# Insomnia in adults with cancer: screening, assessment and CBT-I first

Source: https://onco.cc/protocols/insomnia-in-adults-with-cancer/  
OnCo record `insomnia-in-adults-with-cancer` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Trouble sleeping is very common during and after cancer treatment, and it often lasts. Your team should ask about your sleep at every stage. The treatment with the best evidence is cognitive behavioural therapy for insomnia (CBT-I), face to face or online. Sleeping tablets can help for a short time but are not recommended for long-term use; exercise can help too.

## Summary

ESMO (2023) recommends that every patient with cancer be screened and assessed for insomnia regularly, from diagnosis through treatment and survivorship [I, A]; that people who screen positive have their severity measured with a validated tool, with the Insomnia Severity Index recommended [II, B]; and that a clinical interview is needed for a detailed evaluation [I, A]. CBT-I is the standard of care for insomnia in cancer survivors [I, A]. Where face-to-face CBT-I cannot be had, electronic CBT-I should be offered [II, A]; brief behavioural therapy should be considered during active treatment [II, B]; and mindfulness-based therapy is an alternative when CBT-I is not available or is preferred [II, B]. Exercise tailored to the person should be offered alone or alongside [II, B].

Hypnotics are an option, but their limited evidence of benefit does not outweigh the harms of long-term use [II, C]; short-term use of up to two weeks is not ruled out. Melatonin should be considered when circadian disruption is thought to maintain the insomnia and non-drug options are limited [II, B]; ESMO notes studies used 2 to 20 mg and that there is no dosing recommendation. Bright light therapy has insufficient evidence [II, C]. MASCC (2023) found no high-quality evidence to recommend cannabis for insomnia or other psychological symptoms in cancer.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: insomnia during cancer treatment; sleep problems after cancer; CBT-I; cognitive behavioural therapy for insomnia; digital CBT-I; sleeping tablets in cancer; melatonin for sleep in cancer
- Tags: protocol; supportive-care; sleep

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Cognitive behavioural therapy for insomnia (CBT-I)](https://onco.cc/technologies/cbt-insomnia-cancer/), [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/), [Mindfulness-based stress reduction and cognitive therapy](https://onco.cc/technologies/mindfulness-based-interventions/), [Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works](https://onco.cc/technologies/rejuv-mind-sleep-after-cancer/), [Sleep and circadian interventions in cancer](https://onco.cc/technologies/sleep-circadian-interventions/), [Sleeping tablets after cancer: what they do and what they do not](https://onco.cc/technologies/rejuv-mind-sleeping-tablets-after-cancer/)
- institutions: [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/)
- terms: [Cancer-related fatigue (tiredness)](https://onco.cc/terms/cancer-related-fatigue/), [Quality of life](https://onco.cc/terms/quality-of-life/)

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