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.
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.
9. SHRUG IT OFF. When you find yourself wide awake at 3:00 A.M., just shrug it off. Okay, so you’ll lose one night’s sleep. Big deal. You have got enough to worry about.
10. FIGHT NIGHTTIME NAUSEA. Grate one tablespoon of gingerroot into a cup of hot water. Steep for 10 minutes, then sip. Forget the packaged stuff—you can’t count on the same amount of active ingredient in each and every tea bag.
11. USE THE 4-STEP METHOD. A study at Harvard Medical School found that women who experienced tamoxifen-induced hot flushes had significantly fewer hot flushes during cancer treatment when they practiced the relaxation response pioneered by Herbert Benson, M.D., a cardiologist who heads the Mind/Body Medical Institute in Boston.In general, the response involves these four steps: Choose a word that has deep personal meaning for you, such as “peace.” Close your eyes and focus your attention on the word. Repeat it silently to yourself. When your attention wanders, as it will, gently bring it back to the word.Take a deep breath and exhale. Begin to consciously relax each of your muscles from your face to your toes.
When you’re finished, continue to focus on your chosen word for another 10 to 15 minutes.Then allow yourself to gently move into sleep.
12. TREAT WHAT YOU CAN TREAT. Sometimes you have an underlying condition—arthritis, back pain, or snoring, for example—that has always troubled your sleep but was never a big deal. Then all of a sudden you add chemotherapy to the mix and find that sleep is a thing of the past. There’s not a lot you can do about the chemotherapy, but you can do something about the arthritis, back pain, or snoring. Tell your oncologist about the underlying problem and ask him what treatment will work best with your chemotherapy. Chances are, just treating the underlying problem will reduce what’s disturbing you enough to let you sleep.
13. DITCH NEWS AND STUPID OPINIONS. Negative words and images are not going to help you sleep. So—at least in the hours before bed—avoid TV news programs and the amazing collection of opinionated talk-show hosts who make their living stirring up anger and controversy. Allow yourself to get ready for bed without their voices in your head.
14. STRIKE A BALANCE. Women aren’t used to nurturing themselves or putting themselves first. But sleep is so necessary for healing that you have to do it. If the dog’s snoring wakes you up, put him in another room. If your partner’s snoring wakes you, whether it’s just a seasonal allergy, a cold, or even sleep apnea, help him get treatment. If he refuses to cooperate, put him in another room, too.
“One thing that really kept me up, and keeps me up today, is my kids,” admits Dr. Silver. “My daughter has been in three times this week with nightmares. She’s seven years old and it’s September, and she’s just starting school again. So she has a lot of things going on in her mind. But she wakes me up, and it’s hard to go back to sleep.
The thing is, you can’t just turn off being a mom. Yes, you need to nurture yourself so you’ll heal. But your children are going through cancer, too. They’re worried about you, about themselves, about how everything has changed. So you need to nurture yourself, but within the constraints of reality.
“You can’t just send your kid back to bed with her fear,” says Dr. Silver, “but I would use every trick to reassure my kids so that I could get them to sleep.” She’d also use some parenting tactics that, under normal circumstances, would horrify her—like promising to buy them gifts if they would go to sleep.
“Desperate times call for desperate measures,” says Dr. Silver. “And when you’re having cancer treatment and you’re desperately trying to heal, well, maybe that isn’t exactly the way you would parent under normal circumstances. But you do what you need to do to get them”—and you—“to sleep.”
15. CONNECT. Reach out to friends and family. Call your best friend, sit with a neighbor in your backyard as she cuts back your roses, ask your mom to come make you lunch, have friends from your spiritual community drop by. Feel a part of that rich network of human sustenance.
16. ASK FOR PRAYER. “I asked people to pray for me at 9:00 P.M. every night,” says Dr. Silver. “That was after I’d put my kids to bed and I was alone in my room, usually in pain, trying to sleep.
“I was incredibly lonely and incredibly scared. My usual routine had been changed. I went to bed much earlier, and when I went to bed, I was very worried and very lonely.”
She hesitates. “You know, cancer’s a very lonely disease. I have a wonderful, wonderful husband, awesome kids, a great family, terrific friends. But cancer’s a lonely disease, and you fight it by yourself.
“To feel surrounded and uplifted by prayer—it helps.”