Beat Insomnia with Cognitive Behavioral Therapy: A Guide for Cancer Patients

by Martin Reed Patient Advocate

For cancer patients, that most precious escape – sleep – is often elusive. According to the National Center for Biotechnology Information, up to 75 percent of cancer patients experience sleep disturbances, including insomnia. Sleeping pills may help over the short-term, but they also come with side-effects or interfere with existing drug regimens.

Therefore, the ability to fall asleep naturally, without the need for drugs, is preferable. For those who cannot or will not take sleep-inducing drugs, cognitive behavioral therapy (CBT) can be a safe, natural, and highly effective alternative.** Why is sleep so important?**

Sleep and healing go hand in hand. The ability of the body and brain to rest and recharge is needed to calm the mind and maintain, or regain, health.

Sleep boosts the immune system and is linked to reductions in depression, which increases quality of life. Lack of sleep causes daytime fatigue and may even make it harder to withstand pain and discomfort.

Causes of sleep disruption in cancer patients

Cancer can muddy sleep’s waters in many ways. Typical causes of insomnia in cancer patients can include:

  • Emotions such as worry, anxiety and fear

  • Side effects from specific medications

  • Side effects from the disease, such as pain and inflammation

  • Side effects from treatment, including hot flashes, incontinence and nausea

  • Deregulation of natural circadian rhythms and REM sleep by radiation treatment

How Cognitive Behavioral Therapy helps

CBT is highly effective in both the general population and among cancer patients and works by targeting and altering negative sleep thoughts and behaviors. It takes time to master the various components of CBT but for those willing to do the work, it’s a long-lasting, highly effective protocol.

CBT techniques include:

Cognitive Restructuring

Many insomnia sufferers have incorrect thoughts and assumptions about sleep; For example, the myth that we all need 8 hours of sleep. CBT will help correct these misperceptions, which often helps reduce the amount of pressure insomnia sufferers place on themselves to fall asleep and stay asleep.

Sleep Restriction Therapy

Many people who don't get as much sleep as they'd like spend far too much time in bed. They think that by spending more time in bed (and therefore, allotting more time for sleep), they'll get more sleep.

Unfortunately, the opposite is usually true. By spending too much time in bed, insomnia sufferers end up adding to their sleep anxiety and teach their brains to associate the bed with wakefulness and frustration rather than sleep. CBT programs will look at the amount of time you're spending in bed to see if sleep restriction will be beneficial.

Stimulus Control Therapy

People can break sleep-busting habits by using the bedroom only for sleeping, eliminating nocturnal clock-watching and getting out of bed if they can't fall asleep within around half an hour.

Many people remove clocks from their bedroom completely, to avoid the panic and frustration stemming from clock-watching when sleep won’t come. The goal of stimulus control therapy is to teach the mind to associate the bed with sleep and nothing else.

Practicing good sleep hygiene

This can be accomplished by creating and sticking to a relaxing (and consistent) bedtime routine, reducing late-night stimulation like watching television and maintaining optimum temperature, light and noise control.

Cancer patients can learn CBT through a sleep specialist or psychologist, or use apps or CDs as self-guiding tools.

Acquiring proficiency in CBT techniques does take time and effort but it is often well worth the commitment since the positive effects of CBT have been proven to last over the long-term.

Martin is the creator of Insomnia Land’s free online sleep training for insomnia. If you suffer from a lack of sleep, his course is there to help. Over 4,000 insomniacs have completed his course and 97 percent of graduates say they would recommend it to a friend.


Fiorentino, Lavinia, and Sonia Ancoli-Israel. "Sleep Dysfunction in Patients with Cancer." Current Treatment Options in Neurology. September 2007. Accessed February 19, 2016.

Martin Reed
Meet Our Writer
Martin Reed

Martin is the creator of Insomnia Coach, an eight-week course that combines online sleep education with individual sleep coaching. His course helps clients improve their sleep so they can enjoy a better life with more energy and start each day feeling happy, healthy, rested, and refreshed. Martin also runs a free sleep training course that has helped over 5,000 insomniacs. He holds a master’s degree in health and wellness education and studied clinical sleep health at the University of Delaware.