Managing night sweats and sleep disruption

Night sweats are hot flushes that happen during sleep, often waking you drenched in sweat and needing to change clothes or bedding. They are very common after breast cancer treatment, particularly with chemotherapy-induced menopause, ovarian suppression and hormone therapy. Repeated waking breaks up sleep, and over weeks this can lead to daytime tiredness, poor concentration, irritability, low mood and reduced ability to cope with treatment. Poor sleep can also be caused by pain, anxiety, worry about recurrence, needing to pass urine at night, steroids or other medicines, and changes in routine. Managing night sweats usually involves several approaches together. Keeping the bedroom cool, using light breathable bedding and nightwear, having a fan and cold water nearby, and avoiding triggers such as alcohol, caffeine, spicy food and hot drinks in the evening can reduce sweats. Good sleep habits, such as a regular bedtime, limiting screens and daytime naps, and relaxing before bed, help sleep quality. Cognitive behavioural therapy for insomnia is very effective for long-term sleep problems. Some non-hormonal medicines can reduce night sweats and improve sleep. It is also important to check for other causes of sweating, such as infection, thyroid problems or medicines, if sweats are new, severe or come with fever or weight loss.

Night sweats are common

Many women experience them during and after treatment.

Sleep problems are treatable

Practical changes and therapy can greatly improve sleep.

Report unusual sweats

Sweats with fever, weight loss or other new symptoms need checking.

Consistent habits help reset sleep patterns.

Regular times

Go to bed and wake up at similar times every day, including weekends.

Wind down

Spend the last half hour before bed relaxing, away from screens and work.

Limit stimulants

Avoid caffeine in the afternoon and evening, and limit alcohol.

Daytime light and activity

Morning daylight and regular exercise support night-time sleep.

If you cannot sleep

If awake for a long time, get up, do something calm in dim light, and return to bed when sleepy.

Cognitive behavioural therapy for insomnia, often called CBT-I, is recommended as the first treatment for long-term sleep problems, including in people who have had cancer. It works by changing habits and thoughts that keep poor sleep going.

Sleep diary

You record when you go to bed, how long it takes to fall asleep, how often you wake and how rested you feel. This helps identify patterns.

Sleep scheduling

You may be asked to limit time in bed to the hours you actually sleep, then gradually extend it. This strengthens the body's natural drive to sleep.

Linking bed with sleep

Using the bed only for sleep and intimacy, and leaving the bedroom if awake for a long time, helps the brain associate bed with sleeping.

Changing unhelpful thoughts

Worries such as I will never sleep again can increase alertness. CBT-I helps replace them with calmer, more realistic thoughts.

Relaxation

Breathing exercises and muscle relaxation reduce tension before sleep.

How long it takes

Most programmes last around six to eight weeks, and improvements often last long after therapy ends.

Where to find it

Psychologists, some hospital supportive care services and online programmes offer CBT-I.