The Struggle for Sleep and How I Finally Got Rest
Here is how I addressed my sleep issues, learning over time how to maximize my rest. (The follow up to: The Struggle for Sleep, From Fatigue to Insomnia.)
Getting effective sleep is not easy for a cancer patient on active treatment. Over the course of 40 rounds of traditional chemotherapy, and more recently a targeted drug, I have had to explore various means of treating the side effects that kept me awake or kept me from being rested.
Of the main issues I had regarding a good night's sleep, one of the more interesting was the fact that falling asleep too early caused me to stay awake longer. This "second wind" effect was a consistent problem, especially if I sat down to watch television and almost immediately nodded off. Invariably, I would wake after twenty or thirty minutes, either to go to the bathroom or to make my way to the bed, always naively thinking that I would simply fall back asleep. Instead, by the time I was settled, I would be wide awake and temporarily refreshed and at least two hours away from being back in slumberland.
Planned naps to increase productivity
To address these evening catnaps -- more appropriately described, perhaps, as mental and physical collapse -- I realized that I needed to proactively nap during the day. The best way to stave off the cause of my disruptive second wind was to simply move it forward. Then it became a useful burst of energy rather than merely keeping me awake when I was still tired from a long day. In fact, the more I experimented with deliberate napping, the better I was able to extend my limited bouts of productivity during my more difficult periods of fatigue. While it did not solve all my sleep issues, the embrace of napping removed a serious roadblock to a good night of rest.
A cautious approach to medication
As much as I hate to admit it, there is a lot to be said for the proper use of pharmacology. I have generally eschewed the use of additional medication as much as possible in my life, preferring to use more natural approaches for things like pain relief or sleep aides. Often times this merely translated to a mind over matter approach, which admittedly became more difficult under the throes of chemobrain. At one point I had to address a few issues point blank and have a frank discussion with my doctors. Some drug modification was in order.
A primary cause of my insomnia had been the steroid pills I was required to take before and after my chemotherapy infusions. The drug remained in my system, messing with my sleep patterns. The less of this I could take (and still tolerate my infusions), the better it would be for my sleep. We gradually reduced my dose and my sleep greatly improved. When I was eventually done with chemo and steroids were no longer part of my regimen, insomnia all but disappeared from my list of sleep woes. Now when I am plagued by insomnia, it is generally something that I can address with a little more of that mind over matter approach.
Drugs are also useful for addressing anxiety, panic attacks, and pain. These are issues that used to consistently interrupt or prevent my sleep, but which can be carefully managed with limited treatment. While many of these medications are potentially addictive, a careful discussion with my doctors helped to establish guidelines for when and how I would use them -- and also for what to do if the proper dosing was not working (hint: call my doctor before modifying anything on my own). There are many extremely useful drugs on the market for palliative care and often they are too easy for patients to access. While they offer necessary help, they also come with a level of responsibility that a patient must be willing to accept. Still, for the rare occasions that I do use these medications, I am grateful to have them at my disposal.
Exercise to combat fatigue
The last and perhaps most important tool in my arsenal of sleep aides has multiple benefits beyond helping to ensure a deeper and more restful slumber. Exercise during the day will actually increase energy levels and reduce fatigue, both mentally and physically. The more active a cancer patient is able to be, the better. Whether just moving around the room or bouncing on a small trampoline, any muscle flexing is going to help the lymphatic system do its job, assisting with the body's basic immune functions. And the more exercise a patient does, the more beneficial hormones will be released, including endorphins which, in addition to being credited as generating a sense of euphoria, also act as both analgesics and sedatives. This means that the sensations of pain may be diminished, feelings of anxiety or depression may be reduced, and sleep may improve -- may even be induced. All in, exercise addresses the underlying causes of most issues that afflicted my own erratic sleep patterns.
Sleep is still an ongoing struggle for me, though much less so than it had been. When I use my toolbox effectively, I am now able to sleep like I used to, at least a few nights each week. The difference in my waking life is profound.1
Editor's Note: We are extremely saddened to say that on October 21, 2018, Jeffrey Poehlmann passed away. Jeffrey’s advocacy efforts and writing continue to reach many. He will be deeply missed.
Do you find that staying zen through your lung cancer diagnosis has helped you in your journey?