Living with persistent insomnia after cancer: A qualitative analysis of impact and management

Abstract

ObjectivesTo conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed‐diagnoses cancer survivors.MethodsTwenty‐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.ResultsPoor 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.ConclusionsInsomnia 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.

Sleep reactivity predicts insomnia in patients diagnosed with breast cancer

“…The finding that sleep disruption is a persistent and troubling problem in this population is consistent with a number of previous studies 9,17 . Indeed, a recent qualitative study in 27 cancer survivors reported that poor sleep was a long-term problem that impacted negatively on quality of life including sociability, physical activity and psychological well-being 48 . Chroinic insomnia is associated with risk of exacerbated morbidity and mortality in cancer patients 49 .…”

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile—An Exploratory Review and Analysis Paper in the Cancer Survivors’ Mental Health Morbidity Context

“…Clinically significant psychopathology symptoms are detected throughout the course of cancer survivorship up to several years post-diagnosis and treatment have been welldocumented, even before the COVID-19 pandemic [31]. Compared with the general population, adult cancer survivors have an increased prevalence of mental health comorbidities including major depressive and anxiety episodes, severe psychological distress, bipolar disorders, obsessive-compulsive disorders, neurocognitive dysfunction and suicidal outcomes [32][33][34][35][36][37][38], as well as other adverse late-effects interdependent with mental illness outcomes such as post-cancer chronic pain, fatigue and sleep disturbances [39][40][41][42][43]. Besides the pre-existing medical conditions at the time of cancer diagnosis [44], many of these chronic condition and multimorbidity clusters are identified following cancer [45,46].…”

Factors Affecting Sleep Quality of Breast Cancer Patients with Chemotherapy

“…with cancer and undergo chemotherapy treatment and continue to experience sleep disturbances because they often wake up in the middle of the night to urinate in the bathroom, anxious, cannot sleep before or after waking up in the middle of the night [20]. Moreover, the patients who have repeatedly received chemotherapy are increasingly at risk of experiencing sleep disorders and insomnia, so they need to be given with therapy to deal with sleep disorders [10].…”