Many people find it hard to fall asleep while going through the diagnosis and treatment of cancer. Even at the end of a day that felt "not bad" — one where you read a little, moved your body gently, and ate well — sleep can still refuse to come once the lights are off. It can feel puzzling to have had a calm day and yet lie awake, which sometimes stirs up even more restlessness.
This kind of insomnia usually has several overlapping causes. Physically, medications such as chemotherapy drugs or steroids, pain, night-time hot flushes, frequent urination, and hormonal changes can all disrupt sleep. Emotionally, worries you managed to set aside during a busy day often surface only in the quiet of night. On a peaceful day in particular, it is natural for tension to ease and for postponed feelings to arrive after dark.
A helpful first step is to keep your wake-up time steady rather than your bedtime. Whatever time you fell asleep, getting up at a similar hour each morning and exposing yourself to bright light helps your body clock (circadian rhythm) settle. Keep naps short — under 20 to 30 minutes and in the early afternoon — and try to avoid them later in the day.
If you have been lying in bed awake for more than about 20 minutes, rather than forcing it, get up, go somewhere with dim light, read something dull, and return to bed when you feel drowsy. Tossing and turning for a long time can teach the brain that the bed is a place for being awake. Cut back on caffeine in the afternoon, and remember that although alcohol may seem to help you drift off, it often fragments sleep in the early hours and lowers its overall quality.
When worries pile up, it can help to set aside a "worry time" a few hours before bed to write them down on paper, and to calm the mind in bed with slow breathing or by gradually releasing tension from the body. If insomnia lasts more than two to three weeks, or noticeably drains your daytime energy and mood, it is better to talk with your care team than to endure it alone. They can check whether your current medications affect sleep and offer safe help if needed.
This article is for general information only and does not replace individual medical care. Symptoms and circumstances differ from person to person, so please discuss any decisions about sleep problems or medications with your doctor or other health professionals.