Quality sleep helps your body recover during cancer treatment and strengthens the immune system. But many people living with cancer, including those with non-small cell lung cancer (NSCLC), find it difficult to sleep well.
[1]
Even when you’re tired, breathing issues, pain, and anxiety can keep you awake at night.
[2]
Experts say there are ways to get better sleep when you have NSCLC.
1. Manage Nighttime Cough
One of the most common reasons that people with NSCLC struggle to fall and stay asleep is a persistent cough.
[2]
When you lie down, mucus can accumulate in the lungs or throat, triggering coughing spells, says Jun Zhang, MD, PhD, the vice president of oncology research at OSF HealthCare Cancer Institute in Peoria, Illinois.Here are some tips to help clear and soothe the airways before bed:
[3]
- Inhale steam from a bowl of hot water with a towel draped over your head or run a warm-mist humidifier 20 to 30 minutes before bed to loosen mucus, says Dr. Zhang.
- Sip warm water, herbal tea, or broth to thin mucus secretions.
- Try a teaspoon of honey to coat the throat and reduce coughing.
If the cough is severe, Zhang suggests asking your care team about a prescription cough suppressant or nebulizer treatment before bed.
2. Take Long-Acting Pain Medication Before Bedtime
Sometimes you fall asleep just fine, only to wake up in the middle of the night due to pain.
[4]
Short-acting pain medications wear off within four to six hours, so if you take one in the early evening, it may stop working as you’re sleeping.
[5]
“The process of waking, taking another dose [of pain medication], and waiting for it to take effect can cost one to two hours of sleep each time,” says Zhang, who suggests these steps:
- Talk to your pain management team about switching to a long-acting medication that can control pain through the night.
- Take the medication 30 to 60 minutes before bed so it’s working when you’re sleeping.
- Keep a short-acting rescue pain medication at the bedside for breakthrough pain if needed, but try to use it as little as possible.
Above all, always consult your care team before changing how you take your medications, especially opioids, says Zhang.
3. Adjust Corticosteroid Timing
Your ability to sleep may be more challenging on the days you take steroids, if they’re part of your treatment.
[6]
These medications, such as dexamethasone and prednisone, are commonly used during NSCLC treatment but can be stimulating, says Zhang.Here are some changes you can make to avoid those effects:
[7]
- Ask your oncologist if you can take your steroid doses in the morning or early afternoon, so the stimulating effect wears off by bedtime.
- If you take more than one dose per day, ask whether the later dose can be reduced.
As with pain medications, never change your steroid timing on your own. Stopping steroids suddenly or changing the dose abruptly can be unsafe, so always check with your care team first.
4. Wind Down With Journaling and Relaxation
As the day winds down, worries about treatment, prognosis, and everything else can take over and make it nearly impossible to quiet the mind.
[8]
Here are a few things that can help:
- Set aside a few minutes before bed to journal freely about whatever is on your mind. If writing is difficult due to fatigue or neuropathy, a voice memo app works just as well.
[9]
- While journaling, make a list of things you’re grateful for or things that brightened your day. This helps change your focus toward something positive before sleep.
[9]
- Try progressive muscle relaxation (slowly tense and release each muscle group from toes to forehead), 4-7-8 breathing (inhale 4 counts, hold 7, exhale 8), or meditation to help the body shift out of stress mode.
There are other ways to retrain your brain for sleep. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia.
[10]
This therapy can help you change the thoughts and habits that keep you awake and can be done with a psychologist or through free tools like the CBT-i Coach app, says Meghann Schenk, MD, a palliative medicine physician at Karmanos Cancer Institute in Detroit.
5. Get Ahead of Nausea and Night Sweats
Chemotherapy and immunotherapy can bring more sleep disruptors, such as nausea that lingers into the night, as well as night sweats and hot flashes.
[11]
There are several practical ways to get ahead of them.For nausea, try these habits:
[12]
- Eat a light, bland snack like crackers, toast, or a banana about an hour before bed to keep your stomach settled without triggering reflux.
- Take prescribed anti-nausea medications on schedule, and ask your oncologist about taking an extra dose before bed on difficult days.
- Keep water and a small snack within reach to avoid getting up if nausea wakes you, says Zhang.
For night sweats and hot flashes, try the following:
[13]
- Keep your room cool and use breathable cotton sheets and sleepwear.
- Have a fresh set of pajamas handy. This way, if night sweats occur, you can change quickly and get back to sleep with minimal disruption.
6. Elevate Your Head and Upper Body
Once you’re in bed, shortness of breath may become more noticeable, especially if you lie flat.
[14]
Mucus often pools in the lungs, and the diaphragm has less room to move, which can trigger coughing fits and a feeling of suffocation, says Zhang. Raising your head and upper body helps keep the airways open and encourages mucus to drain downward.
[15]
Here are a few ways to try this:
[14]
- Use a wedge pillow, or stack two or three firm pillows, to create a gradual incline of about 30 to 45 degrees from your lower back to your head.
[15]
“Avoid propping the head forward with a single pillow, as this can kink the neck and actually worsen breathing,” says Zhang. - If you have fluid around the lungs (pleural effusion), Zhang recommends sleeping on the affected side while keeping your head elevated.
[16]
“For shortness of breath, consider having a fan directed at your nose and cheeks,” says Dr. Schenk, to help reduce shortness of breath. If your doctor recommends oxygen or a continuous positive airway pressure machine, use it as prescribed to help with restful sleep, she notes.
The Takeaway
- Clear your airways before bed and elevate your upper body once you lie down to reduce coughing and shortness of breath at night.
- To prevent being woken up by pain or nausea, talk to your care team about long-acting pain medications and try eating a light, bland snack an hour before sleep.
- If steroids are part of your treatment, ask about adjusting the timing to earlier in the day. Practice journaling and relaxation techniques to help quiet your mind before sleep.
- Talk with your oncology team if sleep problems persist, as medication changes or a referral to a sleep specialist may help.
