Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Original Articles and Reviews

Insomnia in Cancer Survivors

A Precision Behavioral Sleep Medicine Approach

Published Online:June 30, 2023https://doi.org/10.1027/1016-9040/a000506

Abstract

Abstract: Insomnia is among the most prevailing and distressing iatrogenic complaints reported by cancer survivors. Untreated insomnia negatively impacts survivors’ functioning, quality of life and health, and may have implications for cancer progression. Cognitive behavioral therapy is recommended as the first-line treatment for cancer-related insomnia but remains largely unavailable in European oncology care. For cancer survivors, it may be prudent to expand the scope of insomnia treatment. In this paper, we analyze the etiopathogenesis of insomnia among cancer populations and review the latest developments in cognitive behavioral therapeutics for cancer-related insomnia. Pondering upon the distinctive nature and pathophysiology of cancer-related insomnia, we discuss opportunities to optimize insomnia treatment in cancer care. We suggest adapting the content and format delivery of standard cognitive behavioral therapy for insomnia to meet the needs of cancer survivors and surmount resource availability. Digital therapeutics may provide cancer survivors who would otherwise be limited to pharmacologic treatment options with the guideline treatment for insomnia. Internet-delivered cognitive behavioral interventions may be integrated into survivorship care programs within healthcare systems.

References

  • Amidi, A., Buskbjerg, C. R., Damholdt, M. F., Dahlgaard, J., Thorndike, F. P., Ritterband, L., & Zachariae, R. (2022). Changes in sleep following Internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer: A 3-year follow-up assessment. Sleep Medicine, 96, 35–41. https://doi.org/10.1016/j.sleep.2022.04.020 First citation in articleCrossref, Google Scholar

  • American Academy of Sleep Medicine. (2014). Insomnia. In AASMEd., International classification of sleep disorders (3rd ed., pp. 19–48). AASM. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2013). Sleep-wake disorders. In APAEd., Diagnostic and statistical manual of mental disorders (5th ed., pp. 378–422). APA. https://doi.org/10.1176/appi.books.9780890425596 First citation in articleCrossref, Google Scholar

  • Andersen, B. L., Goyal, N. G., Westbrook, T. D., Bishop, B., & Carson, W. E. (2017). Trajectories of stress, depressive symptoms, and immunity in cancer survivors: Diagnosis to 5 years. Clinical Cancer Research, 23(1), 52–61. https://doi.org/10.1158/1078-0432.CCR-16-0574 First citation in articleCrossref, Google Scholar

  • Baglioni, C., Altena, E., Bjorvatn, B., Blom, K., Bothelius, K., Devoto, A., Espie, C. A., Frase, L., Gavriloff, D., Tuuliki, H., Hoflehner, A., Högl, B., Holzinger, B., Järnefelt, H., Jernelöv, S., Johann, A. F., Lombardo, C., Nissen, C., Palagini, L., … Riemann, D. (2020). The European Academy for Cognitive Behavioral Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment. Journal of Sleep Research, 29(2), Article e12967. https://doi.org/10.1111/jsr.12967 First citation in articleCrossref, Google Scholar

  • Baglioni, C., Spiegelhalder, K., Lombardo, C., & Riemann, D. (2010). Sleep and emotions: A focus on insomnia. Sleep Medicine Reviews, 14(4), 227–238. https://doi.org/10.1016/j.smrv.2009.10.007 First citation in articleCrossref, Google Scholar

  • Boinon, D., Charles, C., Fasse, L., Journiac, J., Pallubicki, G., Lamore, K., Ninot, G., Guerdoux-Ninot, E., Gouy, S., Albiges, L., Delaloge, S., Malka, D., Planchard, D., Savard, J., … Dauchy, S. (2021). Feasibility of a video-based cognitive behavioral therapy for insomnia in French adult cancer outpatients: results from the Sleep-4-All-1 study. Supportive Care in Cancer, 29(10), 5883–5894. https://doi.org/10.1007/s00520-021-06151-7 First citation in articleCrossref, Google Scholar

  • Bootzin, R. R. (1972). Stimulus control treatment for Insomnia. Proceedings of the 80th Annual Convention of American Psychological Association, 7, 395–396. https://www.med.upenn.edu/cbti/assets/user-content/documents/Bootzin%201972.pdf First citation in articleGoogle Scholar

  • Carvalho, J., Ribeiro, J. S., Martins, F., Ferreira, A., & Azevedo, M. H. (2005). Perturbações do sono no doente oncológico [Sleep disturbances in the oncologic patient]. Oncology Today, 4, 34–36. First citation in articleGoogle Scholar

  • Chung, K. M., Suh, Y. J., Chin, S., Seo, D., Yu, E. S., Lee, H. J., Kim, J. H., Kim, S. W., & Koh, S. J. (2022). A pilot study testing the efficacy of dCBT in patients with cancer experiencing sleep problems. Frontiers in Psychology, 13, Article 699168. https://doi.org/10.3389/fpsyg.2022.699168 First citation in articleCrossref, Google Scholar

  • Davidson, J. R., MacLean, A. W., Brundage, M. D., & Schulze, K. (2002). Sleep disturbance in cancer patients. Social Science & Medicine, 54(9), 1309–1321. https://doi.org/10.1016/s0277-9536(01)00043-0 First citation in articleCrossref, Google Scholar

  • Driskell, J. E., & Mullen, B. (2005). The efficacy of naps as a fatigue countermeasure: A meta-analytic integration. Human Factors: The Journal of the Human Factors and Ergonomics Society, 47(2), 360–377. https://doi.org/10.1518/0018720054679498 First citation in articleCrossref, Google Scholar

  • Edinger, J. D., Arnedt, J. D., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262. https://doi.org/10.5664/jcsm.8986 First citation in articleCrossref, Google Scholar

  • Espie, C. (2022, March). Delivering clinical guideline care for insomnia: The potential of digital therapeutics to close the treatment gap. [Conference session]. World Sleep 2022, Italy. First citation in articleGoogle Scholar

  • Espie, C. A., Broomfield, N. M., MacMahon, K. M., Macphee, L. M., & Taylor, L. M. (2006). The attention-intention-effort pathway in the development of psychophysiologic insomnia: A theoretical review. Sleep Medicine Reviews, 10(4), 215–245. https://doi.org/10.1016/j.smrv.2006.03.002 First citation in articleCrossref, Google Scholar

  • Fleming, L., Gillespie, S., & Espie, C. A. (2009). The development and impact of insomnia on cancer survivors: A qualitative analysis. Psycho-Oncology, 19(9), 991–996. https://doi.org/10.1002/pon.1652 First citation in articleCrossref, Google Scholar

  • Hall, D. L., Arditte Hall, K. A., Gorman, M. J., Comander, A., Goldstein, M. R., Cunningham, T. J., Wieman, S., Mizrach, H. R., Juhel, B. C., Li, R., Markowitz, A., Grandner, M., & Park, E. R. (2022). The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors. Cancer, 128(7), 1532–1544. https://doi.org/10.1002/cncr.34066 First citation in articleCrossref, Google Scholar

  • Harvey, A. (2002). A cognitive model of insomnia. Behavior Research and Therapy, 40(8), 869–893. https://doi.org/10.1016/s0005-7967(01)00061-4 First citation in articleCrossref, Google Scholar

  • Harvey, A. G., & Buysse, D. J. (2018). Treating sleep problems: A transdiagnostic approach. Guilford Publications. First citation in articleGoogle Scholar

  • Hauri, P. J. (1997). Can we mix behavioral therapy with hypnotics when treating insomniacs? Sleep, 20(12), 1111–1118. https://doi.org/10.1093/sleep/20.12.1111 First citation in articleCrossref, Google Scholar

  • Hearson, B., & Sawatzky, J. A. (2008). Sleep disturbance in patients with advanced cancer. International journal of palliative nursing, 14(1), 30–37. https://doi.org/10.12968/ijpn.2008.14.1.28150 First citation in articleCrossref, Google Scholar

  • Howell, D., Oliver, T. K., Keller-Olaman, S., Davidson, J. R., Garland, S., Samuels, C., Savard, J., Harris, C., Aubin, M., Olson, K., Sussman, J., MacFarlane, J., & Taylor, C. (2014). Sleep disturbance in adults with cancer: A systematic review of evidence for best practices in assessment and management for clinical practice. Annals of Oncology, 25(4), 791–800. https://doi.org/10.1093/annonc/mdt506 First citation in articleCrossref, Google Scholar

  • Induru, R. R., & Walsh, D. (2013). Cancer-related insomnia. American Journal of Hospice and Palliative Medicine, 31(7), 777–785. https://doi.org/10.1177/1049909113508302 First citation in articleCrossref, Google Scholar

  • Irwin, M. R., Olmstead, R. E., Ganz, P. A., & Haque, R. (2013). Sleep disturbance, inflammation and depression risk in cancer survivors. Brain, Behavior, and Immunity, 30(Suppl), S58–S67. https://doi.org/10.1016/j.bbi.2012.05.002 First citation in articleCrossref, Google Scholar

  • Ma, Y., Hall, D. L., Ngo, L. H., Liu, Q., Bain, P. A., & Yeh, G. Y. (2021). Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis. Sleep Medicine Reviews, 55, Article 101376. https://doi.org/10.1016/j.smrv.2020.101376 First citation in articleCrossref, Google Scholar

  • Maccora, J., Bean, H. R., Diggens, J., Ftanou, M., Alexander, M., Lu, Q., Stafford, L., Francis, P. A., Bei, B., & Wiley, J. F. (2023). Mechanisms of cognitive behavioral therapy and light therapy for cancer-related insomnia: A randomized clinical trial during chemotherapy for breast cancer. Behavioral Sleep Medicine, 21(3), 227–241. https://doi.org/10.1080/15402002.2022.2075364 First citation in articleCrossref, Google Scholar

  • Mann, E., Smith, M. J., Hellier, J., Balabanovic, J. A., Hamed, H., Grunfeld, E. A., & Hunter, M. S. (2012). Cognitive behavioral treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): A randomised controlled trial. The Lancet Oncology, 13, 309–318. https://doi.org/10.1016/S1470-2045(11)70364-3 First citation in articleCrossref, Google Scholar

  • Maqbali, M., Sinani, M., Alsayed, A., & Gleason, A. M. (2022). Prevalence of sleep disturbance in patients with cancer: A systematic review and meta-analysis. Clinical nursing research, 31(6), 1107–1123. https://doi.org/10.1177/10547738221092146 First citation in articleCrossref, Google Scholar

  • Matthews, E., Carter, P., Page, M., Dean, G., & Berger, A. (2018). Sleep-wake disturbance: A systematic review of evidence-based interventions for management in patients with cancer. Clinical Journal of Oncology Nursing, 22(1), 37–52. https://doi.org/10.1188/18.cjon.37-52 First citation in articleCrossref, Google Scholar

  • Mercier, J., Ivers, H., & Savard, J. (2018). A non-inferiority randomized controlled trial comparing a home-based aerobic exercise program to a self-administered cognitive-behavioral therapy for insomnia in cancer patients. Sleep, 41(10), 1–15. https://doi.org/10.1093/sleep/zsy149 First citation in articleCrossref, Google Scholar

  • Moorey, S., & Greer, S. (2002). Cognitive behavior therapy for people with cancer. Oxford University Press. First citation in articleGoogle Scholar

  • Morin, C. M. (1993). Insomnia: Psychological assessment and management. Guilford Publication. First citation in articleGoogle Scholar

  • Morin, C. M., & Espie, C. A. (2013). Insomnia: A clinical guide to assessment and treatment. Springer. First citation in articleGoogle Scholar

  • Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy and behavior therapy for chronic pain in adults, excluding headache. Pain, 80(1), 1–13. https://doi.org/10.1016/s0304-3959(98)00255-3 First citation in articleCrossref, Google Scholar

  • Mustian, K. M., Morrow, G. R., Carroll, J. K., Figueroa-Moseley, C. D., Jean-Pierre, P., & Williams, G. C. (2007). Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. The Oncologist, 12(S1), 52–67. https://doi.org/10.1634/theoncologist.12-s1-52 First citation in articleCrossref, Google Scholar

  • National Cancer Institute. (2023). Sleep disorders (PDQ®) – Health professional version. Retrieved August 11, 2022 from https://www.cancer.gov/about-cancer/treatment/side-effects/sleep-disorders-hp-pdq First citation in articleGoogle Scholar

  • National Institutes of Health. (2022). NIH stage model for behavioral intervention development. https://www.nia.nih.gov/research/dbsr/nih-stage-model-behavioral-intervention-development First citation in articleGoogle Scholar

  • O’Malley, D. M., Alfano, C. M., Doose, M., Kinney, A. Y., Lee, S., Nekhlyudov, L., Duberstein, P., & Hudson, S. V. (2021). Cancer prevention, risk reduction, and control: Opportunities for the next decade of health care delivery research. Translational Behavioral Medicine, 11(11), 1989–1997. https://doi.org/10.1093/tbm/ibab109 First citation in articleCrossref, Google Scholar

  • Paltiel, O., Marzec-Boguslawska, A., Soskolne, V., Massalha, S., Avitzour, M., Pfeffer, R., Cherny, N., & Peretz, T. (2004). Use of tranquilizers and sleeping pills among cancer patients is associated with a poorer quality of life. Quality of Life Research, 13(10), 1699–1706. https://doi.org/10.1007/s11136-004-8745-1 First citation in articleCrossref, Google Scholar

  • Perlis, M. L., Giles, D. E., Mendelson, W. B., Bootzin, R. R., & Wyatt, J. K. (1997). Psychophysiological insomnia: The behavioral model and a neurocognitive perspective. Journal of Sleep Research, 6(3), 179–188. https://doi.org/10.1046/j.1365-2869.1997.00045.x First citation in articleCrossref, Google Scholar

  • Perlis, M. L., Posner, D., Riemann, D., Bastien, C. H., Teel, J., & Thase, M. (2022). Insomnia. Lancet, 400(10357), 1047–1060. https://doi.org/10.1016/S0140-6736(22)00879-0 First citation in articleCrossref, Google Scholar

  • Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & Clinical Guidelines Committee of the American College of Physicians. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133. https://doi.org/10.7326/M15-2175 First citation in articleCrossref, Google Scholar

  • Reynolds-Cowie, P., & Fleming, L. (2021). Living with persistent insomnia after cancer: A qualitative analysis of impact and management. British Journal of Health Psychology, 26(1), 33–49. https://doi.org/10.1111/bjhp.12446 First citation in articleCrossref, Google Scholar

  • Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia-Borreguero, D., Gjerstad, M., Gonçalves, M., Hertenstein, E., Jansson-Fröjmark, M., Jennum, P. J., Leger, D., Nissen, C., Parrino, L., Paunio, T., Pevernagie, D., Verbraecken, J., … Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675–700. https://doi.org/10.1111/jsr.12594 First citation in articleCrossref, Google Scholar

  • Riemann, D., Baum, E., Cohrs, S., Crönlein, T., Hajak, G., Hertenstein, E., Klose, P., Langhorst, J., Mayer, G., Nissen, C., Pollmächer, T., Rabstein, S., Schlarb, A., Sitter, H., Weeß, H. G., Wetter, T., & Spiegelhalder, K. (2017). S3-Leitlinie nicht erholsamer Schlaf/Schlafstörungen [S3 Guidelines on non-restorative sleep/sleep disorders]. Somnologie, 21, 2–44. https://doi.org/10.1007/s11818-016-0097-x First citation in articleCrossref, Google Scholar

  • Riemann, D., Benz, F., Dressle, R. J., Espie, C. A., Johann, A. F., Blanken, T. F., Leerssen, J., Wassing, R., Henry, A. L., Kyle, S. D., Spiegelhalder, K., & Van Someren, E. J. W. (2022). Insomnia disorder: State of the science and challenges for the future. Journal of Sleep Research, 31(4), Article e13604. https://doi.org/10.1111/jsr.13604 First citation in articleCrossref, Google Scholar

  • Sampson, C., Bell, E., Cole, A., Miller, C. B., Marriott, T., Williams, M., & Rose, J. (2022). Digital cognitive behavioural therapy for insomnia and primary care costs in England: An interrupted time series analysis. British Journal of General Practice – Open, 6(2), Article 146. https://doi.org/10.3399/BJGPO.2021.0146 First citation in articleGoogle Scholar

  • Savard, J., Filion, C., Gagnon, M. P., Caplette-Gingras, A., Bélanger, L., & Morin, C. M. (2022). Barriers and facilitators to implementing a stepped care cognitive-behavioral therapy for insomnia in cancer patients: A qualitative study. Supportive Care in Cancer, 30(8), 6689–6698. https://doi.org/10.1007/s00520-022-07094-3 First citation in articleCrossref, Google Scholar

  • Savard, J., Ivers, H., Savard, M. H., & Morin, C. M. (2014). Is a video-based cognitive behavioral therapy for insomnia as efficacious as a professionally administered treatment in breast cancer? Results of a randomized controlled trial. Sleep, 37(8), 1305–1314. https://doi.org/10.5665/sleep.3918 First citation in articleCrossref, Google Scholar

  • Savard, J., Ivers, H., Savard, M. H., & Morin, C. M. (2016). Long-term effects of two formats of cognitive behavioral therapy for insomnia comorbid with breast cancer. Sleep, 39, 813–823. https://doi.org/10.5665/sleep.5634 First citation in articleCrossref, Google Scholar

  • Savard, J., Ivers, H., Savard, M. H., Morin, C. M., Caplette-Gingras, A., Bouchard, S., & Lacroix, G. (2021). Efficacy of a stepped care approach to deliver cognitive-behavioral therapy for insomnia in cancer patients: A noninferiority randomized controlled trial. Sleep, 44(11), Article zsab166. https://doi.org/10.1093/sleep/zsab166 First citation in articleCrossref, Google Scholar

  • Savard, J., Ivers, H., Villa, J., Caplette-Gingras, A., & Morin, C. M. (2011). Natural course of insomnia comorbid with cancer: An 18-Month longitudinal study. Journal of Clinical Oncology, 29(26), 3580–3586. https://doi.org/10.1200/jco.2010.33.2247 First citation in articleCrossref, Google Scholar

  • Schieber, K., Niecke, A., Geiser, F., Erim, Y., Bergelt, C., Büttner-Teleaga, A., Maatouk, I., Stein, B., Teufel, M., Wickert, M., Wuensch, A., & Weis, J. (2019). The course of cancer-related insomnia: Don’t expect it to disappear after cancer treatment. Sleep Medicine, 58, 107–113. https://doi.org/10.1016/j.sleep.2019.02.018 First citation in articleCrossref, Google Scholar

  • Soh, H. L., Ho, R. C., Ho, C. S., & Tam, W. W. (2020). Efficacy of digital cognitive behavioural therapy for insomnia: A meta-analysis of randomised controlled trials. Sleep Medicine, 75, 315–325. https://doi.org/10.1016/j.sleep.2020.08.020 First citation in articleCrossref, Google Scholar

  • Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep, 10, 45–56. https://doi.org/10.1093/sleep/10.1.45 First citation in articleGoogle Scholar

  • Squires, L. R., Rash, J. A., Fawcett, J., & Garland, S. N. (2022). Systematic review and meta-analysis of cognitive-behavioural therapy for insomnia on subjective and actigraphy-measured sleep and comorbid symptoms in cancer survivors. Sleep Medicine Reviews, 63, Article 101615. https://doi.org/10.1016/j.smrv.2022.101615 First citation in articleCrossref, Google Scholar

  • Van Someren, E. (2021). Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiological Reviews, 101(3), 995–1046. https://doi.org/10.1152/physrev.00046.2019 First citation in articleCrossref, Google Scholar

  • Zhou, E. S., & Recklitis, C. J. (2020). Internet-delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors. Pediatric Blood & Cancer, 67(9), Article e28506. https://doi.org/10.1002/pbc.28506 First citation in articleCrossref, Google Scholar