Insomnia & Sleep Problems During Cancer Treatment

Comprehensive guide to understanding and managing sleep disturbances during your cancer journey

Prevalence

30-50% of cancer patients

Impact

Affects healing & quality of life

Treatment

Many effective strategies

First-Line

Non-medication approaches

Understanding Cancer-Related Insomnia

Insomnia is one of the most common, yet often undertreated, side effects of cancer and its treatment. It affects 30-50% of cancer patients, significantly more than the general population (10-15%). Sleep problems during cancer treatment are not just an inconvenience—they can affect your recovery, immune function, and overall quality of life.

What is Insomnia?

Insomnia is characterized by:

Difficulty falling asleep: Taking more than 30 minutes to fall asleep
Difficulty staying asleep: Frequent awakenings during the night
Early morning awakening: Waking too early and unable to fall back asleep
Non-restorative sleep: Feeling unrefreshed despite adequate time in bed
Daytime consequences: Fatigue, mood changes, impaired concentration

Insomnia Severity Classification

Mild Occasional sleep difficulties, minimal daytime impact

Moderate Frequent sleep problems (3+ nights/week), noticeable daytime fatigue and irritability

Severe/Chronic Persistent insomnia (>3 months), significant impact on daily functioning and quality of life

Types of Sleep Problems

Sleep Onset Insomnia

Difficulty falling asleep initially

Racing thoughts about cancer
Anxiety and worry
Stimulating medications (steroids)
Poor sleep habits
Environmental factors

Sleep Maintenance Insomnia

Frequent nighttime awakenings

Pain or discomfort
Hot flashes (hormone therapy)
Frequent urination
Night sweats
Anxiety

Early Morning Awakening

Waking too early

Depression
Aging-related sleep changes
Medication effects
Circadian rhythm disruption
Anxiety

Causes and Contributing Factors

Sleep problems during cancer treatment have multiple, often overlapping causes. Understanding these can help you and your healthcare team develop an effective treatment plan.

Psychological Factors

Anxiety: Worry about diagnosis, treatment, prognosis
Depression: Common in cancer patients
Fear: Fear of recurrence or progression
Stress: Financial, family, work concerns
Rumination: Inability to stop thinking about cancer
Post-traumatic stress: From diagnosis or treatment experiences

Treatment-Related Causes

Chemotherapy: Direct effects on sleep-wake cycle
Radiation therapy: Fatigue paradox (too tired but can't sleep)
Surgery: Pain, position restrictions
Immunotherapy: Inflammatory effects
Targeted therapy: Various mechanisms
Hospital stays: Noise, lights, interruptions

Medication-Related

Corticosteroids: Especially dexamethasone
Anti-nausea drugs: Some are stimulating
Pain medications: Can disrupt sleep architecture
Diuretics: Frequent urination
Beta-blockers: Can cause nightmares
Stimulants: For fatigue management

Physical Symptoms

Pain: Uncontrolled pain prevents sleep
Hot flashes: From hormone therapy or menopause
Night sweats: Various causes
Nausea: Especially delayed nausea
Breathing difficulties: Lung involvement
Urinary frequency: Bladder irritation, diuretics

Lifestyle Factors

Irregular schedule: Treatment appointments
Excessive napping: Too much daytime sleep
Reduced activity: Deconditioning
Caffeine: Coffee, tea, energy drinks
Alcohol: Disrupts sleep quality
Screen time: Blue light exposure

Circadian Disruption

Chemotherapy effects: Disrupts internal clock
Reduced light exposure: Less time outdoors
Irregular schedule: Varying bedtimes
Hospitalization: 24-hour care environment
Shift in sleep times: Naps at different times

Special Note: Steroids and Insomnia

Dexamethasone and other corticosteroids are a very common cause of insomnia in cancer patients.

Often given before chemotherapy to prevent nausea and allergic reactions
Can cause significant sleep disturbance and agitation
KEY TIP: If possible, take steroids in the morning rather than evening
If you take steroids after 2 PM, you may have difficulty sleeping that night
Talk to your oncology team about optimal timing for your steroid doses
Never adjust steroid timing on your own—always consult your healthcare team first
Some patients may need a sleep medication on nights following steroid administration

Hormone Therapy and Sleep Disruption

Hormone therapy for breast and prostate cancers can significantly impact sleep:

Hot flashes: Sudden feeling of heat that disrupts sleep
Night sweats: Drenching sweats requiring clothing changes
Mood changes: Anxiety and depression affecting sleep
Management strategies:
- Keep bedroom cool (65-68°F or 18-20°C)
- Use moisture-wicking bedding and sleepwear
- Layer bedding for easy adjustment
- Keep a fan nearby
- Avoid triggers: spicy foods, alcohol, caffeine
- Consider medications for severe hot flashes (SSRIs, gabapentin)

Impact on Health and Recovery

Why Good Sleep Matters During Cancer Treatment

Sleep is not a luxury—it's essential for healing and recovery. Poor sleep can:

Immune Function

Weakens immune system response
Reduces ability to fight infection
May affect treatment effectiveness
Impairs wound healing after surgery

Physical Health

Worsens fatigue (fatigue-insomnia cycle)
Increases pain sensitivity
Elevates blood pressure
Affects blood sugar regulation

Mental & Emotional

Increases anxiety and depression
Impairs concentration and memory
Reduces ability to cope with stress
Decreases quality of life

The Fatigue-Insomnia Paradox: Many cancer patients experience a frustrating cycle where they feel exhausted all day but cannot sleep at night. This paradox occurs because cancer-related fatigue is different from normal tiredness—it's not relieved by sleep, yet ironically makes it harder to sleep well.

Sleep Hygiene: The Foundation of Good Sleep

Sleep hygiene refers to habits and practices that promote good sleep. These strategies should be your first-line approach before considering medications.

Core Sleep Hygiene Principles

1. Maintain a Consistent Sleep Schedule

Same bedtime and wake time every day (even on weekends)
This helps regulate your body's internal clock
Avoid sleeping in more than 1 hour on weekends
Set an alarm to wake up at the same time daily

2. Limit Naps Strategically

If you must nap: Keep it to 20-30 minutes
Nap before 3 PM to avoid interfering with nighttime sleep
Consider whether a short walk might be more energizing than a nap
If you sleep >1 hour during the day, nighttime sleep will suffer
Exception: During intense treatment periods, you may need more rest—discuss with your team

3. Create a Bedtime Routine (Wind-Down Period)

Start winding down 60-90 minutes before bed
Dim the lights in your home
Engage in calming activities:
- Reading (but not in bed)
- Gentle stretching or yoga
- Listening to calm music
- Taking a warm bath or shower
- Practicing relaxation exercises
- Writing in a journal
Make your routine consistent—your brain will learn these are sleep cues

4. Limit Screen Time Before Bed

No screens for 1 hour before bedtime (phone, TV, tablet, computer)
Blue light suppresses melatonin production
Mental stimulation from content keeps brain alert
If you must use devices: Use blue light filters or glasses
Consider an old-fashioned alarm clock instead of phone

5. Exercise Regularly (But Not Before Bed)

Regular exercise improves sleep quality
Aim for 20-30 minutes of moderate activity daily
Morning or afternoon exercise is best
Avoid vigorous exercise within 3-4 hours of bedtime
Gentle stretching or restorative yoga is okay before bed
Even light activity (walking) is beneficial

6. Watch Your Diet

Avoid large meals 2-3 hours before bedtime
A light snack is okay if you're hungry
Good bedtime snacks: banana, warm milk, chamomile tea, whole grain crackers
Limit caffeine: None after 2 PM (coffee, tea, soda, chocolate)
Avoid alcohol: It may help you fall asleep but disrupts sleep quality
Stay hydrated during the day but limit fluids 2 hours before bed to reduce nighttime urination

7. Use Your Bed Only for Sleep

Don't work, watch TV, or use devices in bed
Your brain should associate bed with sleep only
Exception: Reading briefly is okay if it relaxes you
If you can't fall asleep after 20 minutes, get up and do something calming in another room

Sample Bedtime Routine (Target Bedtime: 10 PM)

8:30 PM - Begin Wind-Down

Turn off all screens
Dim lights throughout the house
Prepare bedroom (temperature, curtains)

8:45 PM - Personal Care

Take medications if prescribed for bedtime
Shower or bath (warm, not hot)
Brush teeth, skincare routine

9:00 PM - Relaxation Activity

Read a calming book
Light stretching or gentle yoga
Meditation or breathing exercises
Listen to calming music or nature sounds

9:30 PM - Final Preparations

Last bathroom visit
Set out water if you get thirsty
Review tomorrow's schedule briefly
Practice gratitude (think of 3 positive things from the day)

10:00 PM - Lights Out

Turn off all lights
Practice deep breathing or progressive muscle relaxation
If not asleep in 20 minutes, get up and try a calming activity

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is considered the gold standard treatment for chronic insomnia. It's as effective as medications but with longer-lasting benefits and no side effects. CBT-I has been specifically studied in cancer patients with excellent results.

What is CBT-I?

CBT-I is a structured program that helps you identify and change thoughts and behaviors that interfere with sleep. It typically involves 4-8 sessions with a trained therapist, though online programs are also effective.

Core Components of CBT-I

1. Cognitive Restructuring

Challenge unhelpful thoughts about sleep:

Unhelpful thought: "If I don't get 8 hours of sleep, I'll be worthless tomorrow."
Restructured thought: "Even if I don't sleep perfectly, I can still function. My body will sleep when it needs to."

Unhelpful thought: "I'll never sleep well again because of my cancer."
Restructured thought: "Many cancer patients improve their sleep with the right strategies. This is temporary."

2. Stimulus Control

Re-associate the bed with sleep:

Only go to bed when sleepy (not just tired)
If you can't sleep after 20 minutes, get up and do something relaxing
Return to bed only when sleepy again
Use bed only for sleep (not reading, TV, worrying)
Get up at the same time every morning regardless of sleep quality

3. Sleep Restriction Therapy

This seems counterintuitive but is very effective:

Temporarily limit time in bed to match actual sleep time
This builds "sleep pressure" and consolidates sleep
Example: If you're in bed 9 hours but only sleep 6, limit bed time to 6.5 hours
As sleep improves, gradually increase time in bed
Important: Do this under professional guidance, especially during cancer treatment

4. Relaxation Training

Learn techniques to reduce physical and mental arousal (see Relaxation section below)

5. Sleep Education

Understanding how sleep works and what's normal helps reduce anxiety about sleep

Finding CBT-I Resources

In-person therapy: Ask your oncology team for referral to sleep psychologist
Online programs: Several evidence-based apps and websites (Sleepio, CBT-i Coach)
Self-help books: "Say Good Night to Insomnia" by Dr. Gregg Jacobs
Cancer centers: Many offer CBT-I programs for patients

Relaxation Techniques for Better Sleep

Relaxation techniques help calm your mind and body, making it easier to fall asleep and stay asleep. Practice these during the day to become skilled, then use them at bedtime.

Deep Breathing (4-7-8 Technique)

Exhale completely through your mouth
Close your mouth and inhale through your nose for 4 counts
Hold your breath for 7 counts
Exhale completely through your mouth for 8 counts
Repeat 4 times

Why it works: Activates relaxation response, slows heart rate

Progressive Muscle Relaxation

Lie comfortably in bed
Tense muscles in feet for 5 seconds, then release
Notice the feeling of relaxation
Move up body: calves, thighs, buttocks, abdomen, chest, arms, hands, neck, face
Each time: tense 5 seconds, release, notice relaxation

Why it works: Releases physical tension, focuses mind on body sensations

Guided Imagery

Close your eyes and imagine a peaceful place
Use all senses: What do you see, hear, smell, feel?
Examples: Beach, forest, mountain meadow
Stay in this scene, adding more details
Use apps or recordings if helpful

Why it works: Distracts from worries, creates calming mental state

Body Scan Meditation

Lie down and close your eyes
Bring attention to your toes
Notice any sensations without judgment
Slowly move attention up through entire body
If mind wanders, gently return to body scan

Why it works: Mindfulness practice that reduces rumination

Mindfulness Meditation

Focus on your breathing
Notice thoughts without engaging with them
Imagine thoughts as clouds passing by
When you notice you're thinking, gently return to breath
Practice 10-20 minutes daily

Why it works: Reduces anxiety and racing thoughts

Counting Techniques

Simple counting: Count slowly backwards from 100
Counting breaths: Count each exhale up to 10, then start over
Gratitude counting: Think of things you're grateful for, one per breath

Why it works: Occupies mind, prevents worry thoughts

Additional Calming Strategies

Aromatherapy: Lavender essential oil (on pillow or diffuser)
White noise or nature sounds: Blocks disruptive sounds
Calming music: Slow tempo, no lyrics, specifically designed for sleep
Warm bath: 1-2 hours before bed; body cooling afterward promotes sleep
Gentle stretching: Releases muscle tension
Journaling: Write down worries to get them out of your head ("worry dump")

Optimizing Your Sleep Environment

The Ideal Sleep Environment Checklist

Temperature

Keep room cool: 65-68°F (18-20°C)
Your body temperature drops during sleep; cool room facilitates this
If you have hot flashes, keep room even cooler
Use lightweight, breathable bedding
Layer blankets so you can adjust as needed

Light

Make room as dark as possible
Use blackout curtains or eye mask
Remove or cover electronic lights (clocks, devices)
Use dim nightlight if needed for bathroom trips
Get bright light exposure during the day (helps regulate circadian rhythm)
Open curtains first thing in the morning

Noise

Minimize disruptive sounds
Use earplugs if needed
White noise machine or app can mask sudden noises
Fan provides consistent background sound
Ask family members to be quiet during sleep hours
Turn off phone or use "Do Not Disturb" mode

Comfort

Invest in comfortable bedding
Supportive mattress (replace if >7-8 years old)
Pillows that support your neck and spine
Breathable sheets (cotton, bamboo)
If you have hot flashes: moisture-wicking sheets and sleepwear
Keep extra pillows for positioning if you have pain

Air Quality

Ensure good ventilation
Use air purifier if you have allergies
Keep room clean and dust-free
Fresh air during the day (open windows when weather permits)

Minimize Distractions

Remove TV from bedroom if possible
Charge phone in another room
If you check clock during the night, turn it away
Clock-watching increases anxiety about sleep

Medication Management for Better Sleep

Many medications used in cancer treatment can interfere with sleep. Working with your healthcare team to optimize medication timing can make a significant difference.

Steroids (Corticosteroids)

Most common medication cause of insomnia in cancer patients

Common steroids: Dexamethasone (Decadron), prednisone, methylprednisolone
Why they're used: Prevent chemotherapy nausea, reduce swelling, treat some cancers
How they affect sleep: Increase energy and alertness, can cause agitation
KEY STRATEGY: Take as early in the day as possible
If chemotherapy is later in the day, ask if steroid timing can be adjusted
Some patients take steroids at 7-8 AM to minimize sleep impact
NEVER change your medication schedule without consulting your oncology team first
If steroids are causing severe insomnia, ask about temporary sleep medication

Pain Medications

Can both help and hinder sleep

Opioids: May cause drowsiness but can disrupt sleep architecture
Uncontrolled pain prevents sleep
Talk to your team about long-acting pain medications at bedtime
Some patients need "breakthrough" pain medication available at night

Diuretics ("Water Pills")

Increase urination frequency

Often used for fluid retention
Strategy: Take in morning rather than evening
If you must take in evening, take as early as possible
Limit fluids 2 hours before bed

Anti-Nausea Medications

Some are alerting, others sedating

Alerting: Metoclopramide (Reglan) in some people
Sedating: Promethazine (Phenergan), meclizine
Discuss with team whether timing can be adjusted

Stimulants

Used for severe fatigue

Methylphenidate (Ritalin), modafinil (Provigil)
Must take early in day (before noon)
Effects can last 6-8 hours or longer
Avoid caffeine if taking stimulants

Targeted Therapies

Various effects on sleep

Some cause insomnia, others cause drowsiness
Ask your oncologist about optimal timing
Read medication information sheet for sleep-related side effects

Immunotherapy

Can affect sleep through multiple mechanisms

Inflammatory response may disrupt sleep
Thyroid dysfunction (hyper or hypo) affects sleep
Report sleep problems to your team

Questions to Ask Your Healthcare Team About Medications

"Are any of my medications known to affect sleep?"
"Can the timing of my medications be adjusted to improve sleep?"
"Is there an alternative medication with fewer sleep side effects?"
"Should I take my steroids in the morning instead of evening?"
"If I'm taking multiple medications, which ones are most important to take at specific times?"

Sleep Medications

Medications for sleep should generally be used short-term and in combination with non-medication strategies. They can be helpful during acute treatment periods or while learning behavioral techniques.

Melatonin

First-line for many patients

Dose: 3-10 mg taken 1-2 hours before bedtime
How it works: Natural hormone that regulates sleep-wake cycle
Benefits: Very safe, non-habit-forming, few side effects
Best for: Difficulty falling asleep, circadian rhythm problems
Side effects: Rare; possible morning grogginess, vivid dreams
Note: Start with lower dose (3 mg) and increase if needed
Extended-release formulations may help with sleep maintenance

Trazodone

Commonly prescribed in cancer patients

Dose: 25-100 mg at bedtime
How it works: Antidepressant with sedating properties
Benefits: Not habit-forming, also helps anxiety/depression
Best for: Patients with depression or anxiety
Side effects: Morning grogginess, dry mouth, dizziness
Caution: Can lower blood pressure; stand up slowly

Mirtazapine (Remeron)

Dual benefit for sleep and appetite

Dose: 7.5-15 mg at bedtime for sleep (lower doses more sedating)
How it works: Antidepressant with strong sedating effects
Benefits: Also increases appetite (helpful if poor appetite)
Best for: Patients with poor appetite, weight loss, depression
Side effects: Increased appetite, weight gain, morning sedation
Note: Paradoxically, lower doses are MORE sedating

Zolpidem (Ambien)

Short-term use for sleep onset

Dose: 5-10 mg at bedtime
How it works: Binds to GABA receptors in brain
Benefits: Effective for falling asleep, short-acting
Best for: Difficulty falling asleep (not staying asleep)
Side effects: Dizziness, potential for dependence, rare complex sleep behaviors
Caution: Use short-term only; can be habit-forming

Eszopiclone (Lunesta)

Longer-acting than zolpidem

Dose: 1-3 mg at bedtime
How it works: Similar to zolpidem but longer duration
Benefits: Helps with both falling and staying asleep
Best for: Sleep maintenance problems
Side effects: Metallic taste, dizziness, potential dependence
Caution: May have morning grogginess due to longer action

Lorazepam (Ativan)

Benzodiazepine for sleep and anxiety

Dose: 0.5-2 mg at bedtime
How it works: Enhances GABA (calming neurotransmitter)
Benefits: Also reduces anxiety
Best for: Significant anxiety interfering with sleep
Side effects: Grogginess, confusion (especially in elderly), dependence
Caution: Habit-forming; short-term use recommended

Gabapentin

Dual benefit for neuropathy and sleep

Dose: 300-900 mg at bedtime
How it works: Nerve pain medication with sedating effects
Benefits: Also treats neuropathy and hot flashes
Best for: Patients with peripheral neuropathy or hot flashes
Side effects: Dizziness, swelling, weight gain
Note: Can take several days to reach full effect

Doxepin (Low Dose)

Specifically for sleep maintenance

Dose: 3-6 mg at bedtime (much lower than antidepressant dose)
How it works: Blocks histamine receptors
Benefits: Specifically designed for sleep maintenance, not habit-forming
Best for: Staying asleep through the night
Side effects: Minimal at low doses; possible morning drowsiness

Important Notes About Sleep Medications

Always consult your oncology team before starting any sleep medication
Some sleep medications can interact with chemotherapy or other cancer treatments
Start with the lowest effective dose
Use short-term (ideally <4 weeks) while implementing behavioral strategies
Avoid alcohol when taking sleep medications
Don't drive or operate machinery if you wake during the night after taking medication
Older adults are more sensitive to side effects (confusion, falls)
Don't stop benzodiazepines suddenly after regular use—taper with doctor's guidance
Keep medications secure, especially if there are children in the home

Medications to Generally Avoid

Diphenhydramine (Benadryl): Anticholinergic effects, tolerance develops quickly
Alcohol: Disrupts sleep quality even if it helps you fall asleep
Over-the-counter "PM" medications: Often contain diphenhydramine
Long-acting benzodiazepines: High risk of falls and confusion, especially in elderly

Special Situations

Hospital Sleep

Sleeping in the hospital is challenging

Ask about "quiet hours" protocols
Request vital signs be clustered when possible
Bring earplugs and eye mask
Ask about private room if available
Bring familiar items (pillow, blanket)
Use white noise app
Request sleep medication if needed

Steroid-Induced Insomnia

Common with dexamethasone

Take steroids as early in day as possible
May need sleep medication on steroid nights
Extra vigilant about sleep hygiene
Avoid caffeine entirely on steroid days
Plan for less sleep on these nights
Symptoms usually improve 2-3 days after steroid dose

Hot Flashes & Night Sweats

Hormone therapy side effect

Keep room very cool (65°F or lower)
Use moisture-wicking sheets and pajamas
Layer bedding for easy adjustment
Keep cold water bedside
Consider fan directed at bed
Ask about medications: SSRIs, gabapentin
Avoid triggers: spicy foods, alcohol, caffeine

Pain-Related Sleep Problems

Pain prevents restful sleep

Take long-acting pain medication at bedtime
Have breakthrough pain medication available
Use supportive pillows for positioning
Try warm bath before bed
Gentle stretching may help
Don't "tough it out"—pain control is essential

Anxiety-Related Insomnia

Racing thoughts about cancer

Practice "worry time" earlier in day
Write down concerns before bed ("brain dump")
Use relaxation techniques
Consider counseling or support group
Mindfulness meditation very effective
May benefit from anti-anxiety medication

Chemotherapy Week

Sleep often worse around chemotherapy

Expect some sleep disruption
Be extra diligent about sleep hygiene
May need temporary sleep medication
Rest when you can, but avoid excessive daytime sleep
Maintain sleep schedule as much as possible
Usually improves a few days post-treatment

When to Seek Help

Contact Your Healthcare Team If:

Insomnia affecting daytime function: Unable to perform daily activities
Chronic insomnia: Sleep problems >3 nights/week for >3 months
Severe depression or anxiety: Especially thoughts of self-harm
Excessive daytime sleepiness: Despite adequate time in bed
Loud snoring or gasping: May indicate sleep apnea
Restless legs: Uncomfortable sensations in legs preventing sleep
Uncontrolled pain: Pain preventing sleep
Medication side effects: New medications causing severe insomnia
Safety concerns: Falling asleep while driving or during activities

What Your Doctor May Recommend

Sleep study: If sleep apnea or other sleep disorder suspected
Referral to sleep specialist: For chronic insomnia
Mental health evaluation: For anxiety or depression
Medication review: Adjust timing or change medications
CBT-I program: Structured insomnia treatment
Sleep medications: Short-term or as-needed basis
Treatment of underlying conditions: Thyroid, pain, hot flashes

Questions to Ask Your Team

"Could any of my cancer treatments or medications be affecting my sleep?"
"What sleep strategies do you recommend for cancer patients?"
"Are there sleep medications that are safe with my cancer treatment?"
"Should I be evaluated for depression or anxiety?"
"Do you have a sleep psychologist or CBT-I program you recommend?"
"How long should I try sleep strategies before considering medication?"
"Could my insomnia be affecting my cancer treatment or recovery?"

Sleep Diary: Track Your Sleep

Why Keep a Sleep Diary?

Tracking your sleep helps you and your healthcare team:

Identify patterns and triggers
Assess effectiveness of interventions
Provide objective data for treatment decisions
Recognize improvements over time

What to Track Daily:

Bedtime: What time you got into bed
Sleep latency: How long it took to fall asleep
Number of awakenings: How many times you woke during the night
Wake time: Final wake-up time
Total sleep time: Estimated hours of actual sleep
Sleep quality: Rate 1-10
Daytime naps: Time and duration
Medications: Sleep medications and timing
Caffeine/alcohol: Amount and timing
Exercise: Type and timing
Daytime symptoms: Fatigue, mood, concentration
Possible triggers: Stress, pain, hot flashes, etc.

Sample Sleep Diary Entry

Date: January 25, 2026

Bedtime: 10:30 PM

Time to fall asleep: 45 minutes

Number of awakenings: 3 (bathroom, hot flash, unknown)

Final wake time: 6:30 AM

Total sleep: ~6 hours

Sleep quality: 5/10

Naps: 2 PM, 30 minutes

Medications: Melatonin 5mg at 9 PM

Caffeine: 2 cups coffee (morning only)

Exercise: 20-minute walk at 11 AM

Notes: Took dexamethasone with chemotherapy yesterday. Racing thoughts about upcoming scan. Hot flash at 3 AM woke me.

Digital Sleep Tracking

Many apps and wearable devices track sleep automatically:

Fitness trackers: Fitbit, Apple Watch, Garmin
Apps: Sleep Cycle, SleepScore, Pillow
Smart rings: Oura Ring
Benefits: Objective data, trends over time
Limitations: Not as accurate as clinical sleep studies
Use as supplement to sleep diary, not replacement

Resources and Support

Professional Support

Sleep psychologist: Specializes in CBT-I and sleep disorders
Sleep medicine physician: For complex sleep problems
Oncology social worker: Counseling for cancer-related stress
Psychiatrist: If depression or anxiety is significant
Integrative medicine: Acupuncture, meditation instruction
Support groups: Connect with other cancer patients

Online Resources

National Sleep Foundation: Sleep hygiene information (sleepfoundation.org)
American Cancer Society: Sleep problems during cancer treatment
Cancer.Net: Sleep disorders information for patients
CBT-I Coach app: Free app from VA/Department of Defense
Sleepio: Online CBT-I program (often covered by insurance)
Headspace, Calm: Meditation and sleep stories apps

Books

"Say Good Night to Insomnia" by Dr. Gregg Jacobs
"The Sleep Solution" by Dr. Chris Winter
"Why We Sleep" by Dr. Matthew Walker
"Quiet Your Mind and Get to Sleep" by Colleen Carney and Rachel Manber

Relaxation Resources

YouTube: Guided meditation, progressive muscle relaxation videos
Insight Timer: Free meditation app with thousands of recordings
Podcasts: "Sleep With Me," "Nothing Much Happens"
Spotify: Sleep playlists, nature sounds

Tips for Caregivers

Understand the problem: Insomnia is a real medical issue, not laziness
Create quiet environment: Minimize noise during sleep hours
Help with sleep hygiene: Encourage consistent schedule
Manage medications: Help track timing of medications
Reduce nighttime disruptions: Let them sleep when they can
Encourage professional help: If sleep problems persist
Be patient: Irritability from poor sleep is not personal
Protect your own sleep: You need rest to be an effective caregiver
Encourage daytime activity: Gentle exercise and light exposure

References

Palesh O, et al. Management of insomnia in cancer patients. NCCN Clinical Practice Guidelines. 2026.
Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2025.
Johnson JA, et al. Cognitive behavioral therapy for insomnia in cancer survivors. JAMA Oncol. 2025.
American Academy of Sleep Medicine. Sleep and Cancer Treatment. 2026.
Garland SN, et al. Sleeping well during cancer treatment: A systematic review. Sleep Med Rev. 2025.
Howell D, et al. Sleep disturbance in adults with cancer: systematic review. Support Care Cancer. 2025.

Last reviewed: January 25, 2026 | Medical Review: Dr. Sarah Thompson, MD, Sleep Medicine | Clinical Review: Jennifer Martinez, RN, OCN