People going through treatment for cancer deal with several difficult physical and emotional symptoms, but the one that is especially frustrating is poor sleep. Not sleeping well leaves you with daytime fatigue, irritability and trouble concentrating long enough to get anything done, which is especially upsetting on days that you have off from medical appointments. Being awake in the middle of the night is psychologically difficult given that the quiet of night hours leave little to distract you from worries about your cancer experience and other life stressors.
Given the distress of not sleeping, of course people are going to look for relief. Just one Google search, conversation with a friend, or inquiry about insomnia at the pharmacy will likely bring up the suggestion of using CBD (cannabidiol) or melatonin. Both supplements are widely marketed and promise to help people rest well without the trouble of a prescription. They are both considered “natural” remedies, which appeals to people.
If you’re considering one of these options, the most important thing to know is that since supplements are not regulated by the Food and Drug Administration there is no quality control or oversight of these products. In fact, studies have shown that in a high percentage of cases, what is in the supplement is not exactly what is on the label. Supplement contamination with other sedatives or added chemicals to help with shelf life, smell, consistency, etc. may come serious side effects such a lung injury as the recent news about vaping harms demonstrated.
CBD can legally be obtained from the hemp plant (a cousin of the marijuana plant) since the passage of the Farm Bill in 2018. However, regulation of the hemp growing industry is not widely done, and what is sold as CBD may actually have more THC (the psychoactive part of the marijuana plant) than you want, which could cause an abrupt change in thinking which is very anxiety provoking for some people (and not good for sleep!). The CBD products are so new to the market that we have almost no research into whether or not CBD helps insomnia in patients with cancer, or is safe during cancer treatment. Be sure to talk to your oncologist if you are planning to use a CBD supplement.
There has been more use of melatonin in medical care, primarily because it has always been legal, but also because there is research to support the use of melatonin to correct circadian rhythm disorders, situations when people have their days and nights reversed because of jet lag or night shift work. If melatonin is used for insomnia, the recommendation is to take it 2 hours before bed, because the goal is not to feel sleepy right away, but to reset your circadian rhythm, meaning the melatonin in your body gets released at the right time in the day night cycle.
Is it better to take one of these supplements than a prescription sleep aide like Ambien or Lunesta? Supplements still come with side effects (sedation, confusion, falls, and medication interactions), they may be more expensive than prescriptions (so no financial savings) and there is no guarantee “natural” is better. Actually, the best medicine for insomnia is not a medication or supplement at all, but a type of therapy called “cognitive behavioral therapy for insomnia” (CBT-I). This therapy, backed by research, is administered by a professional therapist and emphasizes healthy sleep hygiene. If you do not have access to CBT-I therapy, you can still make changes to your sleep hygiene – and improve your sleep – on your own.
For better sleep, set up your daily schedule so that you are primed for restorative rest at night:
- Get out of bed at the same time every single day (alarms are helpful), and let your eyes be exposed to morning light. The morning light will reset the melatonin already in your body.
- If you drink any caffeine, only drink it at breakfast (the half-life is long, it will be in your system at night).
Get outside and walk daily – exercise is literally medicine for your sleep.
- Schedule time to manage cancer (scheduling appointments, research, bills) early in the day, and no cancer talk after dinner (so you are not thinking about it when you try to sleep).
- Put a paper and pen by the bed, and if you have a worry or question pop up, jot it down, better on the paper than in your head.
- Sleep in a cave (a cold, dark, quiet room) and turn off all screens at least one hour before bed (the light will disrupt your day night cycle).
- Talk to your doctor about your sleep and whether you might need an appointment with a specialist. If your sleep is disrupted by clinical depression or an anxiety disorder, then treating the mood and worry will be the appropriate sleep medicine.
Having cancer is hard enough, and then trying to manage sleep disturbances on top of that does not seem fair. However, the payoff for working on your sleep is so worth it! Feeling rested in the morning makes the day feel like something you can handle. Patients in survivorship have commented that the skills that they developed during cancer treatment are useful long after treatment ends. “I did not want to deal with cancer, but it taught me a lot about really taking care of myself,” “if I pay attention to my sleep habits, I my energy is so much better” and “there is no perfect pill for sleep, but I know I will eventually sleep, especially if my days are busy.”