- Researchers say cognitive behavioral therapy is the most effective way to treat insomnia in cancer survivors.
- They say the intensity and trauma of cancer diagnosis and treatment causes insomnia in up to 30 percent of people who survive the disease.
- A lack of sleep can affect a number of health issues, including immunity, blood pressure, and depression.
Chronic insomnia is a serious health concern for many cancer survivors.
One effective way to treat it is with cognitive behavioral therapy (CBT).
But that’s often an expensive and time-consuming process, taking as many as 6 to 8 sessions. There’s also a shortage of trained specialists, so CBT for insomnia (CBT-I) isn’t available in most cancer treatment centers.
Researchers from Dana-Farber Cancer Institute say that as many as 30 percent of cancer survivors face chronic insomnia years after completing treatment.
Their study involved 51 cancer survivors with moderate to severe insomnia.
In what the researchers call step one, participants took a single-session sleep education program. About 45 percent said that resolved their insomnia problem.
Some of those who still had insomnia went on to the second step, a 3-part program with a cognitive behavioral approach.
Of those who completed step two, 79 percent were successfully treated.
“Our results demonstrate that a stepped care model — in which the first treatment is low-intensity and easily accessible to patients — can be effective for improving insomnia in cancer survivors,” said Eric Zhou, PhD, lead author of the study and a psychologist at the Dana-Farber Cancer Institute.
“This represents a tremendous opportunity to treat a problem that can significantly diminish cancer survivors’ health and quality of life when not addressed,” he continued.
The researchers acknowledge the study’s limitations, including that participants were drawn from a single center and were mostly white women of a higher socioeconomic level.
The study also lacked a control group, which they plan to address in future trials.
Dr. Diwakar Balachandran is a professor in the department of pulmonary medicine in the division of internal medicine, as well as medical director of the Sleep Center at The University of Texas MD Anderson Cancer Center.
Balachandran told Healthline that a number of things can lead to insomnia after a diagnosis of cancer.
He points to the Spielman model for insomnia, which includes predisposing factors, precipitating factors, and perpetuating factors.
“Predisposing is what patients bring to the illness, such as history of depression, anxiety, family history, and other medical problems. Precipitating factors would be adjusting to the cancer diagnosis, facing mortality, complicated treatment, side effects, change in body perception,” said Balachandran.
Perpetuating factors are the maladaptive behaviors you develop as a consequence of predisposing and precipitating factors.
Balachandran said that treatments such as chemotherapy and immunotherapy are highly inflammatory.
“We know a lot of symptoms such as insomnia, fatigue, poor appetite, and pain are driven by inflammatory change. Add surgery, radiation, and the psychological baggage that comes with the diagnosis. Everybody deals with it differently,” he added.
“Fifty percent of our patients come from out of state,” said Balachandran. “For months, they’re living in a hotel or apartment. Maybe they’re not working or can’t keep their job. It’s a total change of schedule and social cues.”
“They’re disassociated from healthy habits that help sleep, so they learn that they can’t sleep. Once that happens, it can persist for 5, 10, or 15 years after a cancer diagnosis,” he explained.
Lawrence Chan, DO, is a sleep expert at The Ohio State University Wexner Medical Center.
“Lack of sleep has wide-ranging effects on most aspects of both physical and mental health. It has negative effects on immunity, blood pressure, weight gain, and depression,” he told Healthline.
“I think insomnia and other sleep disorders are an important health and quality of life issue. Given the high prevalence, it is a definite area of need,” Chan continued.
Noting that it wasn’t a randomized controlled study, Chan likes that CBT-I was part of the intervention. He also agrees that access to CBT-I is a nationwide problem.
“It was encouraging to see the high response and remittance rates and the improvement in mood. This adds to a growing body of literature that even short courses of behavioral treatment can be helpful,” he said.
Balachandran added that chronic insomnia can make it hard to comply with complex regimens and treatments for cancer.
A big believer in the efficacy of CBT-I, Balachandran applauds the study authors.
“They are very honest about the limitations, but what they’ve done has added significantly to the literature,” he said.
Early detection and intervention are vital, said Balachandran.
“Oncologists are extremely busy treating the cancer, but there’s a growing understanding that managing these symptoms is important. If we actually intervene while someone is on chemo, it could make a difference in outcome. We could prevent it from becoming a year long or multi-year long problem,” he said.
Balachandran added that it’s important to address insomnia in a nonpharmacological way. He cautions that people being treated for cancer shouldn’t take over-the-counter sleep aids without medical advice.
“There haven’t been randomized control trials [on] these drugs in cancer patients. Trials have been for people without cancer and limited to short-term use. They’re not meant to be used for years — it won’t work. It’s a short-term solution for an acute problem,” he said.
For cancer survivors facing insomnia, Chan recommends starting with basic sleep hygiene.
Chan said this includes:
- maintaining a regular sleep schedule
- avoiding caffeine, alcohol, and smoking near bedtime
- maintaining a cool, dark, and quiet bedroom environment
- decreasing light and electronics at night
- keeping naps short — less than 20 minutes
He also suggests checking out CBT-I resources online if there are no providers nearby.
“If their sleep problems are persistent and affecting their life, it is worth checking in with either their oncologist or primary care provider. Ideally, they would be assessed for any other types of sleep disorders and be appropriately referred for CBT-I or a sleep provider,” explained Chan.