Sleep problems, also called insomnia, are common when you have an advanced chronic health condition. They can come and go or can be something you experience all the time. They can include:

• Trouble falling or staying asleep,
• Waking up in the night and not being able to fall back to sleep,
• Feeling tired or needing to sleep during the day,
• Your breathing stopping for short amounts of time when you are sleeping, also called sleep apnea, and/or 
• Feeling so tired that you can’t do the things you need to do every day or do the things you enjoy.

Managing sleep problems works best when you play an active role. 

• Try to figure out if there is a cause for your sleep problems. 
• Is it better or worse at different times?
• What helps or makes it worse?

You may want to use a symptom diary to record information about your sleep problems. Tracking this information will help you talk to healthcare team about your sleep problems.

Physical steps you can try:

• Medication: If you take medication for your sleep problems, take it as prescribed and not too early so it doesn’t wear off in the middle of the night.
• Gentle exercise: If it is safe for you, do gentle exercises like walking, swimming or riding a stationary bike every day, either in the morning or afternoon. Try to be in bright sunshine as well in the earlier part of the day.
• Create a sleep routine: Go to bed and get up the next day at the same time every day. Try not to nap in the afternoon or evening.
• Don’t try and force sleep: If you can’t fall asleep within 20 minutes, get up and do something you find relaxing in a dimmed light. Get back into bed when you feel sleepy.
• Create a sleep-friendly bedroom: Use your bedroom for sleep (and sex) only. Keep your bedroom cool, quiet and comfortable.
• Sleep on your side: Use a pillow to support your head and neck and try to lie on your right side.
• Avoid: Using mobile phones, tablets or computers in bed. Also avoid watching TV 60-90 minutes before bed. The light from these can affect the hormones that make you feel sleepy.
• Limit or stop: Alcohol, caffeine and nicotine to see if your symptoms get better. These can make your sleep difficulties worse, especially in the evenings or at night.

Mental activities you can try:

• Don’t keep your worries and fears to yourself: Talk to someone about your worries during the day or write them down. Keep a notepad by your bed so that if you wake up, you can write down the thought and go back to sleep, instead of thinking about it all night.
• Relax: Try meditation, mindfulness, or relaxation therapy. Learning to relax and to change the way you think may help you cope with.

Relaxation techniques you can try at home. 
Ask if someone on your healthcare team can help you get started. You can also learn some on your own. Some techniques include: 

• Progressive muscle relaxation: Focus on slowly tensing and then relaxing each muscle group.
• Deep breathing exercises: Slow your breathing to the point where you are as relaxed in your breathing as possible. Breaths should be deep and fill your lungs. 
• Meditation: Sit or lie in a comfortable position for 20 minutes. Be aware of your breathing, your sensations, your thoughts and feelings. 
• Guided Imagery: Form mental images to take a visual journey to a peaceful, calming place or situation. 
• Yoga: Can relax your breathing, ease muscle tension.
• Massage: Helps reduce all over muscle tension and pain, which can help you relax.
• Hydrotherapy: Uses flowing water to relax muscles.
• Music and art therapy: Listening, playing music, drawing and painting can help you to relax.

Speak with your healthcare team if sleeping is a problem for you. Your worries and questions are important to you and them. Your healthcare team may speak to you about the different medications you can take.   

• Let them know if you think your medical condition or medications are the reason for your sleep problems.
• Let your healthcare team know if a medication is working for you or if you’re having side effects. You may have to try a few different ones to know what works best for you.Talk to them before taking over-the-counter medication, including vitamins and herbal remedies.

Tips on sharing your symptoms with your healthcare team:

• Make some notes about your sleeping problems and tell your healthcare team about them.
• Has there been a change in your sleeping?
• What do your sleep problems feel like? How bad is it?
• When does it happen and how long does it last?
• What makes it better or worse? What have you tried already?
• Make a list of all the medications you are taking including over the counter medications.