If you are tired, you can't fight the cancer in your life let alone the one in your body. Some fatigue is unavoidable, but much is entirely avoidable and you must go after that with a vengeance.

Fatigue is the most common side effect of treatment. Depression is the most common side effect of fatigue. Inactivity, loss of ambition and poor sleep are the most common side effects of depression. All of these in turn cause more fatigue and set up a vicious cycle downward. To avoid this you have to be proactive about sleep and exercise.

But first don't confuse the fatigue of treatment with the fatigue of progressive cancer which usually occurs only in the last few months of life and is most often associated with a large amount of cancer in the liver. The fatigue of treatment gets precipitously worse with each treatment and usually improves between treatments just before the next one is due. While cyclical it is also cumulative and will not go away until treatment stops - but you can limit it if you are proactive about taking care of yourself.


  1. Get to bed on time and stay there 7 to 8 hours.
  2. Go to sleep and wake up at about the same time daily.
  3. Nap daily – at least 10 minutes – often right after lunch is best. If you're working, go to your car, recline, enclosure eyes. Even if you don't sleep review all the things you're grateful for.
  4. Be sure you or your spouse don't have sleep apnea – review this with your doctor.
  5. If your partner snores, sleep separately until treatment is over.
  6. No caffeine after 2 PM. Research shows that caffeine even six hours before bedtime decreases actual sleep time by an hour as well as decreasing the quality of sleep. It takes six hours for half the caffeine you consume to be eliminated from your system. Aim for no more than 3 cups per day and remember that decaf coffee can have as much as 20% of the caffeine in a brewed cup. Brands very greatly. Also know that a latte has only 1/3 to 1/2 as much as brewed coffee.
  7. Limit alcohol to 1–2 drinks twice a week. It does help you fall asleep faster and deeper initially by increasing SWS, slow wave sleep, during the first few hours (which helps with healing of injured tissues) but it also decreases REM, the deepest, most restorative sleep and often wakes you up at two or 3 AM leading to daytime fatigue and depression. Some research shows a stepwise increase in relapse rates for breast cancer (other cancers unstudied as yet) starting with one alcoholic drink per day. 1-2 drinks twice/wk may be the safest strategy.
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