People with cancer, including multiple myeloma, are twice as likely to report sleeping difficulties compared to the general population. Some studies suggest that up to 75 percent of people with cancer face sleep disturbances. People with multiple myeloma often report fatigue as one of their main concerns.

The stress of a multiple myeloma diagnosis, pain from the condition, and side effects of cancer treatment can make it hard to sleep. Unfortunately, poor sleep can significantly impact your quality of life, energy, and physical and mental well-being.

Here are some reasons people with multiple myeloma may struggle with sleep and tips on how to manage it.

1. Pain

Many people with multiple myeloma often experience bone pain in their back, hips, and chest. Neuropathy (nerve pain, numbness, or tingling) is another common symptom of multiple myeloma. It can be caused by the condition itself, conditions you had before your myeloma diagnosis, or side effects of myeloma treatment.

Peripheral neuropathy (neuropathy that affects the arms, hands, legs, and feet) can occur in up to 75 percent of people with myeloma after treatment. About 20 percent of people with myeloma have symptoms of peripheral neuropathy when first diagnosed.

Bone and nerve pain from multiple myeloma can keep you awake at night and contribute to sleep problems. Some people find that pain and other symptoms, like numbness and burning sensations, are worse at night. One MyMyelomaTeam member described how neuropathy affects their sleep: “At night, I feel a spastic electrification of nerve endings and, at times, an electrical shooting pain that wakes me up.”

Bone and joint pain can also be caused by bisphosphonates, a type of medication healthcare professionals may prescribe to help reduce bone weakening from myeloma. If you take bisphosphonates, talk to your doctor about possible side effects.

2. Extreme Exhaustion

Sleep problems and insomnia can be caused by fatigue from the cancer itself and its treatments. Fatigue related to multiple myeloma is different from regular tiredness. This type of fatigue is an extreme exhaustion that can’t be resolved with rest and usually lasts longer than regular fatigue. Along with the fatigue, you might also have trouble concentrating, feel dizzy, or lose interest in things around you.

3. Anemia

It’s very common for people with multiple myeloma to experience anemia, either when they’re diagnosed or later in the course of the disease. Anemia happens when your blood doesn’t have enough hemoglobin, a protein that carries oxygen. Fatigue is a key symptom of anemia. Anemia usually improves once you start cancer treatment. Your healthcare provider might also recommend erythropoietin injections or a blood transfusion to help your body make more healthy red blood cells.

4. Steroids

Corticosteroids are often prescribed for multiple myeloma. They help manage common symptoms and side effects of chemotherapy, like nausea and vomiting. However, these steroids can cause their own side effects, including hyperactivity and trouble sleeping.

One MyMyelomaTeam member mentioned that taking dexamethasone or other steroids contributes to their insomnia, especially when they take them later in the day. They warned, “Always take steroids in the morning, or you can forget about sleeping at night!”

If you notice that steroids are keeping you up, discuss your concerns with your oncology team. They might suggest taking the medication in the morning or adjusting your treatment plan.

5. Anxiety and Depression

A multiple myeloma diagnosis can be stressful and emotionally challenging. Many people with multiple myeloma experience depression and anxiety before, during, and after treatment. These feelings can disrupt your sleep and overall quality of life.

If you’re overwhelmed, talk to your healthcare provider about how you’re feeling. They can give you a referral to a mental health professional who can help.

6. Hot Flashes

Hot flashes are common for people living with cancer, including those in remission. They can be caused by many triggers, including radiation therapy, surgery, and some medications. One MyMyelomaTeam member shared, “I have hot flashes, and they are very annoying because sometimes I can’t sleep at night.”

Hot flashes caused by multiple myeloma can also lead to night sweats, which can leave you feeling uncomfortable. You might need to get up and change your pajamas or pillowcases. Night sweats are your body’s way of trying to cool itself down.

Your cancer care team may recommend medications, such as hormone therapy, to reduce hot flashes and night sweats. Some people also find relief by using a fan at night, wearing loose clothing to bed, or practicing relaxation techniques like deep breathing or cognitive behavioral therapy.

How You Can Improve Your Sleep

A good night’s sleep is essential to help your body fight cancer and heal after multiple myeloma treatment. A mix of lifestyle changes and medical support can help you get the rest you need.

Practice Good Sleep Hygiene

Good sleep habits can improve your sleep quality. Make a nightly routine that you can follow to help yourself wind down before bed. Here are some tips on good sleep hygiene:

• Stick to a consistent bedtime routine to signal to your mind that it’s time to sleep.
• Spend 30 minutes relaxing before bed. Wind down with reading, soft music, or try mindfulness techniques.
• Keep your bedroom dark and cool. This can also help with hot flashes at night.
• Avoid alcohol, caffeine, and heavy meals before bed, as these can keep you awake.
• Try not to lie in bed for a long time. If you’re still awake after 20 minutes, get out of bed and do something relaxing, like reading or listening to calming music. When you feel sleepy, try going back to bed.

Add Physical Activity to Your Routine

Healthy habits during the day can improve your sleep at night. Although physical activity can help with fatigue, it can be hard to stay active while managing multiple myeloma. If you want to get more physical activity, ask your healthcare provider for tips. They can suggest safe ways to stay active without overexerting yourself.

Limit Naps During the Day

Naps can be a great way to rest when you need it, but too many naps during the day can disrupt your sleep at night. One member shared, “I woke up very early, so I’m catching up on the local news. I will do some light housework, then rest. Then I’ll walk my dog, fix a little lunch, then nap. With neuropathy, extreme fatigue, and insomnia, I get tired easily and rest often.”

It’s important to listen to your body and give yourself a break when you need it. However, you should try to limit daytime naps, because they can interfere with your sleep schedule, making it harder for you to get quality sleep at night.

Talk To Your Doctor

If you are having trouble falling or staying asleep, your healthcare provider or oncologist can help. They can suggest ways to improve your sleep habits, adjust medications that may be affecting your sleep, and explore other treatment options. Your doctor may recommend massage therapy, cognitive behavioral therapy, or relaxation techniques. While they can prescribe medication to help regulate your sleep, most prescription sleep aids are meant for short-term use only, since they can have negative effects. Your doctors can also prescribe medications to manage pain, which can help you sleep better.

Some members of MyMyelomaTeam have worked with their doctors to find treatments for better sleep. One member said, “My oncologist gave me Ambien. It’s the only thing that shuts my brain off so I can sleep.” Another wrote, “I take Unisom and melatonin sublingual tablets.”

Always talk to your healthcare team before using any sleeping aids or supplements. Just because something is available over the counter doesn’t mean it’s safe for you. Some sleep aids can interact with other medications, which could be dangerous. Make sure to discuss any changes with your doctor first.

If you are struggling with sleep problems or insomnia due to multiple myeloma, you are not alone. Talk with your oncologist about ways to manage your sleep. They can suggest lifestyle changes or treatments to help you get a good night's rest.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people with myeloma and their friends, family, and caregivers. On MyMyelomaTeam, more than 27,000 members come together to ask questions, give advice, and share their stories with others who understand life with blood cancer.

How does multiple myeloma affect your sleep? Does multiple myeloma make you sleep more or less than usual? Share your experience in the comments below, or start a conversation by posting on your Activities page.