Monday, 16 September 2024

The 'Wide Awake' Club: Coping with Insomnia

 





“We've forgotten what it's like to have a good night's sleep. Many of us dread the sound of our alarm clock and feel as though we live in a constant state of exhaustion”

 

Insomnia is a faithful partner of anxiety and so many members reported having that “middle of the night active mind” that refuses us rest. Intrusive thoughts about cancer are magnified in the lonely dark of the night, and our fears about our health can easily occupy us for hours when we want to be sleeping. Nightmares plague many of us – add in family and work worries and it’s no wonder we are unable to settle.

 

        Our members are women with both primary and secondary breast cancer, meaning as well as feeling anxious, other issues such as side effects of treatment and early menopause can also hinder sleep. Chemotherapy and the anti-sickness and steroid drugs used to manage side-effects cause huge problems for us, preventing us from sleeping and as a result leads to extreme fatigue. We feel completely washed out but unable to sleep due to the buzz of the chemo cocktails.  Fatigue is both a symptom and a contributor. Being woken up by hot flushes was also cited by many as a key issue.  Pain is another problem, also cramps, and needing to get up for the toilet frequently.

        Some of us find it hard to get to sleep, others drop off quickly but wake frequently throughout the night. Some wake in the middle of the night and then cannot get back to sleep again. Some women reported a reduction in the quality of their sleep rather than insomnia, with many sharing the feeling that they sleep very lightly. We've forgotten what it's like to have a good night's sleep. Many of us dread the sound of our alarm clock and feel as though we live in a constant state of exhaustion.

 

        Our ability to function on so little sleep is a huge worry to us. This sets up a vicious circle of being unable to sleep because of our worrying about not being able to sleep!  The trauma of a breast cancer diagnosis may also affect our subconscious and introduce fear we aren't even aware of, which affects our peace of mind and consequently our ability to sleep well and wake refreshed.

        Naz told us that insomnia may be harmful to cognitive function, both in the short and long term.  She also explained that it can be really hard to break out of this cycle as the brain gets used to the habitual patterns of sleep and learns the pattern as a familiar state which it will try to maintain and replicate. 


How Do We Cope?

Despite all the complaints about insomnia, our members have many ways of helping themselves to sleep better. Some have asked their GPs for medication, others rely on lavender oil.
Breathing exercises, either just before bed or while lying in bed (ante-natal breathing exercises are great, and a simple 'breathe in relaxation', 'breathe out tension' repetition is a good place to start). Keeping active during the day by taking classes in Yoga, making time for relaxation exercises, or trying Reiki, may be helpful in calming us. Relief from hot flushes may help better sleep, with women trying acupuncture, medication, and chill pillows. Not drinking caffeine late in the day may help cutting out regular trips to the loo. A cool, dark, quiet, well-aired bedroom, plus a bedtime routine without the phone or tv, maybe including a warm bath or a cool shower, can all be helpful.  Some need to rely on painkillers to get comfortable enough to drop off.  For those who can, a short, early afternoon nap can help to make up for sleep deprivation, and those of us who are at work full-time often need to have a restorative nap at weekends.

        Naz pointed us towards this article, which largely aligns with what our members find useful:


http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips

Our brains are highly active during sleep, and deep sleep performs a restorative function, processing our daily activities and refreshing and stabilising our brains. Sleep is important for retaining memories and for learning new things. She told us that women with a breast cancer diagnosis can take at least half an hour longer to fall asleep than those without, research shows, and their sleep quality is impaired as substantiated by our members. Brain function and structure are affected by the PTSD and anxiety inhibits the brain’s ability to become calm as we try to fall asleep. Our hormones are severely imbalanced, whether due to medication or trauma or both, and our brains remain on high alert, and we are fearful, even while we are asleep.


        Naz's advice to all of us who struggle with sleep is to accept it, work with it, go with the rhythm. It will, if we're lucky, come and go. We may feel at a low ebb after we've slept badly, but generally our bodies cope well and can live with it.


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