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After treatment and remission

Restoring sleep

Hospital nights, steroids, pain and worry can disrupt your sleep pattern. This topic explains why sleep is slow to recover after treatment and what helps.

Last updated: ~2 min read
A glowing crescent moon over still dark water.
Figure 1.A calm night is part of recovery.

01Short answer

Sleep problems are common after cancer treatment: difficulty falling asleep, waking often at night, or waking early and not getting back to sleep. The causes include steroids, night-time noise and light in hospital, pain, night sweats, needing to pass urine often, anxiety, depression and long daytime naps. The NCI and ACS recommend sleep hygiene principles: a fixed wake time, daylight and movement during the day, fewer screens and less caffeine in the evening, and a quiet, dark bedroom. For persistent insomnia, the first-choice treatment is cognitive behavioural therapy for insomnia (CBT-I). If sleep problems last for weeks, tell your doctor.

02Simple explanation

Sleep problems are very common.

Causes include steroids, pain and anxiety.

The most important habit is a fixed wake time.

Light by day, calm by evening.

For persistent insomnia — CBT-I.

03Scientific explanation

How common: the NCI notes that about half of people with cancer have sleep problems.

Circadian rhythm: daylight and a fixed wake time set the body clock; bright screen light at night reduces melatonin release.

CBT-I: the American College of Physicians (ACP) recommends cognitive behavioural therapy as first-line treatment for chronic insomnia.

Steroids: corticosteroids increase wakefulness; taking them in the morning (as your doctor prescribes) may reduce the effect on sleep.

04What happens in the body?

Why is sleep disrupted?

Night checks, noise, light and worry in hospital upset the body’s rhythm. After returning home this pattern can persist for a while.

A glowing ring with a sun on one side and a moon on the other.
Figure 2.The day–night rhythm drives sleep.

Get causes checked

Pain, night sweats, cough, frequent urination, depression or sleep apnoea can be treated — tell your doctor.

What to do by day

Get up at the same time each day, go into daylight in the morning and move. If you nap, keep it under 20–30 minutes and not late in the day.

What to do in the evening

Reduce screens an hour before bed, limit caffeine after midday and avoid heavy meals. Keep the room cool, dark and quiet.

An empty, calm bedroom with a dim warm lamp.
Figure 3.A quiet bedroom helps sleep.

If sleep does not come

If you cannot sleep for more than 20 minutes, get up, do something calm in dim light and go back when you feel sleepy. This helps your bed stay linked with sleep, not wakefulness.

When to call your doctor

Worrying signs — fever, bleeding, new pain, breathlessness — should be reported to your doctor between visits too. Getting in touch early is always better than waiting.

05From day to night

Steps to a healthy sleep rhythm.

Fixed wake time — Get up at the same time daily.1Fixed wake timeGet up at the same time daily.
Daytime — Light and gentle movement.2DaytimeLight and gentle movement.
Evening — Fewer screens, wind down.3EveningFewer screens, wind down.
Night — Bed is for sleep.4NightBed is for sleep.
SleepDeeper and steadier.
DaytimeMore energy.
CalmLess worry.

06Sleep hygiene: what helps and what hinders (simplified)

HelpsHindersNote
Fixed wake timeLate, changing wake timesThe most important habit
Morning daylightA dark room by daySets the rhythm
Gentle movementAll day in bedSee “Muscles and stamina”
A calm eveningScreens at night1 hour before bed
A cool, dark roomNoise, lightAn eye mask and earplugs may help

* If the problem persists, see your doctor.

07Key terms

Insomnia
Difficulty falling or staying asleep.
Circadian rhythm
The body’s internal 24-hour clock.
Melatonin
A sleep hormone released in darkness.
CBT-I
Cognitive behavioural therapy for insomnia.
Sleep hygiene
Habits that support sleep.
Sleep apnoea
Episodes of stopped breathing during sleep.

08Key points

  • Sleep problems are common.
  • Get causes checked.
  • Get up at the same time.
  • Daylight and movement by day.
  • Fewer screens in the evening.
  • Agree medicines with your doctor.

09Frequently asked questions

Can I nap?

A short nap (20–30 minutes) before mid-afternoon usually does no harm.

Should I take melatonin?

Only after agreeing it with your doctor.

What is CBT-I?

A structured programme that changes sleep habits and worrying thoughts; delivered by a specialist or an online programme.

What about night sweats?

Tell your doctor — sometimes they need checking.

Does this information replace medical advice?

No. This is general education; only your treating doctor can assess your situation.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Can I nap?

  2. Should I take melatonin?

  3. What is CBT-I?

  4. What about night sweats?

  5. Does this information replace medical advice?

My questions

12Sources

  1. National Cancer Institute (NCI). Sleep Disorders (PDQ®)–Patient Version
  2. American Cancer Society. Sleep Problems
  3. NHS. Insomnia
  4. MedlinePlus (U.S. National Library of Medicine). Healthy Sleep
  5. Annals of Internal Medicine, 2016. Qaseem A et al. Management of Chronic Insomnia Disorder in Adults: ACP Clinical Practice Guideline
  6. National Cancer Institute (NCI). Follow-Up Medical Care
  7. National Cancer Institute (NCI). Cancer Survivorship
  8. Cancer.Net (ASCO). Follow-Up Care After Cancer Treatment
  9. Leukemia & Lymphoma Society (LLS). Long-Term and Late Effects of Treatment
  10. National Cancer Institute. Facing Forward: Life After Cancer Treatment
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
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