Experts say there are ways to improve sleep even with NSCLC.
1. Deal with nighttime cough
Here are some tips to help clear and calm your airways before bed.
- To loosen mucus, Dr. Zhang says, put a towel over your head and breathe in the steam from a bowl of hot water, or run a warm mist humidifier 20 to 30 minutes before bed.
- Drink lukewarm water, herbal tea, or soup to thin mucus secretions.
- Try coating your throat with a teaspoon of honey to relieve your cough.
If your cough is severe, Zhang suggests talking to your care team about prescribing cough medicine or nebulizer treatment before bed.
2. Take long-acting pain medication before bed
Even if you fall asleep well, you may wake up in the middle of the night with pain. Short-acting painkillers wear off after 4 to 6 hours, so if you take them in the evening, they may wear off while you sleep.
“The process of waking up, taking another dose, and waiting for it to take effect can require an hour or two of sleep each time,” says Zhang, who suggests the following steps:
- Talk to your pain management team about switching to a long-acting medication that can control your pain throughout the night.
- Take the medicine 30 to 60 minutes before bedtime to ensure its effectiveness at bedtime.
- Keep short-acting emergency pain medication at your bedside if needed in case of breakthrough pain. However, try to use it as little as possible.
Above all, always talk to your care team before changing the way you take your medications, especially opioids, says Zhang.
3. Adjust the timing of corticosteroid administration
Here are some changes you can make to avoid these effects.
- Ask your oncologist if you can take your steroid dose in the morning or early afternoon so that the irritating effects wear off by bedtime.
- If you are taking more than one dose per day, ask if you can take a smaller dose later.
As with painkillers, do not change the timing of steroid administration on your own. Always check with your care team first, as suddenly stopping steroids or changing the dose suddenly can be dangerous.
4. Relax by journaling and relaxing.
At the end of the day, worries about treatment, prognosis, and everything else can take over and make calming your mind nearly impossible.
There are a few things that can help.
- Take a few minutes before bed to freely write in your journal what’s on your mind. If writing is difficult due to fatigue or neurological disorders, voice memo apps can work as well.
- As you journal, make a list of things you are grateful for and things that brighten your day. This will help shift your mind to something positive before bed.
- Try progressive muscle relaxation (slowly tensing and relaxing each muscle group from your toes to your forehead), 4-7-8 breathing (inhale for 4 counts, hold for 7, exhale for 8), or meditation to help bring your body out of stress mode.
5. Be prepared for nausea and night sweats
If you’re feeling nauseous, try these habits:
- To calm your stomach without causing reflux, eat a light, bland snack like crackers, toast, or a banana about an hour before bed.
- Take your prescribed anti-nausea medication as scheduled, and ask your oncologist about taking an extra dose before bed on tough days.
- Keep water and snacks within reach so you don’t wake up feeling nauseous, Chan says.
If you have night sweats or hot flashes, try the following:
- Keep your room cool and use breathable cotton sheets and sleepwear.
- Have a new set of pajamas on hand. This way, if you have night sweats, you can change quickly and get back to sleep with minimal interruption.
6. Elevate your head and upper body
Shortness of breath may become more pronounced when you get into bed, especially if you are lying down. Mucus often builds up in the lungs, leaving less room for the diaphragm to move, which can lead to coughing attacks and feelings of choking, Zhang said. Elevating your head and upper body helps keep your airways open, which helps mucus drain downwards.
There are several ways to try this.
- Use a wedge pillow or stack two or three firm pillows to create a gentle slope of about 30 to 45 degrees from your hips to your head. “Avoid pushing your head forward on one pillow, as this can twist your neck and actually make your breathing worse,” says Zhang.
- If you have fluid around your lungs (pleural effusion), Zhang recommends sleeping on the affected side, keeping your head elevated.
“If you’re short of breath, consider pointing a fan at your nose and cheeks,” says Dr. Schenk. If your doctor recommends oxygen or a continuous positive airway pressure device, use it as prescribed to help you sleep more restfully, she points out.
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- Open your airway before bed and elevate your upper body when you lie down to reduce coughing and shortness of breath at night.
- To avoid waking up with pain or nausea, talk to your care team about long-acting painkillers and eat a light, bland snack an hour before bed.
- If steroids are part of your treatment, adjust timing or discuss earlier in the day. Keep a journal or practice relaxation techniques to calm your mind before bed.
- If sleep problems persist, talk to your oncology team, as a change in medication or a referral to a sleep specialist may be helpful.
