When navigating cancer, challenges extend far beyond treatment decisions and physical symptoms, such as nausea or fatigue. One barrier that is often underestimated, despite affecting the majority of patients, is the profound impact cancer has on sleep. 

At Protocol Behavioral Health, we have witnessed firsthand how frequently our patients struggle with chronic insomnia and persistent sleep disruptions. These sleep difficulties can significantly affect daily functioning and overall wellbeing.

Insomnia and Cancer in Numbers

The prevalence of sleep difficulties in our patient population is striking. At Protocol Behavioral Health, 52% of patients experience moderate to severe symptoms of insomnia. This number rises to 83% when subthreshold insomnia is included, highlighting just how widespread sleep disruption is among those we support. Insomnia is not a rare side effect but a common struggle with challenging consequences throughout the oncology and hematology experience.

In a recent podcast episode of The Patient From Hell, Protocol’s Co-Founder and Chief Clinical Officer Dr. Cara Bohon discussed the impact of insomnia on patients undergoing cancer treatment, as well as evidence-based strategies to create meaningful change. Her insights reflect both clinical experience and a growing body of research highlighting effective, non-pharmacological approaches for treating insomnia in cancer patients, including Cognitive Behavioral Therapy for Insomnia (CBT-I).

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The Broader Context: Insomnia Across Cancer Populations

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Protocol’s findings reflect broader trends in cancer care. Research consistently shows that 57–61% of people with cancer experience sleep disturbances—nearly three times the rate seen in the general population. Multiple factors contribute to these high rates, including treatment side effects, emotional stress, and the physical challenges of living with cancer.

The consequences of insomnia extend far beyond fatigue, creating cascading effects on recovery and wellbeing. Chronic sleep disturbances in cancer patients are associated with worsened physical symptoms, heightened anxiety and depression, impaired cognitive functioning, and increased fatigue. Sleep problems can also affect immune function and, in some cases, treatment tolerance. As Dr. Bohon notes in the podcast episode, insomnia has serious effects for anyone, but it is especially compounding for patients already experiencing fatigue, pain, and emotional distress. 

For those already facing the challenges of cancer, insomnia intensifies symptoms and diminishes quality of life.

CBT-I: An Evidence-Based Approach to Improving Sleep

Given the high prevalence and serious consequences, effective interventions for insomnia in cancer patients are essential. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured, evidence-based treatment that targets the thoughts, behaviors, and patterns that contribute to chronic sleep difficulties. Unlike sleep medications, which may offer short-term relief but can lead to dependency, CBT-I provides long-term tools to improve sleep quality by addressing insomnia at its root.

For oncology patients, insomnia often involves a self-perpetuating cycle. Physical symptoms such as hot flashes, pain, and fatigue can disrupt sleep. These disturbances often trigger maladaptive cognitive patterns, including catastrophic thinking about sleep loss, hyperarousal, and heightened anxiety regarding the ability to sleep. CBT-I’s cognitive restructuring and behavioral modification techniques interrupt this cycle, addressing both the physiological and psychological factors that maintain insomnia.

Multiple studies support its effectiveness in cancer populations. A PCORI-funded randomized clinical trial led by Dr. Jun J. Mao (the CHOICE trial) compared CBT-I with acupuncture for cancer-related insomnia in 160 cancer survivors and found that CBT-I produced greater and more durable improvements in sleep quality and insomnia severity. These findings reinforce that CBT-I is not only safe and non-pharmacological, but also one of the most effective interventions available for individuals undergoing cancer treatment or navigating survivorship.

By improving sleep onset, sleep continuity, and overall sleep efficiency, CBT-I can help patients experience better daily functioning, improved emotional regulation, and reduced fatigue. For many, it represents a meaningful path toward restoring rest during an already demanding chapter of life.

Barriers to Care and the Need for Greater Access to CBT-I

Despite the proven benefits, access to CBT-I remains limited for many people with cancer. Most therapists lack formal training in both psycho-oncology and CBT-I delivery, leaving patients without providers who understand both the psychological and medical realities of cancer-related sleep issues.

For individuals actively undergoing treatment, in-person therapy can also be difficult to manage. Fatigue, immunosuppression, transportation challenges, and unpredictable treatment schedules often make regular appointments unrealistic. Geographic barriers add another layer of inequity. Patients in rural or underserved areas may have no local providers trained in CBT-I at all.

These clinical, logistical, and workforce gaps collectively mean that many patients who could benefit from an effective, non-pharmacological treatment simply cannot access it. This creates both a care quality gap and an opportunity for innovative delivery models.

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Digital Solutions for Insomnia Care

Fortunately, digital health tools are emerging as an effective way to expand access to CBT-I. Digital and remote CBT-I programs offer flexible, accessible, and evidence-based support for patients who cannot attend in-person sessions. These platforms allow patients to engage in structured insomnia treatment from home, on their own schedule, while still receiving guidance from trained professionals. By leveraging virtual care, patients can overcome geographic, logistical, and treatment-related barriers, making effective insomnia interventions more widely available.

How Protocol Behavioral Health Can Help Oncology Clinics

At Protocol Behavioral Health, we provide oncology clinics with turnkey access to comprehensive behavioral health support including CBT-I. Our mental health professionals are trained in psycho-oncology and evidence-based insomnia treatment, enabling your practice to address a critical, but often unmet, patient need without expanding your internal staff.

Our virtual Collaborative Care Model offers:

• Flexible scheduling that accommodates treatment cycles and patient energy levels
• Seamless integration with existing oncology workflows
• Specialized expertise in cancer-related insomnia, anxiety, depression, and distress
• Remote access that eliminates geographic and transportation barriers

By partnering with Protocol Behavioral Health, your clinic can enhance supportive care offerings, improve patient satisfaction, and address the 52-83% of cancer patients experiencing sleep disturbances—all while maintaining focus on oncology treatment.

Ready to expand your behavioral health services? Contact Protocol Behavioral Health to discuss how our evidence-based programs can integrate into your care delivery model.

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References

Al Maqbali, M., Al 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

Chen, M. Y., Zheng, W. Y., Liu, Y. F., Li, X. H., Lam, M. I., Su, Z., Cheung, T., Ungvari, G. S., Tang, L., Ng, C. H., Zhang, Q., & Xiang, Y. T. (2024). Global prevalence of poor sleep quality in cancer patients: A systematic review and meta-analysis. General Hospital Psychiatry, 87, 92–102. https://doi.org/10.1016/j.genhosppsych.2023.12.004

Mao, J. J., Li, Q., Garland, S. N., et al. (2020). Comparing acupuncture and cognitive behavioral therapy to treat insomnia among cancer survivors — The CHOICE trial. Patient-Centered Outcomes Research Institute. https://doi.org/10.25302/07.2020.CER.140314292IC

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