Sleeping Problems (Insomnia), ASCO's curriculum

This section has been reviewed and approved by the PLWC Editorial Board, 05/05

Insomnia is the experience of not being able to fall asleep or stay asleep during the nighttime. It can cause problems during the day, such as tiredness, low energy, poor concentration, and irritability.

Most people experience insomnia at some point in their lives, but the risk of insomnia increases with age and with serious illnesses, such as cancer. In one study, 44% of people with breast and lung cancers experienced insomnia. In another, more than half of people with advanced cancer experienced insomnia.

Insomnia can cause other cancer-related conditions and symptoms to worsen, such as pain, fatigue, or anxiety. It can also decrease a person's ability to cope and cause feelings of isolation.


Understanding what is causing insomnia is important to knowing how to treat it. When finding the cause of insomnia, your doctor will ask you about the following symptoms:

  • A history of a sleep disorder
  • Depression, anxiety, or delirium
  • Pain, dyspnea, cough, nausea, or itching
  • Use of caffeine, alcohol, or tobacco
  • Withdrawal from medicine
  • Side effects of other medicines
  • Poor sleep habits
  • Emotional distress or worry
  • Unfamiliar, noisy, or uncomfortable sleep environment


The goal for managing insomnia is to achieve restful sleep and a better overall quality of life. Medications may help relieve insomnia but should only be used in the short term, unless other treatments are ineffective. Behavioral techniques are usually more effective for long-term relief.

First, any sources of insomnia, such as pain, depression, anxiety, stimulating medications, or sleep disorders should be addressed.

The following suggestions may be helpful in managing insomnia:

  • Sleep and wake at the same time each day.
  • Avoid caffeine, alcohol, and tobacco, especially at night.
  • Eat a light snack if you are hungry before bed, which may help bring on sleep.
  • Exercise regularly, if possible.
  • Sleep in a quiet, dark room that is not too hot or too cold.
  • Start a bedtime ritual, such as reading or taking a bath.

In addition, the following approaches may help:

  • Relaxation techniques, which can include music, prayer or meditation, breathing exercises, or professional therapy to learn biofeedback or hypnosis
  • Sleep restriction, which involves limiting the time spent in bed and asleep. If you maintain a constant state of mild sleep deprivation, it may help you sleep at normal times.
  • Stimulus control, which means that the bed should be used only for sleep, not reading, sex, or tossing and turning

More Information

PLWC Feature: Strategies for a Better Night's Sleep

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