleep problems are usually caused or made worse by a number of different things, so having a plan which involves changes in a number of different areas (e.g. physical activity, diet, breathing and relaxation, CBT and complementary therapies,) may have the best chance of success, If none of the above is improving your sleep, then do go to your GP as it may be that there is an underlying problem (for example depression or a hormonal problem) that needs addressing before your sleep problems can improve.