Overcoming Insomnia and Anxiety After Breast Cancer Chemotherapy

Severe insomnia after chemotherapy for breast cancer?

Hello Dr.
Chen,
Five years ago, I underwent surgery and chemotherapy for breast cancer, and since then, I have been struggling with insomnia and anxiety.
I have consulted with doctors during this time for treatment, but my symptoms have been recurrent.
Besides continuing with medication, are there any other methods that could help improve my condition? Thank you very much.

Sincerely, Sherry

Xue Li, 50~59 year old female. Ask Date: 2016/07/27

Dr. Chen Wenke reply Psychiatry

Good afternoon, Sherry.
I was somewhat surprised to receive your letter, as I have not been involved in addressing medical issues for quite some time.
However, I would like to discuss the concerns that have troubled you over the years.

Firstly, chemotherapy drugs can cause physical fatigue, which often leads to feelings of drowsiness during the day and can certainly affect nighttime sleep as well.
Secondly, during chemotherapy, patients frequently experience uncomfortable symptoms that may require the use of corticosteroids, which can create a sense of increased energy.
Therefore, if such medications are taken at night, they can also impact sleep.
If this is the case, it may be necessary to adjust the timing of medication administration.
The third point is that having cancer itself is a significant source of stress, and stress is often a major contributor to insomnia.
Many people worry about not being able to sleep at night, which leads to persistent thoughts and anxiety, further negatively affecting sleep.
So, what can be done? Here are some sleep hygiene practices for your consideration.
These are conceptual guidelines, and if you can adjust and practice according to these principles, it should help with your insomnia:
1.
Avoid eating and exercising for two hours before bedtime.
2.
Turn off the lights in your room.
3.
If there is a clock in the room, it is advisable to remove it.
4.
The bed should be used for sleeping, so avoid watching TV or reading in bed.
5.
Establish a consistent sleep routine by keeping regular sleep and wake times.
6.
Minimize daytime napping.
7.
If possible, schedule regular physical activity during the day, such as walking for 30 minutes.
8.
Try to avoid caffeinated beverages.
9.
If pain is affecting your sleep, you may need to consult your physician for pain management.
10.
If your sleep issues are related to emotional stress, engaging in moderate stress management and relaxation activities, such as listening to soft music and practicing relaxation techniques, can be beneficial for your sleep.
11.
If you experience symptoms of depression, it is important to seek assistance from a professional healthcare provider.
12.
Finally, incorporating meditation and mindfulness practices can help you learn to relax your tense body, which will greatly benefit your sleep.
There are many free relaxation and meditation resources available online that you can utilize.
I hope these basic strategies provide you with some assistance.
By practicing relaxation and meditation techniques, you will gradually find that your sleep becomes less of a concern.

Best wishes,
Dr.
Wen-Ko Chen

Reply Date: 2016/07/27

More Info

Overcoming insomnia and anxiety after breast cancer chemotherapy can be a challenging journey, especially when the symptoms persist despite medical intervention. It's important to understand that both insomnia and anxiety can be common experiences for cancer survivors, particularly after undergoing treatments like chemotherapy. Here are some strategies that may help you manage these symptoms more effectively.

Understanding the Causes
1. Physical Effects of Chemotherapy: Chemotherapy can lead to fatigue, hormonal changes, and other physical symptoms that may disrupt sleep. The medications used during treatment can also have side effects that contribute to insomnia.

2. Psychological Impact: The diagnosis of cancer and the subsequent treatment can create significant emotional distress. Anxiety about health, fear of recurrence, and the stress of managing a chronic illness can all contribute to sleep disturbances.

3. Medication Side Effects: If you are taking medications such as Xanax or Ativan for anxiety, it's crucial to discuss with your healthcare provider how these might be affecting your sleep patterns. While these medications can help with anxiety, they may also lead to dependency or withdrawal symptoms that can disrupt sleep.

Strategies for Improvement
1. Sleep Hygiene Practices: Establishing a consistent sleep routine can significantly improve sleep quality. Here are some tips:
- Regular Sleep Schedule: Go to bed and wake up at the same time every day to regulate your body's internal clock.

- Create a Relaxing Bedtime Routine: Engage in calming activities before bed, such as reading, gentle stretching, or meditation.

- Limit Screen Time: Reduce exposure to screens (phones, tablets, TVs) at least an hour before bedtime, as blue light can interfere with melatonin production.

2. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices can help reduce anxiety and promote better sleep:
- Meditation: Regular meditation can help calm the mind and reduce anxiety. There are many guided meditations available online specifically designed for sleep.

- Deep Breathing Exercises: Practicing deep breathing can help lower stress levels and prepare your body for sleep.

- Progressive Muscle Relaxation: This technique involves tensing and then relaxing each muscle group, which can help release physical tension.

3. Physical Activity: Regular physical activity can help improve sleep quality and reduce anxiety. Aim for at least 30 minutes of moderate exercise most days of the week, but try to avoid vigorous exercise close to bedtime.

4. Dietary Considerations: Pay attention to your diet, especially in the hours leading up to bedtime:
- Limit Caffeine and Alcohol: Both substances can disrupt sleep patterns. Try to avoid them, especially in the afternoon and evening.

- Healthy Snacks: If you're hungry before bed, opt for a light snack that includes sleep-promoting nutrients, such as a banana or a small bowl of oatmeal.

5. Professional Support: If your insomnia and anxiety persist, consider seeking help from a mental health professional who specializes in working with cancer survivors. Cognitive-behavioral therapy (CBT) has been shown to be effective for insomnia and anxiety.

6. Medication Review: Consult with your healthcare provider about your current medications. They may suggest adjusting dosages or switching to alternatives that have fewer side effects related to sleep.

Conclusion
While the journey to overcoming insomnia and anxiety after breast cancer treatment can be difficult, implementing these strategies can help you regain control over your sleep and emotional well-being. Remember to be patient with yourself as you navigate this process, and don’t hesitate to reach out for support from healthcare professionals, family, and friends. Your health and peace of mind are paramount, and taking proactive steps can lead to significant improvements in your quality of life.

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