1. ACCEPT THE NEW NORMAL. “There’s no five-year cure,” says breast cancer survivor Julie Silver, M.D., an assistant professor at Harvard Medical School and author of After Cancer Treatment. “Even once you’ve been treated, you won’t ever feel safe again. But you can learn to live with it.”
When the fear wakes you up at night, counter it with positive images. Read books that keep your attention without having a plot that is too heavy. “I kept books by my bed that were very positive,” says Dr. Silver, explaining that when you read, your brain literally takes a right turn away from what you’ve been thinking about, retools, and goes in a new direction. “So I really focused on putting positive images in my brain.”
2. TRUST YOUR INSTINCTS. “You know your body best,” says Dr. Silver. “No doctor will ever know it as well. Whether you think it’s women’s intuition or whatever, there’s something that tells us when something’s wrong. So when you think something’s wrong, write down your symptoms and tell your doctor. And don’t let anyone label you a hypochondriac. Trust your instincts.”
3. MOVE. “Exercise improves sleep as effectively as benzodiazepines in some studies,” reports Kalyanakrishnan Ramakrishnan, M.D., an associate professor at the University of Oklahoma Health Sciences Center. That makes exercise the number one treatment for insomnia in cancer survivors. But what also makes exercise the perfect prescription is the fact that it reduces the enormously debilitating fatigue that cancer survivors say is their chief complaint—and it cuts the eye-popping nighttime worry about recurrence.
In a Harvard Medical School study of more than 3,000 women with breast cancer, researchers found that those who walked 3 to 9 hours a week at a moderate (2 to 2.9 m.p.h.) pace reduced their risk of recurrence and death by 20 percent. If they walked 9 to 15 hours a week, they cut their risk by 50 percent. If they walked 15 to 24 hours a week, they cut their risk by a whopping 60 percent. More exercise than that, or more intense exercise, had no added benefit.
4. MEDICATE. “Pain is something that cancer patients really worry about,” says Dr. Silver. Pain from tumors, pain from treatment, pain from the physical deconditioning that can take place through treatment, pain during recovery. Unfortunately, she adds, “the worry that pain is coming back can keep you awake as much as the pain does itself.”
The trick is to stay on top of pain with regular doses of medication 24 hours a day. Women wake up in the morning and they feel good, so sometimes they don’t take the pain medication their doctor has prescribed, or they don’t take as much as they could, says Dr. Silver. They figure they can handle the little bit of pain they’ve got and save the medication for the big stuff. The problem is that the little stuff builds up during the day so that at night it’s too big for the medication to handle. So take as much as your doctor prescribes, as often as she prescribes it.
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5. GIVE UP NAPS. Since cancer and its treatment generally increase fatigue, chances are you’ll start taking naps while you’re undergoing treatment. But don’t forget to give them up once you finish treatment. Otherwise, they’ll begin to interfere with your ability to sleep at night.
6. ALERT YOUR DOCTOR. Sometimes your sleep is disrupted by the side effects of medication. So don’t just dismiss insomnia as a natural consequence of middle-of-the-night worry over your health. Tell your doctor about it and ask what she thinks is the cause. Between the two of you, and maybe a night in a sleep lab, you may be able to get it fixed. If your chemotherapy is causing hot flushes, for example, a simple device like a Chillow—an ice-cooled pillow—and lowering your bedroom temperature may be enough to help you sleep through the night.
7. MAKE A SPECIFIC APPOINTMENT. Insomnia and fatigue are so common among cancer survivors that doctors sometimes don’t pay attention when patients mention them. There’s a lot going on during your appointment, and your doctor may tend to focus on other problems.
The way to get your doctor to focus on your sleep problem is to keep a sleep log (see page 104), says Dr. Silver. “Write down what’s happening—what time you go to bed, how long it takes you to fall asleep, how often and when you wake up during the night, whether or not you fall back asleep, and what time you do,” says Dr. Silver.
Then make a specific appointment that is devoted only to the sleep problem. That alone will impress your doctor of the seriousness of your sleep’s disruption. But you should also pay attention to how you present the problem, she adds. “If a patient comes in and says, ‘I’m really concerned about my sleep’ rather than just saying, ‘I haven’t been sleeping,’ that will trigger your doctor’s concern.”
8. PLAY BY THE RULES. The tenets of sleep medicine are well established, says Dr. Silver. And you can maximize your chances of a good night’s sleep by sticking to them. Aim for between seven and eight hours of sleep a night. Avoid alcohol, exercise, and caffeine after 4:00 P.M. Shut down the computer early. Take a hot bath—not a shower—about an hour before bed to help you unwind. A light snack can help. Go to bed only when you’re tired. If you wake up, lie in bed for only 20 to 30 minutes. After that, you should get up, go to another room, and return to bed only when you’re sleepy again. Use your bedroom only for sleep or sex. Oh, all right—and for reading romance novels.
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