Illness and Insomnia: How One Patient Fights Cancer and Sleep Issues

Insomnia is often triggered by an underlying health problem, and together the conditions can create a vicious cycle. It's difficult for your immune system to recover if you're not sleeping, but it's nearly impossible to sleep when you're plagued by the stress and discomfort of another illness.

If a serious condition such as cancer triggers your insomnia, there are many potential factors to deal with: fear, pain, nausea, and more. Should you develop insomnia on top of everything else, it's important to see your primary care doctor or a sleep specialist to address the problem.

Sean Graham, a media relations consultant in Raleigh, N.C., is dealing with several health issues: insomnia, sleep apnea, and cancer. Developing non-Hodgkin's lymphoma in June 2007 actually improved his apnea because he lost 35 pounds. The insomnia he'd struggled with for years, however, got worse.

"I try not to dwell on the cancer, but sometimes the anxiety and frustration just blindsides me," says Graham, 53, who finished his second round of chemotherapy in early 2008. "My medication usually puts me out, but once or twice a week I have trouble. The ongoing stress about my health and finances can really encroach on my sleep."

Graham's doctor initially gave him Ambien, a nonbenzodiazepine sleeping pill, which he took every night for about two years. But renewing his supply each month was difficult, especially after he changed jobs and insurance companies. "It was a high co-pay, like $50 a month, and my doctor had to periodically jump through hoops to convince my insurance company that I should have a new prescription," he says.

So he switched to trazodone, a generic antidepressant often prescribed for sleep problems. Graham can get up to 60 pills for a $10 co-pay.

Trazodone hasn't been working as well for Graham; he has trouble waking up in the mornings and feels groggy for several hours. But he says he needs medication to sleep most nights, and it is the best he can afford while dealing with cancer expenses.

Chemotherapy actually improved Graham's insomnia: "It totally wiped me out; for once I had trouble staying awake instead of trouble sleeping." For some cancer patients, however, it can have the opposite effect.

Once Graham's chemo was completed, his insomnia came back, though not as bad as it once was. "It's different now," he says; "I used to have no problem falling asleep, but I'd just wake up around 2 or 3 and couldn't get back to sleep. Now, I have a lot of trouble falling asleep, even with sleeping pills."

When he's too anxious to sleep, Graham takes a low dose of Xanax, which seems to relax him enough to doze off. He also compromised with his doctor, taking trazodone most nights but keeping a 15-day prescription of Ambien on hand for nights before early morning work meetings.

Graham's general practitioner is the doctor who treats his insomnia, but every time he starts on a new drug, he informs his oncologist.

"The key is to have open lines of communication between doctors," says James Wyatt, PhD, director of the Sleep Disorders Center at Rush University Medical Center in Chicago. "Insomnia is still treated separately, but it's important to look at it as part of the big picture."