Cancer-Related Insomnia: New Research Finds Effective Treatments
April 15, 2019
Nearly 70% of people with cancer experience insomnia symptoms — difficulty falling or staying asleep and/or poor sleep quality.
A new study led by Dr. Jun Mao of Memorial Sloan Kettering Cancer Center shows cognitive behavioral therapy and acupuncture offer solutions for cancer-related insomnia.
“Both treatments, CBT and acupuncture, produced sustained benefit over time,”
Mao told The Mesothelioma Center at Asbestos.com. “CBT is, overall, a bit more effective.”
Results from this controlled clinical trial support the beneficial effects of nonpharmacologic approaches for insomnia and point the way to effective, nondrug insomnia management options for patients with mesothelioma and other cancers.
Cancer-Related Sleep Problems Common and Unaddressed
According to a comprehensive survey of 25 National Cancer Institute-designated cancer centers, insomnia symptoms affect up to 68% of cancer survivors.
Fewer than 50% of survivors treated at these facilities received optimal insomnia-related care, highlighting the need for effective interventions to address this challenge.
Mao’s study describes cancer-related fatigue and pain contributing to poor sleep quality.
Other cancer experts note the relationship also operates in reverse: Inadequate sleep can worsen fatigue and pain.
Without proper treatment, insomnia may become chronic and debilitating.
Direct Comparison of Nondrug Insomnia Management Options
For the study, the investigators randomized 160 cancer survivors to receive eight weeks of acupuncture or cognitive behavioral therapy for insomnia.
Participants completed insomnia assessments at the beginning of the study and at weeks 8, 12, 16 and 20.
Although the interventions only lasted eight weeks, the researchers wanted to determine if the effects of the therapy lasted beyond the treatment period.
This study was a first of its kind. It involved a head-to-head comparison of acupuncture and cognitive behavioral therapy, enrolled patients with many different types of cancer and included nearly 30% minority participants.
Previous studies focused solely on breast cancer and included 90% white participants.
Limitations of the previous research make it difficult to determine if the results are applicable to patients with other cancers and people of diverse backgrounds.
Cognitive Behavioral Therapy and Acupuncture Are Effective
Acupuncture and cognitive behavioral therapy treatments produced clinically meaningful reductions in insomnia severity and symptom management.
Key Findings of the Trial Include:
- The beneficial effects of the therapies persisted for the full three-month, post-treatment period.
- Over the full 20 weeks of follow up, cognitive behavior therapy was slightly more effective overall than acupuncture for improving insomnia.
- Both therapies yielded similar improvements in fatigue, mood, quality of life and reduced sleep medication use.
- Cognitive behavioral therapy was more effective in white, highly educated men.
- Women and participants with less formal education appeared to benefit equally from acupuncture and cognitive behavioral therapy.
- Acupuncture was more effective for pain management in the short term.
Options May Depend on Unique Patient Needs
While both interventions proved effective for lessening severity and symptoms of insomnia, cognitive behavioral therapy was slightly more effective overall.
“Some insomnia issues are behavioral, such as setting a regular bedtime and eliminating screen time while in bed,” Mao said. “Such behaviors are more directly addressed with cognitive behavioral therapy, which may explain the more effective overall results with this treatment.”
Mao explained how insomnia is not one unified disorder, which is why the effectiveness of each therapy varies in different patient groups.
“For example, people with pain and insomnia may experience pain that disrupts their sleep,” he said. “Acupuncture may be a bit more effective for addressing the pain, which in turn improves patients’ sleep.”
Mao noted more research is needed to figure out how to best provide insomnia treatment to each unique individual.
“It is likely cognitive behavioral therapy improves pain via improvement of sleep,” he said. “However, acupuncture seems to improve pain directly, which agrees with past work in this area.”