Sleeping Through Chemo (Part 2)

Calming the nervous system and rebuilding conditions for rest

In Part 1, we looked at a framework to identify causes of your insomnia, reset your circadian clock and address hormonal imbalances. If you haven’t read it yet, it’s worth starting there.

Today is about how to calm a wired nervous system, use your body and breath as medicine, eat and drink in ways that support sleep, and create an environment that stops working against you.

Paid subscribers can access A Stepwise Plan For Managing Chemo-Related Insomnia. Read it online or download it as a PDF.

Reset your nervous system

At its core, chemotherapy-related insomnia is a state of chronic hyperarousal. Your sympathetic nervous system (the branch responsible for alertness, vigilance, and stress responses) is running overtime while the parasympathetic branch (the one that governs rest, digestion, and recovery) is taking a back seat.

Thank God the autonomic nervous system is trainable. These simple interventions will actively shift the balance toward the parasympathetic state your body needs to sleep.

Deep breathing exercise

Breathwork is my favourite. Slow diaphragmatic breathing activates the vagus nerve and dials down sympathetic drive. You’ll feel the effect within minutes.

Here are some easy exercises to try:

• 4-7-8 breathing - Inhale 4, hold 7, exhale 8 counts.

• Box breathing - Inhale 4, hold 4, exhale 4, hold 4.

• Physiological sigh (my favourite) - Short sniff through the nose, immediately top up with a full second inhale, and long slow exhale through the mouth.

• Humming exhale (another good one) - Inhale through the nose, exhale with a continuous “mmm” hum until the breath runs out.

Yoga nidra and NSDR (Non-sleep deep rest)

These guided, body-scan practices activate the parasympathetic system and appear to restore neurochemical depletion. They work well as both a daytime recovery tool and a pre-sleep wind-down, especially on days when full sleep is elusive. There are plenty of Youtube videos to guide you through a session.

Mindfulness meditation and progressive muscle relaxation (PMR)

Both meditation and PMR reduce arousal, lower cortisol, and shorten sleep latency (the amount of time it takes to transition from full wakefulness to sleep).

A warm bath 1–2 hours before bed

A warm shower or bath shunts blood to the skin surface, which accelerates the drop in core body temperature that triggers melatonin release. Add a handful of Epsom salts and a few drops of lavender oil while you're at it. Magnesium and lavender both have calming effects.

Move Your Body

Physical activity is one of the most consistently effective non-pharmacological treatments for insomnia in people with cancer. It regulates your body clock, lowers anxiety, lifts mood, and builds the kind of physical tiredness that promotes deeper sleep. You don’t need to push hard. Even 20–30 minutes of walking on most days is beneficial.

Work within your current energy level and adjust around your treatment cycle. If neuropathy, anaemia, or joint pain is limiting you, ask your oncology team about a referral to an exercise physiologist or physiotherapist. They can tailor an exercise program for you.

Avoid vigorous exercise in the 2–3 hours before bed if sleep onset is your main problem. It can temporarily raise alertness which is helpful in the morning but counterproductive at night.

Mind-Body Therapies

Yoga

A multicentre trial enrolled 410 cancer survivors and found that a 4-week standardised gentle yoga program produced significantly better sleep quality, reduced daytime dysfunction, and meaningfully cut sleep medication use compared with standard care.

Look for classes or YouTube channels specifically designed for people with cancer or chronic illness. Avoid intense or heat-based yoga.

Mindfulness and meditation

Mindfulness-based practices can relax your mind and body, preparing you for better sleep. Try these:

• Body scan meditation - lie down and slowly move attention through each body part. It anchors an overactive mind in physical sensation

• Focused breathing - notice each inhale and exhale. Gently return attention when your mind wanders

• Guided apps - Calm, Headspace and other meditation apps usually have sleep-specific tracks

Any of the breathing exercises listed above will also help you relax before bed.

Consistency matters more than perfection. Even 10–15 minutes of intentional relaxation each night creates measurable changes over time.

What you eat and drink affects your sleep

What and when you eat and drink can affect how easily you fall asleep, how often you wake, and how rested you feel in the morning.

Caffeine

Caffeine can impair sleep even when consumed 6 or more hours before bedtime. It’s found in coffee, black and green tea, most energy drinks, many soft drinks, some over-the-counter pain tablets, and chocolate. Don’t drink caffeine after 12pm. Swap afternoon drinks for herbal teas (chamomile, peppermint, ginger, rooibos) or warm milk.

Alcohol

I used to have a 10th of a glass of wine (because I’m Asian) after a stressful day to help me sleep but it was the wrong move. Alcohol may initially make you drowsy, but it can fragment the second half of the night, suppresses both deep and REM sleep, and worsens snoring, sleep apnoea, and night sweats. Alcohol is also bad for other reasons which we will discuss another time.

Meals and timing

Large, rich, or spicy meals close to bedtime worsen reflux when you lie down. Going to bed hungry also disrupts sleep. Try to eat a moderate-portioned evening meal 3–4 hours before bed.

Try to limit high-carbohydrate meals at dinner and avoid large desserts. A significant insulin spike after a carbohydrate-heavy evening meal can lead to a subsequent drop in blood glucose levels while you sleep. This nocturnal hypoglycemia often triggers a compensatory release of cortisol, which can cause you to wake up.

Stay well hydrated through the day but reduce large fluid volumes in the 2–3 hours before bed if frequent night-time toilet trips is keeping you awake.

Acupuncture

A 2025 systematic review found that electroacupuncture significantly improved sleep quality in cancer patients, increased total sleep time, and reduced sleep disturbances, with no serious adverse events reported.

Acupuncture also addresses pain, fatigue, anxiety, nausea, and hot flushes simultaneously, which makes it especially valuable when several of those symptoms are driving the insomnia.

Safety considerations during chemotherapy:

• Always share your current blood results with your acupuncturist before each session. Acupuncture is generally avoided or significantly modified when platelet counts are very low or when you are neutropenic.

• Choose a practitioner with oncology acupuncture training. Not all acupuncturists are trained to work within cancer care.

EMF exposure and your sleep environment

This is a controversial one but worth mentioning. Electromagnetic field (EMF) exposure MAY undermine sleep through suppression of melatonin synthesis and activation of the sympathetic nervous system.

Marnie from Healing After Breast Cancer wrote a comprehensive article about EMF and breast cancer so I won’t go into EMFs in detail here.

People with pre-existing insomnia may be more vulnerable to these effects than healthy sleepers, which makes practical mitigation worth implementing.

Even though EMF may or may not be contributing to your insomnia, these steps are easy enough to implement and not having technology close to your bed comes with other obvious benefits:

• Switch off the Wi-Fi router at night (or use a timer)

• Put your phone on airplane mode or move it out of the bedroom

• Unplug non-essential electronics near the bed

• Avoid electric blankets

• Use a battery-powered alarm clock

Sleep hygiene is the foundation of good sleep

No supplement, herb, or therapeutic technique will consistently work if the basic conditions for sleep are wrong. Sleep hygiene is not optional lifestyle advice. It’s foundational terrain restoration. Try some of these lifestyle tweaks.

Evening wind-down:

• Dim all artificial lights. Use warm-spectrum bulbs or candles (romantic!)

• Set your bedroom to 16–19°C. Core body cooling is a prerequisite for melatonin release.

• No screens without blue-light filters. No work emails or stimulating content (no Trump updates)

• Last meal at least 2–3 hours before bed. No alcohol or caffeine after 1 p.m.

• Brain dump. Write down tomorrow’s tasks to offload cognitive load before you close your eyes

• A short gratitude practice

• Have a warm drink

• Take a warm bath or shower

Daytime routines:

• Morning natural light exposure (even 10–15 minutes outside)

• Naps no longer than 20 minutes and before 3 pm

• A consistent wake time every morning, even after a poor night

The bedroom as sleep sanctuary:

• Bed only for sleep and sex. No scrolling, working in bed, or watching TV

• Blackout curtains or a sleep mask for absolute darkness.

Managing insomnia during chemotherapy is not about finding a single silver bullet. It’s about building a stack of evidence-based strategies that address the specific drivers of your sleep problems and progressively restore your body’s own capacity to rest. Start with the foundations, be patient and consistent, and involve your care team.

In Part 3, we’ll go into the targeted supplement and nutritional support that layers on top of everything covered here, including melatonin, magnesium, CBD and more.

This information is for education only and not a substitute for medical advice. Always consult your healthcare team before making changes to treatments, supplements, or lifestyle. While every effort is made to ensure information is accurate and evidence-informed, no guarantee can be given. The author accepts no responsibility for any loss or harm that may arise from reliance on the information provided.