It is 3am and you are awake again. The house is quiet, but your mind is not. Thoughts about your diagnosis, your treatment, your future — they arrive in the dark with a particular loudness, as though they have been waiting all day for this moment.
Sleep disruption is one of the most common and least discussed side effects of cancer and its treatment. It is estimated that more than half of cancer patients experience significant sleep problems, yet it is often the last thing people bring up with their doctors, as though it is a luxury complaint compared to the bigger medical issues at hand. It is not a luxury complaint. Sleep is foundational to healing, immune function, emotional regulation, and pain management. Difficulty sleeping deserves to be taken seriously.
What makes sleep hard during cancer? The list is long: anxiety and worry that peak at night, physical discomfort or pain, night sweats from hormonal changes or certain medications, the emotional weight of the day finally landing when there are no distractions. Sometimes it is the stillness itself — when you are not busy, you are forced to feel everything you have been outrunning all day.
Tell your oncology team. This is the first and most important step. Sleep disruption during cancer is a medical issue, and there may be interventions — medication adjustments, referrals to sleep specialists, or cognitive behavioral therapy for insomnia (CBT-I), which has strong evidence for cancer patients — that can genuinely help. You do not have to just endure it.
Create a wind-down ritual for the hour before bed. Dim the lights. Put down your phone. Try gentle stretching or a short guided meditation. Some people find that writing down their worries in a journal — getting them out of their head and onto paper — makes the bed feel like less of a battlefield. A specific routine tells your nervous system that it is safe to relax.
For the nights when sleep will not come, try not to lie in bed for hours fighting it. Get up. Make a cup of herbal tea. Sit in a quiet chair. Do something gentle and not stimulating for twenty minutes, then return to bed. Lying in bed awake for long periods actually strengthens the brain's association between bed and wakefulness, making insomnia worse over time.
Be patient with yourself. You are carrying something heavy, and your sleep reflects that. The goal is not perfect sleep — it is enough rest to sustain you. And on the nights when you cannot sleep at all, you are still resting. Your body is still doing something. You are still getting through the night, one quiet minute at a time.