Sleeping Problems: Insomnia in Childhood Cancer
Symptom Management, Palliative Care, or Supportive Care to relieve side-effects is an important part of cancer care and treatment and should always form part of the overall treatment plan.
Insomnia is defined as an inability to fall asleep or stay asleep; chronic sleeplessness. It could cause your child problems during the day such as low energy, fatigue, poor concentration, and irritability. Most people experience insomnia at some point in their lives; the risk of insomnia increases with age and with serious illnesses, such as cancer.
Insomnia often causes other cancer-related conditions and symptoms such as pain, fatigue, or depression or anxiety, to become worse. Insomnia may also decrease your child’s ability to cope with their cancer and cause feelings of isolation.
Someone with insomnia will often take 30 minutes or more to fall asleep and may get six or fewer hours of sleep for three or more nights a week over a month or more.
There are two types of insomnia:
- Primary Insomnia: Primary insomnia is when an individual is having sleep problems that are not directly associated with any other health condition or problem.
- Secondary Insomnia: Secondary insomnia is when an individual is having sleep problems because of something else, such as a health condition (like asthma, depression, arthritis, cancer, or heartburn); pain; medication they are taking; or a substance they are using (like alcohol).
Symptoms of insomnia include difficulty falling asleep, waking up often during the night and then being unable to or having trouble falling asleep again, waking up too early in the morning, and still feeling tired when awakening.
Symptoms of insomnia could also include pain, irritability, shortness of breath, concentration or memory problems, sleepiness during the day, nausea, vomiting, coughing, hiccups, hot flashes, itching, diarrhoea, frequent urination, and various other symptoms.
There could be many causes for your child’s insomnia, including past sleep disorders, what time they go to bed, their sleep environment such as location, room temperature, amount of light and noise, or other medical disorders such as low or high thyroid hormone levels, diabetes, heart disorders or urinary problems.
A history of psychological problems such as anxiety, depression, concerns about the cancer getting worse or returning, or delirium (confusion) can also contribute to insomnia.
Some medications (e.g. those used to treat colds, allergies, depression, high blood pressure, and asthma) may interfere with sleep
Your child’s doctor may ask you to complete a questionnaire to determine your child’s sleep-wake pattern and level of daytime sleepiness. You may also be asked to keep a sleep diary for your child for a couple of weeks.
The doctor will in all probability do a physical examination to look for signs of other problems that may be causing insomnia. He or she may also do a blood test to check for thyroid problems or other conditions that can cause insomnia.
If no reason for the insomnia can be found, your child may need to spend a night at a sleep centre where tests will be done to monitor and record a variety of body activities while they sleep, including brain waves, breathing, heartbeat, eye movements and body movements.
Relieving side effects is an important part of total cancer care and treatment, which is why you should discuss any symptoms your child is experiencing, new symptoms and changes in symptoms with their Oncology Team so that they can work out a regimen of palliative or supportive care for them.
The goal for managing insomnia is to achieve restful sleep and improve your child’s overall quality of life. Understanding and treating the underlying cause of your insomnia is the best way to do this.
Changing your child’s sleep habits and addressing any underlying causes of insomnia, such as medical conditions or medications, can restore restful sleep for many people. If these measures don’t work, your doctor may recommend medications to help with relaxation and sleep.
Behavioural treatments teach one new sleep behaviours and ways to improve one’s sleeping environment. Good sleep habits promote sound sleep and daytime alertness. Behavioural therapies are generally recommended as the first line of treatment for those with insomnia and are typically equally or more effective than sleep medications.
Behavioural Therapies include:
- Education about Good Sleeping Habits. Good sleep habits include having a regular sleep schedule, avoiding stimulating activities before bed, and having a comfortable sleep environment.
- Cognitive Behavioural Therapy. CBT helps one control or eliminate negative thoughts and worries that keep one awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.
- Relaxation Techniques. Progressive muscle relaxation, biofeedback and breathing exercises are all different methods used to reduce anxiety at bedtime. These strategies will help your child control their breathing, heart rate, muscle tension and mood.
- Stimulus Control. This means limiting the time your child spends awake in bed and associating their bed and bedroom only with sleep.
- Sleep Restriction. This treatment decreases the time your child spends in bed, causing partial sleep deprivation, which makes them more tired the next night. Once their sleep has improved, their time in bed is gradually increased.
- Remaining Passively Awake. Also called Paradoxical Intention, this treatment for learned insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.
- Light Therapy. If your child falls asleep too early and then awaken too early, they can use light to push back their internal clock. They can go outside during times of the year when it’s light outside in the evenings, or get light via a medical-grade light box.
If other methods do not work, your child’s doctor may suggest that they use some type of medication to help with the insomnia.
- Prescription Medications: Doctors generally don’t recommend prescription sleeping pills for children, or that they use them for more than a few weeks, but several medications are approved for long-term use.
- Over-The-Counter Sleep Aids: Non-prescription sleep medications contain antihistamines that can make your child drowsy, but they may also reduce the quality of their sleep, and can cause side effects such as daytime sleepiness, urinary retention, dizziness, dry mouth and confusion. They can also worsen urinary problems, causing your child to get up to urinate more during the night. It is not recommended that you give your child any type of medication to help them sleep unless it is prescribed by their doctor.
Natural Insomnia Remedies
- Lavender is a cheap, nontoxic way to slip into a peaceful slumber; studies have proven that it aids in sleep. Use a lavender-filled pillow; spritz your child’s pillow with a real lavender spray before bedtime, or add Lavender oil to a warm bath before bed-time to relax your child’s body and mind.
- Jasmine Essential Oil can also help one sleep more peacefully, according to studies conducted at Wheeling Jesuit University in West Virginia. Add a drop on each of your child’s wrists just before bed-time.
You can find some more information about herbal medicine on our Herbal Medicine/TCM Page
Chinese Reflexology & Acupressure Points
The Chinese believe that insomnia is caused by an imbalance in the body. In Chinese Medicine, the Heart and the Mind have a symbiotic relationship. If you’ve ever seen a yin-yang symbol, you can compare the Heart and Mind relationship to the relationship between yin and yang.
In the case of insomnia, the Heart plays a very important role. It acts as an anchor to the Mind. When one thinks and worries at night, the qi (life force energy) in your body goes to where the action is—and that’s up to the head where all the thinking is going on. It’s like when you lift weights and the blood flows to your muscles.
When one thinks too much – during the day and night – one’s qi tends to congregate in one’s head. When there is too much qi in one’s head, it’s a sign that one’s body is out of balance. Normally, when the Heart organ and energy meridian is strong, it acts as a counterbalance to the qi floating up to your head.
However, if the Heart is weak, then the qi has free reign to float upwards and the excess qi in one’s head disturbs one’s sleep. It can also cause one to worry and overthink even more, feeding a perpetual cycle of too much qi in one’s head that disturbs one’s sleep.
The Chinese therefore believe that a combination of Kidney reflexology, Heart-7 Acupressure, and Liver-2 (Xingjian) Acupressure works to relieve insomnia.
There are some tips with pics in this article showing you how you can perform acupressure for insomnia yourself using P6 – (known as pericardium 6); H7 -(known as Heart 7), and UB62 – (known as Urinary Bladder 62) acupressure points.
Also check out our Acupuncture Page where Acupressure is also mentioned under Acupuncture for People with Cancer – acubands.
Progressive Relaxation Exercise
Teach your child to imagine their feet becoming heavy and numb, to feel them sinking into the mattress, then to do the same with their calves, and slowly work their way up their body, letting it all grow heavy and relaxed. The idea is to let oneself go, in gradual phases.
Yoga or Meditation
Teach your child to do gentle easy yoga stretches in bed followed by a simple meditation. Closing their eyes for 5 to 10 minutes and paying attention to nothing but their breathing can do wonders to help them fall asleep more easily.
The best sleep-inducing foods include a combination of protein and carbohydrates, says Shelby Harris, PsyD. She’s the director of the behavioural sleep medicine program at the Sleep-Wake Disorders Center at Montefiore Medical Center in Bronx, N.Y.
Harris suggests a light snack of half a banana with a tablespoon of peanut butter, or a whole wheat cracker with some cheese. Give your child one of these snacks about 30 minutes before bed-time.
Your grandmother’s natural insomnia remedy of sipping warm milk before bed is not just an old wive’s tale; it can actually help one go to sleep.
Conclusive studies have shown milk does not raise tryptophan levels as previously thought, but it can raise one’s internal body temperature when it’s heated, which will relax your child and make them sleepy and calm.
Add some honey, which does contain L-tryptophan, an essential amino acid vital to our rest and the precursor to serotonin, which can be converted into melatonin, which is what regulates our sleep-wake cycles.
Add a dash of nutmeg on top as well, as it is a natural sleep-aid that contains numerous chemical components that act similar to tranquilisers.
Almond milk is an excellent source of calcium, which helps the brain make melatonin.
Natural sleep remedies can do wonders for the occasional bout of poor sleep. They shouldn’t be used for chronic sleep problems, though. If your child has insomnia that lasts for a few weeks or more, talk to their doctor. For more information on Sleep Problems see our page, Hypersomnia, Somnolence Syndrome & Nightmares