Sleep disruption at a glance
Difficulty falling asleep, staying asleep, or achieving restful sleep are all markers of sleep disruption. They can impact your ability to function, may worsen symptoms and side effects during cancer treatment, and may even affect your response to treatment. Many therapies and practices are available to help you get the sleep you need.
If you have difficulty managing your daily schedule to give yourself at least seven hours in bed before you need to get up, see our Sleeping Well handbook for guidance.
In this handbook, we discuss ways to manage and improve your sleep quality if you have trouble falling asleep or staying asleep once you’re in bed.
Prescription sleep medications are effective at promoting sleep, but many come with risks and side effects. Behavior changes and complementary therapies may be effective without these side effects.
Sleep disruption may be a symptom of stress. If stress is contributing to your sleep disruption, stress management will be important for you.
Top practices and therapies for managing sleep disruption
Therapies and practices we have reviewed
The effects of these practices and therapies are described below on this page. Full details of evidence are on the therapy reviews, accessible through the image links below.
Further therapies and practices
Therapies recommended in clinical practice guidelines but that we haven’t yet reviewed; see belowUse your browser's Back button to return to this location. for guidelines ›
Chinese herbal blends (consult a Chinese medicine practitioner)
Cognitive Behavioral Therapy
Minimize alcohol use
Music and arts therapies
Optimize your body weight
Several other therapies have some evidence of benefit. The benefit may be meaningful or even substantial, but our reviews show the evidence so far is preliminary.
Fermented wheat germ extract
Support groups and interventions
On this page
What is sleep disruption?
Sleep disruption, also called insomnia, is the inability to fall asleep in a reasonable amount of time, or to return to sleep on awakening during the night, or to achieve restful sleep.
What are the signs or symptoms of sleep disruption?
Sleep disruption is marked by these symptoms:
Difficulty falling asleep
Nighttime waking frequently and/or with an inability to get back to sleep for an hour or more
Not feeling refreshed in the morning
What may cause or trigger sleep disruption?
Many factors can interfere with the quality of sleep: “These include unresolved stress, a noisy bedroom environment, too much light in the bedroom, a bedroom that is too warm, hormonal issues such as hot flashes, too much alcohol, insufficient protein in the evening meal and side effects of medications.”1Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010.
Some medications used during cancer treatment or for other conditions may trigger sleep disruption. Check the inserts with any prescription medications you use or ask your pharmacist if you have concerns. Therapies that we have reviewed that may trigger sleep disruption:
- Insomnia is a common side effect of nonsteroidal anti-inflammatory drugs (NSAIDs ›
- Difficulty sleeping, nightmares and vivid dreams during the first week of use are reported side effects of low-dose naltrexone ›
Insomnia is often related to lifestyle choices and situations that take us away from our natural rhythms and that promote inactivity:
Overeating, eating foods that interfere with sleep promotion, or eating late in the evening or at night
Consuming energy drinks
Overwork or nighttime work
Staying up late and “screening”—looking at television, computer and/or cell phone screens for long hours, especially late in the evening
Chronic unmanaged stress
Exposures and sleep
Some environmental exposures are thought to contribute to sleep disruption. Research is still sparse, but blue light from electronics and bright light shortly before bedtime may disrupt sleep.
Blue light, which is emitted from screens on electronics such as cell phones, tablets, computers, televisions, and other devices, may disrupt sleep when people are exposed in the evening and/or after bedtime:
- Better balance of hormones related to sleep (melatonin) and wakefulness (cortisol) among people exposed to bright or blue-enriched light during the day and not in the evening (modest evidence)
- Improved sleep efficiencythe ratio of total sleep time to time in bed among fatigued people with cancer exposed to bright white light in the morning (preliminary evidence)
- Some worse indicators of sleep quality among children and adults using electronic devices near bedtime or after going to bed, but no negative effects for adults using electronic devices for 2 hours at night following exposure to bright light for 6.5 hours earlier in the day (preliminary evidence)
Some people suggest that electromagnetic fields from electrical wiring, wi-fi or phone signals, or other sources may disrupt sleep. Evidence to date does not support a link:
- Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of effects from extremely low frequency electromagnetic fields (ELF-EMFs)—produced by power lines, electrical wiring, and electrical equipment—on hormone levels related to sleep
- Shorter time to fall asleep with exposure to signals used in mobile radio and two-way transceivers (TETRA)―used primarily in emergency communications systems―or in mobile communications systems (GSM900 EMF) (preliminary evidence)
- Insufficient (conflicting) evidence of effects on sleep from exposure to wi-fi or cellular signals
Details of the evidence and footnotes are within this handbook.
These conditions are related to sleep disruption in adults:2Smagula SF, Stone KL, Fabio A, Cauley JA. Risk factors for sleep disturbances in older adults: evidence from prospective studies. Sleep Medicine Reviews. 2016 Feb;25:21-30; CJung HK, Choung RS, Talley NJ. Gastroesophageal reflux disease and sleep disorders: evidence for a causal link and therapeutic implications. Journal of Neurogastroenterology and Motility. 2010 Jan;16(1):22-9. Okuyama M, Takaishi O et al. Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults. Scandinavian Journal of Gastroenterology. 2017 Jan;52(1):44-49.
Lower physical activity levels
Lower economic status
Previous manual occupation
Low marital quality among older adults
Loneliness and perceived stress
Long-term benzodiazepine or sedative use
Low testosterone levels
Markers of inflammation
Gastroesophageal reflux disease (GERD)
Some of these relationships with sleep disruption work both ways. For example, physical illness may precede and increase the risk of sleep disruption, but sleep disruption may also precede and increase the risk of physical illness. The same may be true for depressed mood, low marital quality, inflammation, and other conditions.
The increased incidence of depression, inflammation, and illness among people with cancer may also be a factor in why people with cancer report insomnia at twice the rate as the general population.3Irwin MR. Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Current Psychiatry Reports. 2013;15(11):10.1007/s11920-013-0404-1.
Why is managing sleep disruption important?
Getting seven to eight hours of sleep regularly is one step you can take to improve your resilience and well-being. Adequate and quality sleep may improve your ability to manage side effects and symptoms related to your cancer experience, reduce your risk of recurrence, and possibly improve your response to treatment.
Unmanaged symptoms such as pain, depression, or anxiety can contribute to insomnia, and then insomnia can often worsen these and other cancer-related symptoms.
We review the evidence of links between sleep and cancer, and between sleep and side effects and symptoms in this handbook.
What approaches can help me manage sleep disruption?
We present many approaches to reducing sleep disruption and the evidence regarding their effectiveness. Sleep disruption may also be a symptom of stress. If stress is contributing to your sleep disruption, managing your stress will be important in reducing it.
Insomnia and sleep disruption are often treated with sleep medications which may help temporarily but don’t address the underlying cause. In addition, these medications, such as benzodiazepine agonists, can be habit-forming and may even increase risks of death from a variety of causes including overdose, infections, cancer, depression and suicide, hypnotic-withdrawal insomnia, and automobile crashes, falls, and other accidents.4Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000 Research. 2016;5:918. While sleep medications are an option to promote restful sleep, they are only one of many options, as described on this page.
Eszopiclone (Lunesta) showed the best effect at reducing sleep latency among several pharmacological interventions in a large meta-analysis of RCTs of high quality.5Zheng X, He Y et al. Pharmacological interventions for the treatment of insomnia: quantitative comparison of drug efficacy. Sleep Medicine. 2020 Aug;72:41-49.
Ramelteon, a less-known option
Ramelteon (Rozerem) is a prescription drug classified as a melatonin receptor agonist. It works similarly to melatonin, although even more effectively. Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) shows it can improve the time needed to fall asleep (sleep latency) and sleep quality, even among critically ill people.6Kuriyama A, Honda M, Hayashino Y. Ramelteon for the treatment of insomnia in adults: a systematic review and meta-analysis. Sleep Medicine. 2014 Apr;15(4):385-92; Zhang Q, Gao F, Zhang S, Sun W, Li Z. Prophylactic use of exogenous melatonin and melatonin receptor agonists to improve sleep and delirium in the intensive care units: a systematic review and meta-analysis of randomized controlled trials. Sleep & Breathing. 2019 Dec;23(4):1059-1070; Liu J, Wang LN. Ramelteon in the treatment of chronic insomnia: systematic review and meta-analysis. International Journal of Clinical Practice. 2012 Sep;66(9):867-73. Ramelteon is approved in the United States and Japan for the treatment of insomnia, and it offers these advantages as a sleep aid compared to other drugs:
- It is not habit-forming.
- It helps with optimizing your sleep-rest cycle (circadian rhythm).
- It produces less grogginess upon awakening.
Several precautions are noted on the Medline Plus website: Ramelteon ›
Laura Pole, RN, MSN, OCNS, CancerChoices senior clinical consultant: I was impressed by the research on ramelteon as a sleep aid, particularly its apparent safety and effectiveness, without some of the undesirable side effects such as potential for abuse and dependence, or significant morning-after grogginess. I was also surprised that I hadn’t seen it being prescribed in the geriatric and palliative care settings where I worked. I contacted three colleagues specializing in geriatric, integrative and/or palliative care medicine. One was vaguely familiar with it but didn’t prescribe it, while the other two had not heard of it, though all were familiar with the natural product melatonin for its sleep assistance and anticancer properties.
After hearing about ramelteon, the integrative medicine physician did his own research and found no mention of it in the cancer literature, but impressive evidence for helping insomnia. He has decided to begin prescribing it for some of his patients with insomnia not helped by non-drug approaches. None of us knows why this drug isn’t more familiar to the medical community—it may have very little to do with any concerns about safety/effectiveness and more to do with lack of marketing and/or cost compared to commonly used prescription sleep aids.
CancerChoices finds this drug interesting both for the way it helps with sleep and the fact that it’s not a scheduled drug with a high potential for abuse as many other prescription sleep aids are, doesn’t cause physical withdrawal symptoms when stopped and doesn’t cause a “hung-over” feeling the next day. If you take this drug for insomnia, we would like to hear about your experience.
Sleep apnea treatment
If sleep apnea is contributing to your sleep disruption, conventional approaches such as continuous positive airway pressure (CPAP) may improve wellness and your body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more.7Shang W, Zhang Y, Wang G, Han D. Benefits of continuous positive airway pressure on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea: a meta-analysis. Diabetes, Obesity and Metabolism. 2021 Feb;23(2):540-548.
Before turning to conventional or complementary therapies to help you sleep better, you may want to evaluate your sleep environment and lifestyle practices to be sure those don’t interfere with your sleep. They may even promote better sleep.
Practice good sleep hygiene, including these practices:8National Sleep Foundation. Sleep Hygiene. Viewed November 6, 2021; Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.
Set your sleep schedule: try to get to bed and wake up at relatively similar times each day.
Limit alcohol and caffeine.
Don’t dine late in the day—try to finish eating at least three hours before bedtime.
Reserve your bed for sleeping and intimacy, but not other activities such as watching television, phone conversations, eating, or other activities.
Make your bedroom comfortable and promoting of sleep, including keeping it dark, quiet, and not too warm, and get a comfortable bed and pillow if possible
Eating Well: preliminary evidence
Better sleep quality among people eating a diet rich in fruit, vegetables, whole grains, and foods high in omega-3 fatty acids (preliminary evidence)significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently)
Moving More: strong and good evidence
Less sleep disruption and better sleep without regard to treatment among people participating in exercise (strong evidence)consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently)
Better sleep among people participating in exercise, especially aerobic exercise, during treatment (strong evidence)
Better sleep among people participating in exercise after treatment (strong evidence)
Less insomnia among people with advanced cancer participating in exercise (good evidence)significant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently)
Creating a Healing Environment: preliminary and insufficient (conflicting) evidence
Improved sleep efficiencythe ratio of total sleep time to time in bed among fatigued people with cancer exposed to bright white light in the morning (preliminary evidence)
Less sleep disruption among people exposed to blue-depleted light during the evening and night (preliminary evidence)
Insufficient (conflicting) evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of effects from extremely low frequency electromagnetic fields (ELF-EMFs)—produced by power lines, electrical wiring, and electrical equipment—on hormone levels related to sleep
Preliminary evidence of shorter time to fall asleep with exposure to signals used in mobile radio and two-way transceivers (TETRA)―used primarily in emergency communications systems―or in mobile communications systems (GSM900 EMF)
Insufficient (conflicting) evidence of effects on sleep from exposure to wi-fi or cellular signals
If heartburn is contributing to sleep disturbance, raising your bed head may reduce heartburn and lead to better sleep.
Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of fewer symptoms of heartburn and less sleep disturbance among people elevating the head of their beds
- Fewer symptoms of heartburn and less sleep disturbance among people with symptomatic nocturnal reflux and documented recumbent (supine) reflux elevating the head of their beds on a 20-cm block for 6 nights compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design9Khan BA, Sodhi JS et al. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux. Journal of Gastroenterology and Hepatology. 2012 Jun;27(6):1078-82.
We present complementary therapies supported by evidence for managing sleep disruption and promoting sleep. Those with the best evidence are presented first. Details of research evidence are on our reviews of each therapy.
A therapy may show a stronger effect or have more evidence in some situations than in others.
Good or modest evidence of benefit
Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) indicates a relatively high degree of confidence that the therapy is linked to the outcomes as noted. Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) means several smaller or at least one large study have found the effect described.
Acupuncture: modest and weak evidence
Less sleep disturbance among people treated with acupuncture without regard to treatment phase (modest evidence)
Less sleep disturbance during chemotherapy among people treated with acupuncture (weak evidence)
Recommended in a practice guideline for treating insomnia; see belowUse your browser's Back button to return to this location. for guidelines ›
Tai chi or qigong: good and modest evidence
Better sleep quality during or after cancer treatment among people with cancer practicing tai chi or qigong (good evidence)
Less sleep disruption without regard to treatment phase among people with cancer practicing tai chi or qigong (modest evidence)
Recommended in in a practice guideline for improving sleep; see belowUse your browser's Back button to return to this location. for guidelines ›
Yoga: good evidence
Less sleep disruption among people with cancer practicing yoga (good evidence)
Recommended in practice guidelines for improving sleep; see belowUse your browser's Back button to return to this location. for guidelines ›
Therapies with preliminary or weak evidence of benefit for sleep disruption
Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) typically indicates that not much research has been published so far, although the outcomes may be meaningful. Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) may mean that the effects are small or that only very preliminary research has been published.
Better sleep quality among people with several types of cancer, including during chemotherapy (preliminary evidence)
Better sleep among people with advanced metastatic cancers treated with intravenous (IV) astragalus polysaccharides (weak evidence)
Better sleep among people with breast cancer experiencing daily hot flashes treated with electroacupuncture (preliminary evidence)
Less sleep disturbance among people with breast cancer experiencing joint pain related to aromatase inhibitors treated with electroacupuncture (weak evidence)
Fewer symptoms of insomnia among people with breast cancer treated with FWGE (weak evidence)
Better sleep (less insomnia) among people with advanced metastatic tumors following a ketogenic diet (weak evidence)
Better sleep quality without regard to treatment phase among people with cancer treated with melatonin (preliminary evidence)
Better sleep quality after surgery among people treated with melatonin (preliminary evidence)
Better sleep quality during cancer treatment among people treated with melatonin (preliminary evidence)
Better sleep quality during intensive care among people treated with melatonin (preliminary evidence)
Less insomnia among people with advanced or metastatic pancreatic cancer treated with mistletoe extract (preliminary evidence)
Less insomnia among middle-aged women treated with polarity therapy (not specific to people with cancer) (preliminary evidence)
Less sleep disruption during endocrine therapy among people with breast cancer treated with reishi mushroom (preliminary evidence)
Less sleep disruption among people with advanced lung cancer treated with reishi mushroom (preliminary evidence)
Insomnia is listed as a side effect of reishi mushroom.
Better sleep quality among adults and children with cancer treated with relaxation
Better sleep quality, but no significant effect on sleep latency or waking after sleep onset among people with insomnia treated with relaxation (not specific to people with cancer) (weak evidence) (preliminary evidence)
Small decreases in sleep disturbance among people with breast cancer participating in telephone sessions of education/support (preliminary evidence)
Better sleep quality among students (preliminary evidence)
Insufficient evidence of benefit
- Insufficient evidence of better sleep quality among people with cancer or chronic pain treated with oral cannabis or cannabinoids
These therapies are used to manage sleep disruption, but we have not yet reviewed their effectiveness or safety. Those in bold are recommended in at least one clinical practice guideline; see belowUse your browser's Back button to return to this location. for guidelines ›
Chinese herbal blends
Lavender (see Expert commentary about skin application of lavender oil)
Massage, whether with or without aromatherapy
Minimize alcohol use
Music and arts therapies
Optimize your body weight
- Cognitive Behavioral Stress Management (CBSM)
- Cognitive Behavioral Therapy
- Cognitive Behavioral Therapy for Insomnia (CBT-I)
- Mindfulness-based stress reduction (MBSR)
- Sleep Training Education Program
Resources for managing sleep disruption
How do integrative experts manage sleep disruption?
Both medical groups and integrative experts provide recommendations for managing sleep disruption. Learn more about the approaches and meanings of recommendations.
Clinical practice guidelines
2013 clinical practice guidelines from the American College of Chest Physicians weakly recommend mind-body modalities and/or yoga as part of multidisciplinary approach for managing sleep difficulties among people with lung cancer.
Grade C: can be considered for the management of sleep disturbance in women with a history of breast cancer. Evidence provides some support for recommendation(s) but care should be taken in its application.
Purpose-designed cognitive behavioral therapy
Grade D: can be considered, noting there is inconsistent evidence regarding its effectiveness
Not recommended for the management of sleep disturbance in women with a history of breast cancer due to evidence that it is not effective:
The 2019 guideline recommends several traditional Chinese herbal blends or acupuncture for insomnia, depending on the specific pattern of symptoms.
NCCN guidelines for patients for survivorship care for cancer-related late and long-term effects lists these complementary therapies and self-care practices as strategies to manage sleep difficulties.
Cognitive-behavioral therapy (CBT)
Optimize your body weight
Minimize alcohol use
The 2009 guidelines for complementary therapies and botanicals states that exercise and mind-body approaches—as part of a multidisciplinary approach—improve sleep, specifically mentioning these therapies and practices
Autogenic training hypnosis
Music therapy and other forms of expressive arts therapies
Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment › This set of guidelines has been endorsed by the American Society of Clinical Oncology (ASCO).10Lyman GH, Greenlee H et al. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology. 2018 Sep 1;36(25):2647-2655.
The 2017 Society for Integrative Oncology clinical practice guidelines regarding breast cancer patients provide these statements regarding these therapies and practices for sleep disturbances:
Gentle yoga can be considered for improving sleep
Insufficient evidence to recommend calendula cream, meditation, qigong, or acupuncture
Published programs and protocols
These protocolsa package of therapies combining and preferably integrating various therapies and practices into a cohesive design for care, programs, and approaches by leaders in integrative cancer care provide guidance for managing sleep disruption.
We do not recommend specific integrative protocols or programs but provide information for you to evaluate with your healthcare team.
Lise Alschuler, ND, FABNO, and Karolyn Gazella
Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010
Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013.
Approaches are described for certain cancer types, or along with certain conventional therapy treatments, or for particular conditions including sleep disruption.
Keith Block, MD
Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009.
The integrative Block Program has recommendations to people who are at different places along the cancer continuum:
- Those who’ve been recently diagnosed
- Those in treatment
- Those who’ve concluded treatment and need to remain vigilant to prevent recurrence
Integrative physician and CancerChoices advisor Keith Block, MD, and his colleagues offer guidance about how and when to be active to promote normal sleep-rest (circadian) function.11Block KI, Block PB et al. Making circadian cancer therapy practical. Integrative Cancer Therapies. 2009 Dec;8(4):371-86.
In addition to the sleep hygiene practices › recommendations above:
- Avoid exercising to exhaustion, which increases cortisol levels.
- Avoid evening exercise.
- Avoid overwork and other very stressful activities that could disturb sleep through anxiety and catecholamine release; see Managing Stress ›
- Do not lie in bed after waking up at night; if you don’t fall asleep again soon, get up and leve your bedroom.
Further mind–body guidelines:
- Develop a quality social-support network.
- When possible, delegate stressful tasks.
- Use cognitive-behavioral therapy for stress and insomnia issues.
- Adopt effective stress management techniques such as abdominal breathing.
- Fretting over lost sleep only increases anxiety; find practices that can help you let go of worries and intrusive thoughts.
- Keep a notebook for middle-of-the-night worries or thoughts.
Special guidance for people with cancer
Dr. Keith Block and his colleagues offer guidance to promote normal circadian (sleep-rest) function among people in chemotherapy treatment, with advanced disease, or experiencing wasting (cachexia).12Block KI, Block PB et al. Making circadian cancer therapy practical. Integrative Cancer Therapies. 2009 Dec;8(4):371-86.
Foods and eating patterns to emphasize:
- Eat foods high in both calories and nutrition: healthful concentrated carbohydrate sources such as vegetables, lower dietary fiber, and increased proteins, including fish, egg whites, l-glutamine, chlorella supplements, and whey protein.
- Eat more foods and oils rich in omega-3 fatty acids, such as flaxseed oil, soybean oil, and canola oil, medium-chain triglycerides in coconut oil or palm kernel oil, and to a lesser extent, omega-6s.
- Adjust your meal schedule to a grazing pattern of 6–8 meals daily.
- Shift your largest meal of the day to breakfast, when your appetite may be best.
- Supplement meals with whey protein, soy protein, and medium-chain triglyceride shakes
- For wasting (cachexia), use anti-inflammatory supplements such as curcumin, fish oil, boswellia, or scutellaria.
Foods and eating patterns to avoid or minimize:
- Reduce your dietary glycemic load, especially in the morning.
- Lower your salt intake to optimize your potassium–sodium intake and ratio
- Eliminate chemicals that overstimulate neuron receptors (excitotoxins) including monosodium glutamate (MSG) and aspartame.
- Avoid foods containing tyramine after dinner, which increase norepinephrine release.
- Avoid overly spiced foods or other foods that cause digestive problems during sleep.
Guidelines for exercise
- Reduce your emphasis on long sessions of aerobic exercise.
- Emphasize interval training—repeated short sessions of aerobic-type exercise.
- Emphasize strength or resistance training; use light weights or isometrics in short sessions repeated several times daily.
- Emphasize practices such as yoga, Pilates, qigong, or tai chi that increase flexibility.
- Do not overexercise, as this produces inflammation and increases cortisol.
Find and address imbalances in your body terrain
Further actions for balancing sleep, rest and activity and promoting restful sleep:13Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009
Work in partnership with your doctor to assess and monitor hormone imbalances; this may involve lab tests.
Consider supplements as indicated:
- Take adaptogens—such as Siberian ginseng (eleuthero), rhodiola, ginkgo or American ginseng—purported to aid in normalization of stress reactions and improve energy; take only in the morning if your sleep is disturbed.
- Avoid stimulant supplements including B vitamins, tyrosine, phenylalanine, glutamine, ginsengs, dehydroepiandrosteron (DHEA) and licorice in the evening.
- Consume herbal sedative teas or supplements—lemon balm, chamomile, valerian, hops, l-theanine, mimosa bark (Cortex albizziae), lavender, passionflower.
- Take melatonin or 5-HTP at bedtime.
Lorenzo Cohen, PhD, and Alison Jefferies, MEd
Cohen L, Jefferies A. Anticancer Living: Transform Your Life and Health with the Mix of Six. New York: Viking. 2018.
This book introduces the concept of the Mix of Six, which is identical to six of our 7 Healing Practices › Dr. Cohen and Ms. Jefferies explain that while each plays an independent role, the synergy created by all six factors can radically transform health, delay or prevent many cancers, support conventional treatments, and significantly improve quality of life.
Practitioners of traditional traditional Chinese medicine and Ayurveda offer therapies and approaches to manage sleep disruption.
Learn more about traditional medicine and how to find practitioners.
Melatonin and sleep
From CancerChoices staff: Melatonin is produced naturally by the pineal gland during the early hours of night, signaling and initiating the transition from wakefulness to sleep. Then during the day, melatonin production diminishes as your production of other hormones—serotonin and cortisol—increases. Individuals who experience sleep difficulties may have disrupted melatonin production.
Bright light influences melatonin production. Bright light in the morning diminishes melatonin production while boosting serotonin and cortisol, leading to greater wakefulness and setting the stage for the next evening’s production of melatonin. But bright light exposure late in the evening—and especially blue-spectrum light such as from most television, computer, mobile phone, and other electronic screens—can disrupt melatonin production and delay the initiation of sleep.14Kostoglou-Athanassiou I, Treacher DF, Wheeler MJ, Forsling ML. Bright light exposure and pituitary hormone secretion. Clinical Endocrinology (Oxford). 1998 Jan;48(1):73-9.
To optimize our natural melatonin cycles and benefits, evidence shows that we should curb bright light in the evening and increase bright light exposure in the morning.15Leproult R, Colecchia EF, L’Hermite-Balériaux M, Van Cauter E. Transition from dim to bright light in the morning induces an immediate elevation of cortisol levels. Journal of Clinical Endocrinology and Metabolism. 2001 Jan;86(1):151-7; Nesbitt AD. Delayed sleep-wake phase disorder. Journal of Thoracic Disease. 2018 Jan;10(Suppl 1):S103-S111. Treatments for sleep disruptions, such as delayed sleep-wake phase disorder, may reduce exposure to bright and blue-spectrum light in the evening.
Cancer acts more aggressively in people with low nighttime production of melatonin, and people with cancer with high nighttime melatonin levels tend to have better outcomes.16Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009. pp. 412-414; Lissoni P, Tancini G et al. Melatonin increase as predictor for tumor objective response to chemotherapy in advanced cancer patients. Tumori. 1988 Jun 30;74(3):339-45; Bubenik GA, Blask DE et al. Prospects of the clinical utilization of melatonin. Biological Signals & Receptors. 1998;7(4):195-219. Preliminary research also shows that bright light therapy in the morning can improve sleep in people with cancer.17Wu LM, Amidi A et al. The effect of systematic light exposure on sleep in a mixed group of fatigued cancer survivors. Journal of Clinical Sleep Medicine. 2018 Jan 15;14(1):31-39.
Melatonin can also be taken as a supplement to promote sleep. Learn more in this therapy review.
From CancerChoices advisor Ted Schettler, MD, MPH, March 4, 2019: Lavender oil (as with some other essential oils) has estrogenic properties at some concentrations.18Simões BM, Kohler B et al. Estrogenicity of essential oils is not required to relieve symptoms of urogenital atrophy in breast cancer survivors. Therapeutic Advances in Medical Oncology. 2018 Apr 2;10:1758835918766189; Henley DV, Lipson N, Korach KS, Bloch CA. Prepubertal gynecomastia linked to lavender and tea tree oils. New England Journal of Medicine. 2007 Feb 1;356(5):479-85; Diaz A, Luque L, Badar Z, Kornic S, Danon M. Prepubertal gynecomastia and chronic lavender exposure: report of three cases. Journal of Pediatric Endocrinology & Metabolism. 2016 Jan;29(1):103-7; Politano VT, McGinty D et al. Uterotrophic assay of percutaneous lavender oil in immature female rats. International Journal of Toxicology. 2013 Mar-Apr;32(2):123-9; Shinohara K, Doi H, Kumagai C, Sawano E, Tarumi W. Effects of essential oil exposure on salivary estrogen concentration in perimenopausal women. Neuroendocrinology Letters. 2017 Jan;37(8):567-572; Henley DV, Korach KS. Physiological effects and mechanisms of action of endocrine disrupting chemicals that alter estrogen signaling. Hormones (Athens). 2010 Jul-Sep;9(3):191-205. It might be wise to avoid skin application of lavender oil in the setting of an estrogen positive breast cancer diagnosis.
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This section does not replicate the other information on this page but provides additional details or context most relevant to professionals.
Neuropsychologist Michael Howard, PhD, lectures to healthcare professionals on understanding and managing sleep disorders. He advocates first determining if presenting insomnia is primary or secondary, for the causes and remedies are different.19Howard M. The sleep-loss epidemic: understanding and managing sleep disorders. INR Seminar presentation, Roanoke Virginia. May 8, 2018.
Primary insomnia is an independent sleep disorder and typically linked to thinking and worrying, two brain processes that prevent the activation system of the brain from responding to normal signals for sleep.
Secondary insomnia is caused by physical or psychosocial events or issues including these:
- Shift work
- Job loss
- Emotional problems such as depression
- Environmental conditions such as a warm room
- Symptoms such as hot flashes, fever or pain
Secondary insomnia is far more common; the best way to manage it is to address the condition/symptom preventing quality sleep.
Immediately resorting to sleep medications for either type of insomnia is typically not optimal, as these medications are effective less than 10% of the time, they compromise one or more of the sleep cycles, and they come with side effects, some serious.
Of most benefit for primary insomnia are the psychological/behavioral/cognitive therapies that change thinking patterns and reduce worrying. Dr. Howard suggests the following steps for patients to manage primary insomnia:
- Practice good sleep hygiene ›
- Consider further supportive therapies if the following three statements apply:2014 Types of Sleep Disorders—and When to Seek Treatment, According to Experts. American Academy of Sleep Medicine. February 29, 2016. Viewed March 23, 2022.
- The insomnia has lasted more than three weeks.
- It is not improving.
- It is interfering with your ability to function during the day.
Therapies are listed above in What approaches can help me manage sleep disruption? ›
- Consider working with or referring to a sleep specialist.21Breus MJ. Do You Need A Sleep Specialist? WebMD. June 7, 2021. Viewed March 23, 2022.
- If the sleep specialist determines that primary insomnia is the problem, consider therapies or practices that deal with thinking and worrying that interfere with sleep:
- Cognitive-behavioral therapy for insomnia (CBT-I) and counseling
- Specific relaxation and exercise practices
- Behavioral conditioning
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