Insomnia Clinic Helps Cancer Patients Get Better Rest

A night of deep, restorative sleep can be elusive even for the healthiest person. But for cancer patients, insomnia is much more common, putting additional strain on physical and mental health, causing daytime fatigue and reducing overall quality of life. Research shows that up to 60 percent of cancer survivors are affected by sleep difficulties — some of them for many years.

World Sleep Day is recognized on March 14 to raise awareness of sleep disorders, most of which are preventable or treatable. “My main goal, whether a cancer patient isn’t sleeping well due to worry, anxiety, pain or treatment side effects, is to explore the techniques that will best help them fall asleep and stay asleep,” says Constanza Martinez Piñanez, M.D., a psychiatrist and psychosomatic medicine physician who leads the Insomnia Clinic at Baptist Health Miami Cancer Institute.

Supporting All of the Patient’s Needs

The Insomnia Clinic is one of many services offered by the Institute’s Cancer Patient Support Center, which addresses the physical, emotional, social and spiritual needs of patients by offering programs that include meditation training; acupuncture; massage; exercise; nutrition; support groups and physical therapy.

Cancer patients face the same worries that affect anyone — relationship issues, financial problems, job concerns and more — but their sleep is further disrupted by surgery; chemotherapy and radiation side effects; hospital stays and fears of recurrence.

When patients come to Dr. Martinez Piñanez, she starts with a thorough evaluation. If conditions such as sleep apnea or restless leg syndrome are suspected, or a patient’s pain isn’t under control, they may be referred to a specialist who works with those specific problems.

“Otherwise, we use evidence-based cognitive behavioral therapy to identify the thoughts, feelings and behaviors that are contributing to chronic insomnia and then concentrate on techniques to help,” Dr. Martinez Piñanez says. “We work on their worries, fears and thoughts, which are often worse at night.” Within four to six sessions, about 70 percent of patients see significant improvement.

Patients often benefit from behavioral techniques such as bedtime restrictions or getting out of bed if unable to sleep, relaxation strategies such as guided imagery, breathing and muscle relaxation and the reframing of unhelpful thoughts. At each session, the patient works on one or two of the techniques and then they adjust the recommendations if needed. “At home, I ask them to practice during the day, which makes them more comfortable doing it at night,” she says. Appointments are usually a week or two apart to give the patient time to master the technique and assess their progress.

In what may seem contradictory to a good night’s sleep, Dr. Martinez Piñanez often recommends bed restrictions. “People with insomnia tend to spend more time in bed thinking that they will sleep more,” she says. “Decreasing time in bed will lead to more sleep for some people.”

Seven to nine hours of sleep per night is recommended by several medical societies as a guideline for good health. Dr. Martinez Piñanez believes that the quality of sleep is as important as the amount and works with each patient to determine the optimum recommendation for them.

Constanza Martinez Piñanez, M.D., a psychiatrist and psychosomatic medicine physician who leads the Insomnia Clinic at Baptist Health Miami Cancer Institute

For cancer patients and survivors, she has a variety of suggestions for better sleep in addition to the tools she teaches. They include:

·      Keeping a regular sleep schedule with consistent sleep and wake-up times.

·      Having a bedtime routine (which may include a bath or shower, reading or listening to music, turning off digital devices etc.).

·      Ensuring the bedroom is cool, dark and comfortable.

·      Increasing physical activity and exercise during the day.

·      Identifying and solving problems.

·      Getting out of bed if unable to fall asleep or back to sleep in 30 minutes.

·      Keeping a sleep journal.

·      Eliminating or tapering sleep medications (which are typically best for specific, short-term use).

If you have cancer and find yourself unable to fall asleep or if you wake up earlier than you intend and the problem is consistent — at least three times a week for three months — speak to your doctor about getting help.