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Are you asleep during chemo?

Many cancer patients undergo chemotherapy as part of their treatment plan. Chemotherapy involves the use of drugs to kill cancer cells and stop them from spreading. While chemotherapy can be an effective treatment, it often comes with significant side effects like fatigue, nausea, vomiting, and more. One common question cancer patients have is whether it is normal to sleep during chemotherapy infusions. In this article, we’ll provide a quick overview of chemotherapy and its side effects, look at the factors that may contribute to fatigue and sleepiness during chemo, and offer some tips for staying awake and alert during treatment.

What is Chemotherapy?

Chemotherapy refers to the use of drugs to treat cancer. It works by killing fast-growing cancer cells or preventing them from dividing and spreading. Chemotherapy can be used on its own or along with other treatments like radiation or surgery. The drugs used in chemo are powerful medications that target and damage cancer cells. Unfortunately, these drugs can also affect healthy cells, leading to side effects.

There are many different chemotherapy drugs that work in various ways. The type of chemo recommended depends on the type of cancer, its stage, and other factors. Some of the most common chemo drugs include:

– Platinum drugs like cisplatin and carboplatin
– Taxanes like paclitaxel and docetaxel
– Anthracyclines like doxorubicin and epirubicin
– Antimetabolites like 5-fluorouracil and capecitabine
– Alkylating agents like cyclophosphamide

Chemotherapy may be given in different ways:

– Intravenous (IV) – given directly into a vein
– Oral – taken by mouth in pill or liquid form
– Injected – shot into a muscle or fatty tissue
– Intrathecal – injected into the spinal fluid

Chemotherapy is typically given in cycles, with treatment followed by a rest period to allow the body to recover. Cycles generally last a few weeks. Most patients undergo 3-6 cycles total. Sessions can last anywhere from minutes to hours depending on the drugs used.

Side Effects of Chemotherapy

While chemotherapy targets cancer cells, it can also affect healthy cells. This leads to various side effects that patients may experience. Common chemo side effects include:

– Fatigue – feeling very tired, sluggish and weak
– Nausea and vomiting – feeling queasy or throwing up
– Loss of appetite – not feeling hungry
– Hair loss – hair falling out from all over the body
– Mouth sores – painful ulcers in the mouth
– Diarrhea or constipation – loose stools or difficulty going
– Nerve and muscle effects – pain, numbness or tingling
– Skin changes – rashes, dryness, itching, peeling
– Anemia – low red blood cells leading to fatigue
– Infection – low white blood cells raising infection risk
– Bleeding problems – low platelets increasing bleeding

The specific side effects experienced depend on the chemotherapy drugs used, dosage, and the individual. Side effects can range from mild to severe. Most side effects go away once treatment is finished. However, some can linger for months or years after chemotherapy.

Two of the most common and troublesome side effects are fatigue and nausea. Let’s look at these effects more closely.


Fatigue or tiredness is one of the most frequent side effects of chemotherapy. Up to 90% of chemotherapy patients experience fatigue. There are several factors that can contribute to chemo-related fatigue:

– The drugs themselves – they damage cells and impact energy metabolism
– Anemia – low red blood cells reduces oxygen transport
– Poor nutrition – side effects make eating difficult
– Electrolyte imbalances – dehydration and mineral loss
– Sleep problems – difficulty falling and staying asleep
– Emotional distress – anxiety and depression worsen fatigue
– Lack of activity – being inactive causes loss of conditioning

Fatigue from chemo often comes on suddenly and can range from mild to severe. Severe fatigue can leave patients feeling exhausted even with minimal activity. It can significantly impact quality of life. Fatigue typically cumulative over the course of treatment but varies day-to-day. It often peaks a few days after chemo when the drugs effects are strongest.

Managing fatigue is an important part of coping with chemotherapy. We’ll provide some tips on dealing with fatigue later in this article.

Nausea and Vomiting

Nausea affects over 70% of chemo patients, while vomiting impacts about 30-45%. Nausea and vomiting occur because the chemotherapy drugs irritate the stomach lining and trigger the vomiting reflex.

Risk factors for nausea and vomiting include:

– Type of chemo drug – Some are more likely to cause nausea
– Dosage – Higher doses lead to more nausea
– Individual variation – Some people are more prone to nausea
– Younger age – Younger patients tend to have more nausea
– History of pregnancy nausea – Indicates higher susceptibility
– Anxiety – Stress and anxiety worsen nausea

Nausea can occur right after treatment, within the first few hours or days, or be delayed by a few days. It may be occasional or persistent. Vomiting most often occurs within the first 24 hours after chemotherapy.

Controlling nausea and vomiting is key to manage side effects. Anti-nausea medication can help greatly. Lifestyle measures like diet changes, hydration, acupuncture, and relaxation techniques can also reduce nausea.

Why Am I Sleepy During Chemotherapy?

Now that we’ve covered some background on chemotherapy and its side effects, let’s look at why you may feel sleepy and fatigued during chemotherapy infusions.

There are several overlapping reasons why patients often experience tiredness and sleepiness specifically during chemo sessions:

– The drugs themselves – Many chemo agents act directly in the body to induce fatigue as a side effect.

– Sitting still for long periods – Having to sit relatively motionless for hours can increase natural drowsiness.

– Dehydration – Infusions draw fluid from body tissues and can cause dehydration.

– Warm temperatures – Treatment rooms are kept warm which promotes sleepiness.

– Relief of anxiety – Relaxation after the anxiety of arrival can create fatigue.

– Lack of activity – Being inactive during long treatments contributes.

– Circadian dips – Natural drowsiness occurs mid-morning and mid-afternoon. Infusions often align with these times.

– Emotional relief – Some patients feel initial anxiety about chemo that dissipates once started.

– Learned response – Patients associate the environment with sleepiness based on prior experiences.

Let’s look at each of these causes in more detail:

Chemo Drugs Themselves

As covered earlier, fatigue and tiredness are extremely common side effects of chemotherapy drugs. Many of the agents used have a direct impact on cellular metabolism, vitality, and energy production. This leads to feelings of fatigue and sleepiness which tend to worsen over the course of treatment. Even a single infusion can leave patients feeling worn out afterwards. So the chemo drugs themselves promote sleepiness even during administration.

Sitting Still

A chemotherapy infusion involves sitting relatively still in a chair for a prolonged period – often several hours. For some treatments like IV rituximab, patients need to stay motionless for safety reasons. Being inactive for long periods can contribute to sleepiness. Our bodies associate lying still or sitting motionless with sleep and relaxation. Staying alert when sedentary requires effort.


Chemotherapy agents are administered into the bloodstream using intravenous fluids. This can draw water out of body tissues through osmosis leading to some dehydration. Dehydration exacerbates fatigue and sleepiness. Patients are sometimes advised to drink extra fluids after infusions to rehydrate.

Warm Temperatures

Infusion areas are purposefully kept warm and comfortable for patients undergoing long treatments. However, warm environments naturally make people feel sleepy. Our bodies associate heat with relaxation and sleep. Cozy, warm chemo suites can inadvertently promote drowsiness.

Relief of Anxiety

Many patients feel anxious and worried leading up to chemotherapy sessions. This apprehension and stress keeps them alert initially. However, upon being connected to the IV line and starting the drug infusion, this anxiety often fades as patients relax into the treatment. This relief of anxiety can unmask underlying fatigue.

Lack of Activity

Chemotherapy requires long periods of inactivity. The lack of physical movement and muscle contraction contributes to patients feeling sleepy. Our bodies are designed to become drowsy when inactive for long periods as a way to promote rest and recovery. Extended sitting can lead to sluggishness.

Circadian Dips

Our natural circadian rhythms make us prone to sleepiness during mid-morning and mid-afternoon. Infusion appointments are often scheduled during these drowsiness dips. Treatment times frequently coincide with the body’s physiological drive for a nap. This only adds to the sleep-promoting environment.

Emotional Relief

Some patients experience elevated anxiety and worry leading up to chemotherapy that dissipates once treatment begins. This emotional relief and subsequent relaxation can manifest as sleepiness. After the initial stress, patients may let their guard down and feel at ease which allows underlying fatigue to emerge.

Learned Response

In some cases, patients may develop a learned association between the chemotherapy setting and sleepiness based on prior experiences. They associate the environment, situation, and context with feeling tired. This conditioned response means they feel sleepy even prior to administration of drugs.

As outlined, there are numerous overlapping reasons why chemotherapy infusions tend to induce fatigue and sleepiness during the session. However, it’s important to note that excessive sleepiness during chemo may sometimes indicate a complication or underlying health issue that should be evaluated.

Is it Normal to Sleep During Chemotherapy?

Many patients struggle to stay awake and alert during infusions. Some report briefly nodding off for short naps. Others feel compelled to take longer sleeps for a large portion of their session. Fatigue is certainly expected, but is it normal to fully sleep through treatment?

Whether it is normal to truly sleep through chemotherapy depends on the context:

– Brief naps of 10-30 minutes are generally harmless for most treatments. However, longer or repeated sleep should be avoided for drugs with acute infusion reactions.

– Planned sleep is better than inadvertent dozing. Some patients consider chemo “time off” and purposely plan to sleep through it. This requires coordination with nursing staff.

– Excessive drowsiness can sometimes reflect underlying medical issues that should be evaluated. Sudden onset severe fatigue or sleepiness warrants medical attention.

– Frequent long naps may interfere with chemotherapy effectiveness. Some drugs require patient feedback on side effects in real time. Sleeping through the entire infusion prevents this.

– Check with your oncology team about specific chemotherapy agents. Some require the patient to be awake and alert to monitor for infusion reactions. Others are more compatible with rest.

– Listen to your body. Uncontrollable deep sleep during sessions may be a sign you need more rest in general or medication adjustments.

The bottom line is that each patient and treatment is unique. Brief, intermittent naps are generally harmless if you are receiving chemotherapy safely without reactions. But long or frequent sleeping can potentially impact care. Discuss your fatigue openly with your cancer care team. There are often ways to reduce excessive sleepiness through medication or schedule/dose changes. Staying awake and active should be the priority when possible.

Tips for Staying Awake During Chemotherapy

Here are some suggestions to help minimize drowsiness and stay alert during chemotherapy:

Correct Potential Underlying Issues

Excessive fatigue or altered mental status may reflect underlying problems needing correction, like:

– Dehydration – Drink fluids before and after. Get saline with chemo.

– Electrolyte imbalances – Supplement potassium, magnesium, etc. if low.

– Anemia – Have iron levels, hemoglobin checked. Consider erythropoietin.

– Poor nutrition – Eat high protein, complex carbs. Use nutritional shakes.

– Depression – Seek treatment for depression and anxiety exacerbating fatigue.

– Medication effects – Talk to your doctor about adjusting sedating medications.

– Sleep apnea – Get tested for sleep apnea which worsens fatigue. Use CPAP if prescribed.

– Hypothyroidism – Have thyroid levels checked and treated if necessary.

– Heart failure – Evaluate for cardiac causes of severe fatigue.

Time Infusions Carefully

Have chemotherapy scheduled for when you are most alert:

– Avoid early morning infusions when drowsiness is highest

– Schedule sessions for late morning or early afternoon when most awake

– Have a caffeine drink before infusions to perk up

– Plan busy days around infusions to promote daytime wakefulness

– Adjust work schedules to avoid fatigue overlapping treatment

Bring Entertainment and Distractions

Having diversions and entertainment helps pass the time and keeps the mind stimulated:

– Music, audiobooks, podcasts to listen to

– Books, magazines, crosswords to read

– Laptops, tablets for streaming videos

– Handheld video games to play

– Crafts, drawing, knitting supplies for projects

– Friends or family members to accompany and chat with

Keep Moving and Take Breaks

When possible, avoid staying sedentary throughout the entire session:

– Get up and walk around every 30-60 minutes if permitted

– Perform leg lifts, foot circles, shoulder rolls while seated to stay active

– Use stress balls and hand grippers to keep the body busy

– Rotate reclining and sitting upright to change positions

– Use bathrooms breaks as a chance to move around

– Do light stretches and range of motion exercises between drug bags

Stay Hydrated and Fed

Adequate hydration and nutrition prevents fatigue from worsening:

– Drink plenty of fluids before, during and after chemotherapy

– Eat a filling meal rich in protein and complex carbs before the infusion

– Bring nutritious snacks like nuts, yogurt, fruit to eat during treatment

– Opt for infusions later in the morning so you can eat breakfast before

– Request intravenous fluids if needed for hydration and energy

Discuss Medications With Your Doctor

Talk to your oncologist about options to reduce drowsiness:

– Prescription stimulants like modafinil or armodafinil

– Wakefulness agents like Provigil or Nuvigil

– Scheduled caffeine pills to provide a boost

– Anti-nausea drugs to prevent fatigue from nausea

– Steroids like dexamethasone that can increase alertness

– Adjustments to make the regimen less fatiguing if possible


It’s common to feel very fatigued and drowsy during chemotherapy infusions. This is understandable given the prolonged inactivity, anxiety relief, warm suites, and fatigue inducing drugs. Brief catnaps here and there are generally harmless, but long or frequent complete sleep through sessions is best avoided. Staying awake should be the priority when possible to facilitate treatment. Discuss significant sleepiness with your care team. There are often effective solutions like scheduling changes, additional medications, hydration, and stimulants that can help offset excessive drowsiness. Listen to your body and don’t hesitate to speak up if you are struggling to stay awake. Staying active and engaged during chemotherapy is ideal whenever feasible.