Treatments for insomnia and fatigue

If you are having trouble sleeping or dealing with fatigue during breast cancer treatment, let your care team know. Together, you can find ways to reduce your symptoms.

One lifestyle change that can help: Do any needed activities when energy levels are high. Pace yourself and take breaks.

Your care team may recommend strategies such as exercise (including walking and yoga), acupuncture, and lifestyle changes such as developing a regular sleep routine.

For some people, medicines and therapy with a professional counselor can also help.

Medicines for insomnia and fatigue

Medicines that doctors sometimes use to manage fatigue and insomnia include:

• Stimulants such as methylphenidate (Ritalin) can help boost energy and focus.
• Over-the-counter sleep aids may help with a short-term sleeping problem.
• Older sedatives called benzodiazepines are sometimes used to treat insomnia, but they can cause side effects including dizziness, weakness, unsteadiness, depression and headaches. There are many different benzodiazepines, but some you may have heard of are alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan).
• Newer prescription sleeping medicines that are not benzodiazepines such as eszopiclone (Lunesta) and zolpidem (Ambien) can improve insomnia with perhaps fewer side effects than benzodiazepines. But these medicines can also cause side effects and are not recommended for long-term use.
• Antidepressants such as paroxetine may help.
• Medicines to treat anemia are helpful for some people.

Always talk to your cancer care team before starting any new treatment, whether prescribed or over-the-counter. Possible side effects of sleep medicines are:

• Daytime drowsiness
• Feelings of anxiety
• Unwanted interactions with other medicines
• A disruption of sleep patterns over time
• Mild memory loss
• Dependence

Medicines not in the benzodiazepine family are less likely to cause dependence and have fewer side effects. In most cases, if taken correctly and under your doctor’s care, sleep medicines can be helpful and safe during treatment. If you want to try supplements or herbs, talk to your healthcare team first to make sure they won’t interact with other treatments.

Before starting on a recommended treatment, talk with your provider and insurance company about costs and consider the price differences between generic and brand name medicines. If you do not have insurance or your plan does not cover the recommended medicine, your social worker or nurse can direct you to patient assistance programs that may help cover the cost.

Cognitive behavioral therapy for insomnia

Cognitive behavioral therapy for insomnia (CBT-I) involves working with a professional licensed therapist to talk about thoughts, feelings, and behavior that can make it hard to fall asleep and stay asleep.

A counselor can help by combining techniques, such as relaxation exercises and mindfulness meditation. A counselor can also help you identify and reframe negative or unhelpful thoughts about sleep.

In women treated for breast cancer, research shows that CBT-I can be effective at reducing insomnia and improving the quality of sleep.

If you are having trouble falling and staying asleep and are interested in trying CBT-I, ask your care team for a referral to a qualified CBT-I therapist. You can also find a therapist at the Society of Behavioral Sleep Medicine.

Learn more about seeing a professional therapist.