Insomnia and Fatigue
Like many people, you may accept fatigue and sleeping problems as natural results of having cancer. Breast cancer can bring on complex emotions and fears. You may feel so tired from treatments or stress that you have trouble getting through the day. Worrying about recurrence can keep you awake at night. Lack of sleep, which in turn leads to fatigue, may affect your self-esteem, mood, emotions, relationships and work.
But you don’t have to be tired all the time just because you have cancer. Doing what you can to get good quality sleep is an act of self-care that can improve your well-being.
You know what it’s like to be physically exhausted after a tough week at work or a busy day of hiking or chasing a toddler. Fatigue related to cancer or its treatments is different. It’s a constant feeling of tiredness or complete exhaustion that is unrelated to your recent activity. Even a good night’s sleep doesn’t help.
Some warning signs or symptoms of cancer-related fatigue are:
- feeling tired, even after a night’s rest
- lacking energy or having less energy
- difficulty concentrating
- lack of motivation
- increased irritability, anxiety or nervousness
Cancer-related fatigue can:
- Last for long periods and take away your energy to do even easy everyday tasks.
- Make you feel tired, weak and sluggish.
- Cause you to move more slowly than usual or to need help getting around.
- Be common during active treatment and may begin to improve several weeks or a month after treatment ends.
- Persist for as long as 6 months to 1 year after treatment. For some, it takes even longer for energy to return.
A night or two of poor sleep can be annoying, but the problem normally resolves itself. With insomnia, which is a type of sleep disorder, you have trouble falling asleep or staying asleep three or more nights a week over a long period.
Insomnia impacts your body’s ability to fight infection and increases your risk of developing anxiety, sadness and depression. If you think you have insomnia, you should discuss it with your treatment team.
Some signs of insomnia are:
- You have trouble sleeping most nights.
- You lie awake for hours. Or, you fall asleep quickly but wake up and can’t go back to sleep.
- You rarely feel well-rested in the morning.
- You have trouble concentrating, finishing tasks and staying awake during the day.
Sleep Problems Before Breast Cancer
If you had sleep problems before breast cancer, you could have insomnia or another sleep disorder unrelated to breast cancer. Conditions such as low thyroid function, heart disease and anemia (a low red blood cell count) can cause fatigue. Your sleep problems could be caused by emotional issues or medicines you take for other illnesses. If your sleep troubles began with your cancer diagnosis or when a certain treatment began, there likely is a connection.
Whatever the reason, you should talk to your healthcare team.
Many factors can cause sleeping problems in people with cancer, and it can be challenging to find a single cause. Identifying possible causes will help you and your healthcare team figure out ways to help maintain your energy.
Poor sleep habits can take a toll when you are dealing with cancer. Some factors to consider – do you:
- Go to bed and wake up at different times each day?
- Drink coffee, tea or other caffeinated beverages at night?
- Engage in activities that stimulate you – scary or violent movies, video games, computer work, exercise – too close to bedtime?
- Drink alcohol before bed? (It might help you fall asleep, but it keeps you from getting the deep sleep you need to feel well rested.)
Even with a good network of support, you may feel nervous, anxious, sad, depressed, fearful or overwhelmed. These emotions can leave you feeling drained yet unable to sleep. You may:
- Have increased anxiety as you make treatment decisions.
- Worry about what is going to happen to you and your family.
- Have concern about pain or side effects or upcoming treatments, exams or test results.
- Worry about recurrence and a lack of support because you are not seeing your providers as often after treatment ends.
Some people feel so sad that they have trouble enjoying the things that normally make them happy. Some feel like they can’t get out of bed each day. If your emotions are getting in the way of everyday function, you may have clinical anxiety or depression, which can slow down your recovery and lead to other problems. Share your feelings with your healthcare team so they can recommend a treatment.
- Radiation therapy commonly causes fatigue.
- Chemotherapy medicines make it harder for the bone marrow to produce red blood cells, which carry oxygen through the body to cells and tissues. Having fewer red blood cells than normal is known as anemia. If cells aren’t getting enough oxygen, you may feel very tired.
- Nausea, vomiting and diarrhea cause a loss of fluids and electrolytes (salts and minerals in the blood) that help maintain energy.
- Loss of appetite, constipation or mouth sores can make it hard to eat, which means you may not be getting enough nutrients.
- Infection or weight changes due to treatment can affect your energy level.
- Long periods of inactivity or bed rest while recovering from surgery or chemotherapy treatments can make you feel tired and weak.
- Hormonal therapies that shut down the making of estrogen can cause the same symptoms as menopause, including hot flashes, night sweats and changes in mood, sleep, energy and daily function.
- Medicines to treat the side effects of cancer treatments can cause their own side effects. Antidepressants and anti-nausea and pain medicines can cause fatigue. Steroids given before treatment to reduce nausea or allergic reactions, common with taxane-based chemotherapies, can interfere with sleep. Anti-anxiety medicines can add to feelings of fatigue. Your healthcare provider can help you find the right medicines with the least side effects.
- Pain contributes to sleep problems. You may get in a cycle of feeling pain, not being able to sleep, becoming fatigued from not sleeping and being kept awake with worries about pain. Talk with your provider about how to control pain while maintaining your energy level.
Your healthcare team should screen you for signs of insomnia and fatigue during treatment and beyond. If fatigue is interfering with your daily life and your doctor doesn’t mention it, you should bring it up.
Before your appointment, prepare to answer questions about your sleeping, eating and exercise habits and any emotional changes since treatment began. If you can, keep a calendar and mark changes in fatigue or insomnia. Do they vary throughout the day or by the day of the week? How do they relate to your treatment days, physical activity or other events?
Some tips to get ready for your appointment:
- Be as open and descriptive as possible so your team can find the best ways to help.
- Rate how tired you feel on a scale of 0 to 10. Zero being no fatigue, 10 being the most exhausted you have ever felt.
- Describe problems falling asleep, staying asleep, waking too early or being unable to fall back asleep.
- Tell your provider how fatigue interferes with your life and what activities you stopped since it began.
- Let your doctor or nurse know if you can’t keep up with your treatment because of insomnia and fatigue.
- Report any over-the-counter sleep aids you might be taking.
- Make sure to mention pain or shortness of breath during exercise.