Insomnia Therapy May Reduce Cognitive Impairment in Cancer Survivors

For cancer survivors who experience insomnia, cognitive behavioral therapy has been shown to improve cancer-related cognitive impairment, according to recent research. These improvements also lead to improved mood and fatigue levels, an expert said.

A Canadian study published in the Journal of Clinical Oncology included 132 total cancer survivors. Researchers randomly assigned survivors to receive seven weeks of virtual cognitive behavioral therapy for insomnia (CBT-I) or were placed on a waitlist control group.

Survivors who received the CBT-I had improved cognitive impairment related to cancer and reduced insomnia severity, the study stated.

Sleep plays a “critical role” in memory and cognitive abilities, explained Sheila Garland, leading to cognitive impairment if an individual does not sleep enough.

Garland is the study co-author, clinical psychologist and associate professor of psychology and oncology at Memorial University in Canada.

“A lot of people colloquially refer to [cognitive impairment] as chemo brain,” Garland told CURE®. “It's not limited to people who have received chemotherapy. When you look across treatment, some people would score high on measures of cognitive impairment, even at the beginning of treatment.”

She noted that cognitive impairment can be seen as problems with paying attention, remembering things and problems.

“If somebody is having anxiety related to their cancer diagnosis or fear of recurrence, it can be hard to pay attention to the present moment,” Garland said. “So [survivors] may not remember where they put their keys because they weren’t in the moment [when] they laid their keys down.”

Fatigue levels, she also explained, could lead to less mental energy to pay attention.

“When we presented this to [survivors], they said ‘Yeah, I can see why helping my sleep is going to help me think better,’” Garland added. “Because everybody has had those experiences when they didn’t sleep so well and weren’t functioning cognitively very well the next day.”

Importance of Sleep and Cognitive Functioning for Cancer Survivors

Insomnia and cancer-related cognitive functioning for cancer survivors in the real-world setting don’t have a lot of awareness, Garland noted.

“So much change comes from advocacy,” she said. “One of the big issues with CBT-I is that people aren’t aware that it exists.” After survivors learn about the treatment and begin advocating for it, that’s when “change can be made,” she said.

Garland emphasized that advocating for this treatment is “more powerful when there’s a demand for an intervention.”

“The demand needs to come from the grassroots within it to be met,” she explained. “The more people with lived experience who say, ‘We need access to this, this is going to be an efficient treatment for me,’ is where change can be made.”

Managing Insomnia for Cancer Survivors

Ways to address comorbid insomnia and cancer-related cognitive impairment stem from understanding the difference between insomnia and its severity.

“It’s normal for people to have problems sleeping every once in a while,” Garland said. “But when they have difficulty with sleep initiation or maintenance that happens at least three days per week for at least three months or more, that’s considered insomnia disorder.

“The results of this trial would say that CBT-I is going to be an effective intervention for addressing insomnia as well as perceived cognitive impairment.”

To manage insomnia, it does not help for survivors to go to sleep earlier or sleep in the next day, Garland said.

“A lot of people try and compensate for poor night's sleep by sleeping in or going to bed earlier and trying harder to sleep,” she explained. “Maybe they start to get anxious about their sleep, but they can actually make it more likely that the insomnia will persist.”

Sleep pressure, she noted, is what truly helps people fall asleep and continue this pattern.

“What happens is when [a person] sleeps in later, they don't have enough sleep pressure to build before they’re able to fall asleep the following night,” she said. “For some easy math, if I’m an eight-hour sleeper, and I take eight away from 24 hours, I need to have 16 hours of sleep pressure to build before I’m likely to fall asleep again.”

Garland explained that for an eight-hour sleeper, a person might wake up at 7 a.m. and sleep at 11 p.m. However, if a person sleeps in until noon, then 16 hours later would be 4 a.m. — their likely bedtime.

Advice for Cancer Survivors Who Experience Insomnia

Building sleep pressure is important, Garland emphasized, and noted that “the morning wake-up time is critical.”

“Tired doesn’t equal sleep, because someone may be tired, but they may not be sleepy,” she said. “By the time they might be likely to fall asleep, they’d got themselves so worked up that their arousal level prevents them from actually falling asleep. So, these are some things we work through in CBT-I.”

For cancer survivors who are experiencing insomnia and cancer-related cognitive impairment, she recommends survivors speak with their health care providers.

Garland explained that survivors may not ask their doctors about sleep and how it may affect survivors’ quality of life. Even survivors may attribute their fatigue and lack of sleep to the medication they’re still receiving, she said.

“I want to see the conversation changed and sleep being spotlighted as one of those foundational health behaviors that contribute to the development and severity of symptoms.”

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