Sleep can be derailed for many reasons

So consider which of the following solutions and strategies apply to you:

• Ease hot flashes. Hot flashes triggered by anticancer drugs may wake you repeatedly during the night. Speak with your doctor about options. Non medical options include keeping a diary of hot-flash triggers such as alcohol, caffeine, or spicy foods and avoiding them; waiting a while until your body adjusts to medications; and engaging in relaxation therapy,which has been found to help ease hot flashes somewhat when done daily (see sidebar “Really Relaxing”). 

Keep a fan, a cold water bottle, and a cool, damp washcloth at your bedside (plus a change of night clothes and perhaps a folded sheet you can slip beneath you if you experience drenching  sweats).If necessary, discuss medications with your doctor. Possibilities include the antidepressants venlafaxine (Effexor), paroxetine (Paxil), and fluoxetine (Prozac). Venlafaxine is notable for having little impact on sex drive. A 2005 multicenter trial suggests that gabapentin (Neurontin), a medication usually prescribed to treat seizures, migraines, and restless leg syndrome, helps reduce hot flashes related to breast cancer treatments. 

More than 400 women with breast cancer who were experiencing at least two hot flashes a day were randomly assigned for two months to take either 900 milligrams (mg) of gabapentin daily, 300 mg of gabapentin daily, or a placebo (sugar pill). Hot flashes occurred less frequently and were less intense among those who received 900 mg of gabapentin compared to those who took 300 mg or a placebo. There was no difference with respect to 10 other symptoms, suggesting that gabapentin was well tolerated.Currently, no studies compare the effectiveness of gabapentin for hot flashes against other non hormonal medications.

The high blood pressure medication clonidine (Catapres)is sometimes prescribed, although trials suggest that the relief gained does not outweigh possible side effects. Other non hormonal medications less commonly prescribed include the anticancer drug megestrol acetate (Megace) and medroxyprogesterone(Depo-Provera), which is typically used for birth control.

Natural approaches to hot flashes, such as vitamin E, black cohosh, red clover, dong quai, and soy have largely failed to help much, according to available studies. With the exception of vitamin E and, possibly, black cohosh, these natural remedies are weak plant estrogens (phytoestrogens). The question of whether they might be harmful for women who have had breast cancer, which sometimes is fueled by estrogen, is currently unanswered.

• Set the stage for sleep. Smoking, caffeine, and alcohol can disrupt sleep, particularly when indulged in close to bedtime. So can late sessions of exercise, which can actually help you sleep if done earlier in the day. Rearrange your routine as needed and work on cutting out unhealthy habits like smoking.

• Try to calm unsettling emotions. Anxiety or depression can make it hard to sleep. Relaxation tapes and techniques like those described or learning the steps for self-hypnosis may help. Counseling and, possibly, anti-anxiety or anti-depression medications may be necessary, as well.

• Practice good sleep habits. Get up at the same time each day. Try ending naps before mid afternoon and keeping them short. A light bedtime snack, but not a heavy meal, may make you sleepy. A pleasantly dark, quiet bedroom kept at a comfortable temperature encourages sleep. If you truly can’t sleep, it may be best to curl up elsewhere to read a book, listen to calming music, or watch TV until you feel ready for bed. Finally, if all else fails to work, discuss sleep medications with your doctor.