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.
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.
