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Overcoming Battles with Sleep During and After Cancer Treatment

Written by Guest Contributor Dr. Naadira C. Upshaw, Pediatric Psychologist

The importance of sleep cannot be overstated. It is a critical component of our health, and while there has been a movement in pop culture underscoring its importance, our bodies and brains thrive off adequate and quality sleep. In fact, science tells us that inadequate sleep leads to slowed cognitive functioning—or feeling “foggy”—reduced attention capacity, forgetfulness, reduced reaction time, lower mood, and challenges with other aspects of important self-care (e.g., eating, exercising, ability to engage in pleasurable activities). That said, many families who are dealing with pediatric cancer - both during and after treatment - report their children having more difficulties with sleep.

Sleep is one of the top reasons we are consulted in our Pediatric Psychology consultation service within the Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta. Caregivers understand the importance of sleep for their children but find that helping them get adequate sleep can be challenging.

Common concerns include:

  • significant disruptions in the sleep routine following admission

  • nighttime fears and anxiety

  • parental worry about their child’s health during the night

  • reliance on electronics for comfort

  • challenges falling and staying asleep

Interestingly, caregivers often know many of the strategies needed to help their child get their sleep back on track, but often are impacted by caregiver burnout and guilt, making it a challenge to be firm and consistent in sleep approaches. This is a common experience of many caregivers, and normalizing this is important. Here are some strategies to get sleep back on track:

  1. Consistency is key! It is always advised that parents identify a nighttime routine that is reasonable and repeatable every night. Sometimes families pick schedules and routines that sound great in theory, but that are difficult to carry out due to schedules and other variables. As such, pick a routine that involves tasks important to your family that can be done in any environment (e.g., other family members, vacation, etc.). Good routines often involve nighttime baths, book reading for younger children, bedtime hugs, etc.

  2. Eliminate screens before bed. The blue light that is transmitted through screens (e.g., phones, television, tablets) tells our brains to wake up by interrupting its ability to release the sleep hormone melatonin. Being on treatment, rules around screen time become relaxed because it helps comfort kids. However, it can negatively impact sleep going forward, especially when the rules return. A rule of thumb is to eliminate all screens at least 30-60 minutes before bedtime and engage in a calming, relaxing, and non-electronic activity.

  3. Find a comfortable environment. There are many factors that contribute to one’s ability to create a comfortable sleep environment, and sometimes there are financial or physical limitations. However, focus on what is within your control to make sleeping as comfortable as possible. Things to consider include: temperature, covers, night lights, noise, etc. Talk to your child about what helps them get comfortable.

  4. Nighttime fears are real. Nighttime anxiety is real, for both kids and their caregivers, especially after treatment. Validating and normalizing this is important. Providing reassurance through words or a transitional object (e.g., caregiver’s shirt, stuffed animal) can help. Baby monitors can also provide a layer of comfort for caregivers and kids. Also, if a child has a habit of waking up during the night to get in your bed, try the bedtime pass strategy. Make a pass that they get each night. If they come to your bed, they have to give up the pass. If they stay in their bed and/or come to you for quick reassurance and go back to bed, they keep the pass to turn it in the next morning for a fun and exciting reward. This must be a motivating but also small and reasonable reward for you to give every day. Sometimes, rewards that require several nights of success to earn are not motivating enough. Quick and easy rewards can include: an extra five minutes of screen time, special morning snuggle time, picking what to eat for breakfast, picking music for morning car ride, etc.

  5. Aim to get enough sleep. Kids and adults need different amounts of sleep at different ages. According to the Baby Sleep Advice for Parents & Kids | Pediatric Sleep Council, kids need this much sleep in a 24-hour period (including naps):

    1. Infants to 12-months: 12-16 hours per day

    2. Children ages 1-2 years: 11-14 hours per day

    3. Children ages 3-5 years: 10-13 hours per day

    4. Children ages 6-12 years: 9-12 hours per day

    5. Teenagers 13-18 years: 8-10 hours per day

  6. Talk to your medical providers. Oftentimes, kids benefit from the addition of melatonin to support falling asleep. Also, sleep hygiene and patterns are very behavioral, thus there are many strategies that can be put in place to support sleep. Talking to your team may give you some ideas.

While the importance of sleep for brain, physical, and mental health cannot be emphasized enough, it is most important that caregivers give themselves grace. Nothing will be perfect, and giving your best shot at consistency is of most importance.

Dr. Naadira Upshaw is Assistant Professor of Pediatrics at Emory University School of Medicine and Pediatric Psychologist at Children's Healthcare of Atlanta in the Aflac Cancer and Blood Disorders Center. She received her Bachelor's of Science in Child and Family Development and Minor in Biology from UGA in 2010, and her Doctorate in Clinical Psychology specializing in child and family from the Georgia School of Professional Psychology in 2017. Dr. Upshaw is the rare Atlanta native, and she’s a big fan of her hometown—loving the culture, food and diversity of Atlanta. She loves spending time with friends and family with homecooked meals, playing games, going to festivals and concerts (she’s a big Beyonce fan!), and she loves to travel. Dr. Upshaw is also very engaged in social justice and advocacy work at Emory and in the community. And when she gets a little downtime for herself, she likes to watch mindless reality television and cook new recipes.

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