Living with persistent insomnia after cancer: A qualitative analysis of impact and management
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Objectives: To conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed‐diagnoses cancer survivors. Methods: Twenty‐seven cancer survivors with persistent insomnia were recruited to this qualitative study following completion of treatment for breast (12), prostate (7), colorectal (7), and gynaecological (1) cancers. Eleven males and 16 females (mean age 62 years), who met DSM‐5 criteria for insomnia disorder, contributed to one of four focus group discussions, designed to explore the lived experience of persistent insomnia and its management within cancer care services. Results: Poor sleep was a persistently troubling complaint for participants, long after the completion of active cancer treatment. The impact of insomnia was significant for all participants, with six key domains emerging as those most affected: temperament, sociability, physical well‐being, cognitive functioning, relationships, and psychological well‐being. In terms of insomnia management, participants frequently resorted to unfruitful self‐management strategies, due to the lack of professional insomnia expertise within cancer care settings. Three main themes emerged in relation to insomnia management: self‐management, seeking professional intervention, and a lack of focus on sleep. A lack of clinician understanding of the importance of sleep health and the poor availability of evidence‐based insomnia interventions, such as cognitive behavioural therapy for insomnia (CBT‐i), were highlighted as important gaps in cancer care. Conclusions: Insomnia was found to have a detrimental and pervasive impact on cancer survivors’ quality of life, which persisted long into survivorship. There is an absence of professional attention to sleep throughout the cancer care trajectory, contributing to its prevalence, persistence, and impact. In order to break this cycle, sleep health should be integrated as a key aspect of cancer treatment and rehabilitation, much like maintaining a healthy diet and appropriate levels of physical activity.
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Pharmacotherapy remains the most pragmatic resource for cancer-related insomnia, despite limited evidence for long-term efficacy, not being curative, side effects (abuse, dependence, tolerance), and security profile (drug-drug and drug-disease interactions).
“Consequently, pharmacotherapy, a second-line intervention, remains the most pragmatic resource, 4 filling the cancer-related insom -nia treatment gap despite limited evidence for long-term efficacy, not being curative, side effects (including abuse, dependence, and tolerance), and security profile (e.g., drug-drug and drug-disease interactions). 18”
From Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial (2024) · cites this paper as [4]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredInsomnia is a prevalent complaint linked to cancer and its treatments, affecting between 29% and 64% of cancer survivors months or years after treatment completion.
“Insomnia emerges as a prevalent complaint linked to cancer and its treatments, and tends to persist, affecting between 29% to 64% of can -cer survivors months or years after treatment completion. 4-6”
From Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial (2024) · cites this paper as [4]
The Background and Discussion (page numbers unavailable) describe insomnia as common in people with cancer, amplified by treatment, and persistent into survivorship. They do not support the stated 29%–64% prevalence among survivors months or years after treatment; the Background instead gives 18%–29% for diagnosable insomnia in cancer patients and 70% for disturbed sleep. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe daytime consequences of insomnia typically motivate cancer survivors to seek specialized help.
“typically motivate survivors to seek specialized help. 4”
From Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial (2024) · cites this paper as [4]
The Results report substantial consequences of poor sleep, including impaired daytime functioning. In the “I tried to get help” passage, some participants raised poor sleep with a GP or at routine cancer appointments. The paper does not establish that daytime consequences typically motivated survivors to seek specialized help; the help described was not specialized insomnia care. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInsomnia has daytime consequences, including fatigue and mood impairments that affect quality of life.
“The daytime consequences of insomnia, including fatigue and mood impairments that affect the quality of life”
From Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial (2024) · cites this paper as [4]
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Clara, M. I., Hegarty, J. M., van Straten, A., Giudetti, F., Buekenhout, I., Koc, I., Canavarro, M. C., & Gomes, A. A. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09552-0 · Cited by 3 · see citing works
Zanni, L., Journiac, J., Savard, J., Guerdoux, E., Paillard-Brunet, G., Fasse, L., Provost, J.-B. L., Charles, C., Dauchy, S., & Boinon, D. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09284-1 · Cited by 3 · see citing works
Redeker, N. S. (2022) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2022.101632 · Cited by 3 · see citing works
Sleep disorder among patients with breast cancer: A concept analysis
Aini, N., Janitra, F. E., Wicaksana, A. L., Mỹ, Đ. T. T., & Trung, N. V. (2022) · Jurnal Keperawatan Padjadjaran · doi:10.24198/jkp.v10i3.2056 · Cited by 2 · see citing works
Dreaming in patients with cancer and their partners–an underestimated factor for quality of life?
Salomo, S., Hackl, T., Hübner, J., & Hagemeyer, B. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14169 · Cited by 2 · see citing works
Kwon, M., Zhu, J., Wilding, G. E., Larkin, K., Gehrman, P., & Dickerson, S. S. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae096 · Cited by 2 · see citing works
Greeley, K. M., Lee, R. M., Tulk, J., Harding, S., Yi, Y., Aubrey‐Bassler, K., & Garland, S. N. (2025) · Sleep Science and Practice · doi:10.1186/s41606-025-00129-8 · Cited by 2 · see citing works
Sleep–wake state discrepancy among cancer survivors with insomnia symptoms
Kwon, M., Zhu, J., Wilding, G. E., Dickerson, S. S., & Dean, G. E. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-08177-5 · Cited by 2 · see citing works
Cho, E., Song, J., Lee, J., Cho, I., Lee, D., Choi, H., Kim, H., & Chung, S. (2022) · Preprints.org · doi:10.20944/preprints202204.0121.v1 · Cited by 2 · see citing works
Bibliometric and visual analysis of cancer-related insomnia research from 2015 to 2025
Chen, L., Wang, R., Xu, F. G., Zhao, J., Wang, F., & Zhou, D. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09909-5 · Cited by 1 · see citing works
Sleep reactivity predicts insomnia in patients diagnosed with breast cancerPreprint
Rehman, A., Drake, C. L., Fleming, L., & Shiramizu, V. K. M. (2021) · doi:10.31234/osf.io/vgspx · Cited by 1 · see citing works
Self-citationInsomnia in cancer patients: a systematic literature reviewPreprint
Chekani, F., Lipschitz, A., & Mensah‐Osman, E. (2023) · Research Square · doi:10.21203/rs.3.rs-3275728/v1
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Educating Nurses in Sleep Screening, Brief Intervention, and Referral for Treatment
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Fleming, L., Crawford, M., Martin, B., Patience, M., & Fisher-Hicks, S. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197602751.013.30
Self-citationIntegrative oncology approaches to sleep disturbances and insomnia
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Sleep Disorders in Critically Ill Cancer Patients
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Sleep Impairment in Oncology: Development of a Novel Patient-Centric Conceptual Model
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Population-Specific Applications of Digital CBT-I: Evidence, Adaptations, and Emerging Directions
Lee, R. M., & Garland, S. N. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00400-z
- Authors
- Reynolds‐Cowie, P., & Fleming, L.
- Affiliations
- Oxford Health NHS Foundation Trust (GB)
- University of Strathclyde (GB)
- Corresponding author
- Fleming, Leanne
- ORCID
- Fleming, Leanne
- Venue
- British Journal of Health Psychology
- Publisher
- Wiley
- Published
- 2020-06-17
- Volume
- 26
- Issue
- 1
- Pages
- 33-49
- ISSN
- 1359-107X (ISSN-L)
- 2044-8287
- OpenAlex
- W3036217655
- Cited by
- 53
- References
- 55
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 16 · 2023: 8 · 2022: 10 · 2021: 5
- FWCI
- 5.56
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Health Psychology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- chronic insomnia, cancer survivors, insomnia management, sleep health, cognitive behavioral therapy for insomnia, self-management strategies, quality of life, psychological well-being, oncology services, sleep interventions, breast cancer, prostate cancer, colorectal cancer, gynecologic cancer
- MeSH terms
- Cancer Survivors, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Neoplasms, Quality of Life, Sleep, Cognitive Behavioral Therapy
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