Insomnia

What is insomnia?

Insomnia is a sleep disorder in which a person has trouble falling asleep or staying asleep. Chronic insomnia is a common problem in patients and survivors of childhood cancer. Insomnia is considered chronic if it happens 3 or more nights per week for at least 3 months.

Insomnia symptoms

Symptoms of insomnia include:

Trouble falling asleep
Resisting going to bed
Waking up during the night
Trouble going back to sleep after nighttime waking
Waking up too early in the morning
Poor sleep quality
Feeling tired or unrested
Mood changes, irritability
Problems with thinking, attention, or memory
Problems functioning at school or work

What causes insomnia?

Insomnia in children with cancer can occur for different reasons. Often, insomnia is learned through changes in sleep habits (behavioral insomnia).

Insomnia can develop through changes in sleep behaviors and routines during the cancer experience. When a child has cancer, families often change their normal habits and “rules” about bedtime and sleep. Nighttime caretaking may increase with fever checks or other medical care during the night. Parents might also co-sleep in a child’s room to make care easier.

Over time, children develop new habits. They may resist going to bed. They may rely on having parents nearby during sleep and not want to sleep independently. Other factors such as stress, discomfort, and noise can make it hard to fall asleep or stay asleep. Sleep problems can then lead to anxiety about sleep, further contributing to poor sleep.

Symptoms of behavioral insomnia include resistance to going to bed at night, problems falling asleep, waking up during the night, and trouble going back to sleep after waking up in the night.

Diagnosis of insomnia

In cancer patients and survivors, it is important to know if insomnia is a result of the cancer, side effect of medication, or other physical cause.

Assessment of insomnia may include:

Patient and family interview or questionnaire to assess symptoms
Medical history and physical exam
Review of medicines to find out if insomnia might be a side effect of certain drugs the patient is taking
Sleep and activity diary to track sleep patterns, physical activity, light exposure, and other factors that influence sleep

Insomnia treatment

Behavioral and environmental changes are the first steps in managing insomnia in children. Families can take steps to encourage healthy sleep habits and improve specific sleep behaviors:

Create a quiet and comfortable sleep environment.
Set appropriate limits for sleep and bedtime, and support positive sleep behaviors.
Use cognitive behavioral therapy to teach skills such as self-soothing, relaxation training, and managing negative thoughts.
Treat underlying anxiety or depression that may be contributing to insomnia.
Increase exposure to natural light, especially in the morning. Limit bright light at night, and turn off electronic devices 1-2 hours before bedtime. Treatment may also include bright light therapy or use of a melatonin supplement.

Light therapy

Light therapy is the use of artificial light to help set the body’s internal clock. Bright light, especially in the morning, can help promote a healthy sleep-wake cycle. Exposure to sunlight, especially in the morning, can improve nighttime sleep. However, it can be hard for patients to get natural light, especially during prolonged hospital stays or during certain times of the year. In light therapy, patients are exposed to a controlled light source for a specified amount of time. There is some evidence that light therapy may also improve fatigue in teenagers with cancer.
Melatonin
Melatonin is a hormone that helps regulate sleep. It is released by the pineal gland in the brain. Normally, melatonin production increases at bedtime and continues through the night, telling the body that it is time to sleep. Some people with insomnia or circadian rhythm sleep disorders may benefit from taking a melatonin supplement. However, it is important to talk to your doctor or pharmacist before using melatonin or any supplement to help sleep. Although short-term of use is generally safe in children and teens, melatonin can have side effects and possible interactions with other medicines. Be sure to ask about dose, timing, and other instructions for use. If melatonin is not taken properly, it can make sleep problems worse.
- Read more about melatonin

Doctors may sometimes prescribe medicine to help with sleep. However, no medicine is currently approved specifically for insomnia in children under age 16. Families should talk to their doctor before taking any medicine or supplement, including those available without a prescription.

Tips for healthy sleep

Know how much sleep you need. Children and teens need more sleep compared to adults, and those with cancer may need even more sleep. Talk to your doctor about recommended hours of sleep per day including naps and nighttime sleep.
Create a comfortable sleep environment. Set up a quiet, cool, and comfortable place just for sleep. Take steps to limit light and noise during the night.
Avoid caffeine and nicotine, especially at night. Avoid foods and drink with caffeine after 4 p.m. or within 6 hours of bedtime.
Exercise. Physical activity during the day can improve sleep at night. Avoid heavy exercise near bedtime.
Spend time outside. Exposure to sunlight or bright light during the day helps the body’s sleep-wake cycle stay on track.
Have a relaxing bedtime routine. Be sure to turn off the TV, and put away electronic devices. Work with children on self-soothing strategies.

Learn more about Healthy Sleep Habits