Sleep Tips

For at least the first two weeks after I was diagnosed with breast cancer, I would lie in bed awake at night. I could also feel my husband lying there awake, although we both stayed silent pretending that sleep might just be possible. We repeated this cycle when after my first surgery we learned the cancer had spread to my sentinel lymph nodes.

 I did a few things at the time that were helpful.

  • I didn’t talk to anyone about cancer for a few hours before bedtime

  • I didn’t do web searches about health in the evenings

  • I disconnected from devices at least one hour before bedtime

I watched engaging dramas and comedies that I could try to carry on in my head when I went to bed.

 Still, if I woke in the middle of the night, I would have a moment of calm before my life-threatening diagnosis would come rushing back with a wave of anxiety. Sure, I knew there was nothing more I could do in the middle of the night about having cancer, but I couldn’t get rid of the thoughts of what having cancer potentially meant for me and my family.

With what I know now, my Beloved, I recommend trying various strategies to put those worrying thoughts on pause until you find one that works well for you. (OK if you can’t find one that works well, just find one that works better. More on the strategies below.)

Healthy Sleep Habits

First, it is smart to enact the good sleep practices that are recommended for everyone.

Check out, for example, the 8 healthy sleep habits from the MD Anderson Cancer Center.

To those 8 habits, I would add:

Take a break from cancer talk. Don’t talk about cancer in the evening with friends or family. Don’t seek out or process information about cancer in the evening. Allow your mind a few hours to wind down from what is likely to be troubling information before you go to sleep.

Make your bed a place associated with sleep and not worry. If you are unable to sleep after roughly 20 minutes, pull yourself out of bed and go to a “buffer zone,” which is a calming place where you can engage in monotonous activities until you feel sleepy. Monotonous activities are things like reading a book that is not overly exciting, playing Sudoku puzzles, cleaning – things that are boring. Leaving your bed when you’re not sleeping will help condition your bed with sleep. It can also de-condition your bed with worrying about cancer.

I believe those practices will be necessary for you to sleep well, and I also believe that they alone are not sufficient, at least temporarily. You need to set yourself up for the potential for good sleep and then have a way to tamp down worrying thoughts. 

How to put those worrying thoughts on pause: actions before bedtime

Practice expressive writing. Address your strong emotions and worries during the day with an Expressive Writing exercise. It’s very simple:

  • You set yourself a timer for 20 minutes.

  • Write (by hand or computer or talking into your phone) everything you are feeling, especially your deepest emotions and worries.

  • It’s OK to repeat your thoughts.

  • Do this 3-4 days in a row. You start feeling better after your second writing session.

Expressive Writing has been studied for 20 years and has great outcomes in terms of reducing anxiety, intrusive thoughts, rumination, depressive symptoms, and blood pressure. It works not because you vent your emotions, but rather because you a) habituate to the emotions you are feeling, b) start to label what you are going through, and c) figure out coping strategies.

 I’ve used Expressive Writing myself with impressive results. It may feel like giving 20 minutes over to this activity is a lot of time, but I found I saved that time and more in less worrying later, and better sleep.

Actions after bedtime

All that matters right now, is right now. First, start by reminding yourself that the cancer can wait until morning – heaven knows it will still be there – and there’s nothing you need to do about it right now. Also, remind yourself that resting is good for you even if you aren’t exactly asleep. The value of rest is true and it’s just not helpful for you to add on a layer of worry about not getting enough sleep. You’re doing what you can and that is resting. All that matters right now, is right now.

Replace your thoughts with boring ones. To silence worrying thoughts, you can focus on other thoughts. I frankly think that processing a new cancer diagnosis is so strong that you would do well to tune into other people’s thoughts, as opposed to finding different thoughts of your own to focus on. Try finding a boring podcast to fall asleep to. People have created podcasts and bedtime stories just to help adults fall asleep (Bore You to Sleep; Night Falls; Tales by the Fireside; Just Sleep; Listen to Sleep; the Sleep Pod – there are so many! Insomniacs are in good company.). Or find a meditation in which someone takes you on a mental journey. Search for “guided imagery meditation” to find one you like.

Help your body relax. Alternatively, to silence worrying thoughts, you can do things to help your body relax. Our bodies and thoughts are deeply interconnected so calming our bodies can help calm our thoughts, just like thinking about stressful things can make our bodies tense.

  1. Breathe. To help your body relax, do a five-minute breathing exercise to slow your heart rate. I recommend Cyclic Sighing, which has strong evidence for reducing your respiratory rate and anxiety. Breathe in through your nose. When you’ve comfortably filled your lungs, pause and then take another sip of air to expand your lungs a bit more.  Then, very slowly, exhale through your mouth through pursed lips (as though you are breathing through a straw) until all the air is gone. You want the exhale to be longer than the inhale. Doing cyclic sighing for five minutes a day during the day leads to great outcomes. At night if you can’t sleep, try cyclic sighing for a few minutes until your breathing, and therefore your heart rate, is slower. This alone might be boring and calming enough to lead to sleep.

  2. Relaxation exercises. If you’re still awake after finding other thoughts to focus on, do things to make your body relax. These include various breathing exercises, progressive muscle relaxation, and visual relaxation exercises. You can search the web for these exercises –include keywords like cancer and sleep in your search for an even better match. When searching on your behalf, I found The Penny Brohn UK: Living Well with Cancer group. Their healers have designed two digital downloads that only cost one British pound each (like $1.28) and it goes to charity. For this price, I downloaded the Penny Brohn UK Relaxation to Help You Live Well set of four files which check all the boxes named above, including a progressive muscle relaxation exercise, a breathing exercise, a meditative journey (Journey to the Sea), and a White Light Relaxation exercise. The narrator has an extremely soothing voice that is hard to stay awake to.

If you plan to take your phone to bed to listen to podcasts or downloaded audio files in the middle of the night, be sure to put your phone in airplane mode so some random text doesn’t wake you up and make you start back at square one!

Beloved, you’ll probably need to try a few of these strategies to figure out what works for you during this extraordinary time, and you may even use multiple strategies in a single night. This may be the time to ask your primary care doctor about sleep medication. Regardless, if you are still lying awake at night, you might imagine all the other people with new cancer diagnoses lying awake at night and wish them good rest, until sleep finally comes.