Sleep disturbances are common in people living with cancer, affecting physical health, emotional well-being, and quality of life. Insomnia—difficulty falling asleep, staying asleep, or obtaining restorative sleep—is one of the most frequent issues. It can occur at any stage of cancer and may be triggered or worsened by the cancer itself, treatments such as chemotherapy, medications, anxiety related to diagnosis, or lifestyle factors like caffeine, alcohol, or limited daytime activity.
Often, insomnia begins after a sudden change in life or medication. Over time, certain behaviors may make it chronic, such as sleeping with lights or TV on, napping during the day, or consuming caffeine or alcohol in the evening. Patients with coexisting conditions, such as anxiety or depression, may be particularly vulnerable.
Clinical approaches to insomnia
Evidence supports a multi-faceted strategy. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been shown to reduce sleep complaints in cancer patients and may decrease reliance on hypnotic medications. CBT-I addresses maladaptive sleep behaviors and beliefs and can be delivered in-person or through digital programs, such as the FDA-cleared application Somryst.
Pharmacological treatment may be indicated for severe or persistent insomnia, typically as short-term therapy. Commonly prescribed medications include benzodiazepine receptor agonists (e.g., zolpidem, eszopiclone), low-dose doxepin, and orexin receptor antagonists. However, evidence in cancer patients remains limited, and medication should be closely monitored to avoid long-term dependence.
Parasomnias: nocturnal behavioral events
Some patients experience unusual behaviors during sleep, including sleepwalking, night terrors, or acting out dreams (REM sleep behavior disorder). These events may be influenced by treatment, medications, metabolic changes, or other medical conditions, and can sometimes be confused with seizures or delirium. Accurate documentation of the timing, frequency, behaviors, and memory of events is crucial for diagnosis. In cases where safety is at risk, or the events are atypical, video polysomnography may be recommended.
It is a fact that sleep affects multiple physiological processes, and disruptions can influence both quality of life and potentially cancer outcomes. A comprehensive, individualized approach—considering behavioral strategies, careful use of medication, and evaluation for other sleep disorders—is essential. Ongoing research is expanding our understanding of sleep’s role in cancer progression and patient resilience.
At Kapa3, we recognize the importance of sleep in supporting the overall well-being of people living with cancer, and we encourage patients to seek guidance on managing sleep disturbances as part of comprehensive care.
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Text/Adaptation: Ifiyenia Anastasiou for Kapa3
