Basic Sleep Education Class Can Cure Chronic Insomnia in Cancer Survivors

A single-session sleep education program for cancer survivors can cure insomnia in many participants, according to a study by the Dana-Farber Cancer Institute. The study also found that patients who don’t benefit from the single-session program are often helped by a more extensive 3-session program.

Affecting as many as 30% of cancer survivors, the insomnia that many survivors experience often originates during treatment for the disease as a result of a combination of factors, including anxiety, fatigue, and pain. Although these problems may diminish or disappear after treatment, insomnia often lingers. Chronic insomnia can be effectively treated with intensive cognitive-behavioral techniques, but these methods are time-consuming.

Published in Cancer, the study included 51 cancer survivors with moderate to severe insomnia. Participants provided information on their medical history, the severity and duration of their insomnia, and their mood during and after treatment.

Investigators found that survivors who had experienced sleep problems for a shorter period of time and felt less of a burden from those problems with less pain were most likely to benefit from the single sleep education session. Among patients not helped by that session, those with the greatest desire to improve their sleep were most likely to sign up for the second step of the program. These findings may help clinicians identify patients likely to be helped by a single session and those apt to participate in the second step of the program.

After participating in the 1-time sleep-education program, 41% of participants saw their insomnia successfully treated. Fourteen of those whose insomnia remained took part in the second step, a 3-part program using a cognitive behavioral therapy (CBT) approach to insomnia treatment that investigators had previously shown to be effective. Of that group, 71% had their insomnia resolved after completing the program.

Although there is a current cognitive behavioral therapy for insomnia, it is often difficult to access, according to the study authors. CBT for insomnia is a form of talk therapy that helps patients to understand the maladaptive sleep behaviors and thought patterns that cause their insomnia to persist. There is a limited number of providers trained in CBT for insomnia and, therefore, less patients with cancer who can use such an approach.

The trial’s first step, the single-session sleep-education class, can be implemented without the training needed for CBT and could easily be implemented in a small cancer center with limited resources or staff. Much of the material in these classes is not advanced and can be found in handouts commonly available at primary care clinics and cancer centers, according to the study. Investigators have found that in the absence of instruction on how to implement these new sleep behaviors or setting appropriate expectations for the timelines and magnitude of sleep improvements, a handout is inadequate; therefore, added guidance is beneficial.

Although the second step of the model needs to be led by a clinician trained in CBT for insomnia, and therefore might not be feasible for all cancer centers, the fact that it is offered in a group setting instead of a 1-on-1 consultation would expand its availability, the authors concluded.

Reference

• Chronic insomnia can be cured in cancer survivors with a basic, one-session sleep education class, study finds [press release]. Published September 24, 2019. https://www.dana-farber.org/newsroom/news-releases/2019/chronic-insomnia-can-be-cured-in-cancer-survivors-with-a-basic--one-session-sleep-education-class--study-finds/. Accessed September 25, 2019.