May 22, 2024
Survivorship Support

Sleep and Survivorship

The Issue

Sleep is important for maintaining so many parts of our physical and mental health. After a cancer diagnosis, you might find yourself struggling with both falling and staying asleep for a variety of different, completely understandable reasons. Insomnia is a term used to describe difficulty falling asleep, frequent nighttime awakenings, and difficulty returning to sleep, which can make functioning during the day really hard.

For many reasons, patients with cancer and cancer survivors are up to 3 times more likely to report insomnia compared to the general population, and insomnia unfortunately can remain a problem in survivorship. In fact up to 95% of patients with cancer report sleep disturbances during the disease and treatment trajectory, as well as in survivorship.It’s clear that sleep is a big issue for the survivorship community, and furthermore, other symptoms common in survivorship, including hot flashes, pain, and depression, can also contribute to and worsen issues with sleep.

Understanding insomnia is the first step in tackling it, so keep reading if this is a live issue for you.

Why does this happen?

There is no single explanation for insomnia, which is why it’s so important to do a thorough, head-to-toe evaluation of any person who is struggling with sleep. This should include a detailed review of medical issues that could be contributing, discussion of stress, a review of all medications you are on, and an evaluation of your sleep routine and environment.

  • Symptoms like hot flashes, as well as pain (neuropathic pain in particular), may cause sleep difficulties.
  • Stress is a known contributor to insomnia, and it’s natural that related feelings such as depression, anxiety, and fear of recurrence might impact your sleep.
  • There are different behaviors that are also linked to insomnia, such as issues with sleep hygiene (phone use in bed, caffeine late in the day, excessive daytime napping, etc.).

Since sleep is so critical, we put together a set of resources for you to consider.

Take Action!

Check out your environment:  

In order to have high-quality sleep, it’s important to set up a quiet bed environment, avoid caffeine in the late afternoon, and avoid screen time prior to bed. Improvements in sleep hygiene generally result in improvements in sleep, although this doesn’t usually fix the entirety of the problem. Some tips include:

  • Leaving your phone charging in another room overnight. If your phone is also your alarm, try getting a bedside digital clock.
  • If you like guided meditations, experiment with sleepcasts or audiobooks. This can be a really calming way to wind down.
  • Plan a daily relaxing bed routine. This might include a hot shower or bath, decaf tea, listening to your favorite music or going for a walk around the block. Anything to help put your mind at ease and get ready for sleep.
  • Try to be consistent about routines and bedtimes. Think of it as you are training your body to expect sleep after the same routine, each and every day at the same time.

Cognitive-Behavioral Therapy (CBT)

CBT is the gold-standard therapy for insomnia; studies show that CBT can improve most of the symptoms associated with insomnia, and that results persist years post-CBT. The specific type of CBT for insomnia is conveniently named CBT-Insomnia, or CBT-I. The optimal delivery for CBT-I takes place over 4-8 weeks. If you are interested in what CBT for sleep might look like, check out our CBT content.


There’s a good amount of evidence that regular exercise can help improve sleep and sleep quality. If you are experiencing challenges with sleep, it can be really hard to feel like you have the energy to exercise in a way you might have prior to cancer. It’s important to know exercise can take a number of forms, including walking!

Acupuncture: Randomized studies have demonstrated that acupuncture may be useful in insomnia

Tai Chi Chih: Tai Chi Chih, a form of Tai Chi, is a mind-body intervention combining physical activity with relaxation; in randomized trials, it produced improvements in insomnia in survivors.

Medications: Medications for sleep are really only recommended to be used for short term use and are generally not considered effective for managing long term insomnia. Effective management of other conditions that may be contributing to insomnia, such as anxiety and pain, is recommended. While melatonin, a natural sleep hormone your body produces that can be purchased over the counter, is used by some people, the evidence is limited. Additionally because supplements are not regulated by the FDA, the actual melatonin content is highly varaible among different products and doses used in studies have varied in range.

Sleep Medicine Specialist: If your insomnia is not improving, it is important to see a sleep medicine specialist, who can help diagnose the cause of insomnia and treat any disorders such as sleep apnea. Getting a formal “sleep study” can be a good way to assess any other issues that could be contributing to your sleep.

Taken together, it’s important to tackle challenging patterns of sleep as they can lead to other issues in life. As always, we want to hear from your about strategies that have worked in your own life- send us an email or find us on social!

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