[Aussie Girl]

Boy, do I relate to this one. I have had chronic sleep problems since adolescence and have grown used to functioning with little sleep.

Unfortunately, I am severely lactose intolerant and all sleeping tablets contain lactose. I have used them intermittently at low dose with lacteeze (lactase enzyme - I don't find lactase very effective by the way.)

Firstly - Google "sleep hygiene" and get your sleeping conditions set up as best you can for your situation. Reduce as any other side effects you might have like pain and oesophageal reflux at bed time that you can. Everyone has a "sleep wave" that comes over them and that is the best time to get to sleep. Very hard with small children! Set up the best sleeping conditions for them too. Try to get your husband/ partner if you have one to get up to the kids at night if possible, or at least try to get him to get them to sleep so you can have a mental wind down period. Eventually and reluctantly, I had to move into a separate air conditioned quiet room from my husband to sleep, because of his snoring (or even just deep breathing). Oh and did I mention, coal trains come squealing down the range every 60 to 90 minutes near our house all night. I am the only one in our house who notices them.

There are some herbal medication and teas with valerian, chamomile etc that can help, but many people on chemo have to resort to medication just to survive. Depression and dysfunction due to lack of sleep is probably worse for your family than a bit of a morning hangover. Which might be due to the chemo itself anyway.

Rests during the day will help you cope. If there is someone to take care of the kids for an hour while you rest, take advantage of it. Do not do house work during this time!!! Meditation and learning to calm your mind is very helpful too. (Also knowing that dying from lack of sleep is very rare unless you are addicted to drugs like dexamphetamine was a comfort to me!)

I have only used the lightest shortest acting benzodiazepine (I will use the actual drug name and you can look up the brands in the USA) - temazepam. I don't really get a hangover with this if I take it before midnight. Deciding to take it and taking it early is better than when you are worked up and desperate in the middle of the night. In general, I never take it on consecutive nights. That was before chemo craziness though.

Other drugs commonly used for chemo are Lorazepam (Ativan) and Zolpidem (Stilnox). The last is some people's savior, but has some strange side effects on a minority. Your primary care physician is the best person to help you here.

I have had an average of 2 hours sleep a night for over a month, so I am finally giving into my oncologist's insistence that I use more medication despite my bowel problems (I had my 5th infusion of TCH yesterday). I am allowed to try the liquid oxycodone which I was given for severe rectal problems in my first round, but have never used since. Taking that is like taking a triple whisky. I'm only going to use that as a last resort and it would be a poor option for you.

One of my main problems is the hot and cold flushes. I think this is partly due directly to the chemo drugs, but chemo induced menopause has probably now set in. My oncologist says I can try vaginal estrogen cream to see if it helps. I am ER, PR negative. She wouldn't prescribe it for an ER+ breast cancer patient who usually have anti-estrogen therapy to block it anyway. However there is no good evidence that a small amount of vaginal estrogen increases blood levels of estrogen above the normal menopausal range. There is a good dose of paranoia out there about this and the drug companies don't recommend its use in breast cancer patients. This is not evidence based and I would not be worried if you are ER neg. I am getting my cream this week and will tell you if it helps me. Almost all hormonal tablets have lactose in them and I am allergic to the adhesives in patches, but vaginal cream is a good low dose way of getting a little estrogen on board. It is the most effective treatment for menopausal symptoms with the fewest side effects.

SO - I hope that helps a little. Learning about sleep hygiene, day time rests, meditation, herbal help and a short acting benzodiazepine might be the best chances for you.

Good luck, dear LMB3. I would hate to tell you how little I slept when my kids were small and how long it took me to realize that I needed to look after myself before I could look after them properly.

Aussie Girl