Cognitive behavioural therapy for insomnia (CBT-I)
Insomnia is one of the most persistent problems after cancer treatment. A short structured talking therapy that retrains sleep habits works better and for longer than sleeping tablets, and digital versions bring it to people who cannot reach a therapist.
Overview
Insomnia affects a large minority of people during and after cancer treatment and rarely resolves on its own. CBT-I combines sleep restriction, stimulus control, cognitive work on sleep-related worry and sleep hygiene over four to eight sessions. A 2016 meta-analysis of randomised trials in cancer survivors found large improvements in insomnia severity, sleep efficiency and sleep-onset latency that held at follow-up; trials of digital CBT-I show similar effects. Sleep guidelines from ASCO (2024), NCCN and the American College of Physicians place CBT-I first line, ahead of hypnotic drugs, which are second line for short-term use. Tai chi was non-inferior to CBT-I in one randomised trial and mindfulness has moderate evidence. Untreated insomnia amplifies fatigue, pain and depression, so screening for it is part of good survivorship care.
How it works
Restricting time in bed and decoupling the bed from wakefulness rebuild the homeostatic sleep drive and conditioned sleep cues, while cognitive work reduces the arousal that maintains insomnia.
- Large, durable effects in meta-analysis
- First line in multiple guidelines
- Effective digitally and in groups
- Requires effort over several weeks
- Trained therapists are scarce
- Less studied in advanced disease
Latest papers
topQuery for this technology: (TITLE:"Cognitive behavioural therapy for insomnia" OR ABSTRACT:"Cognitive behavioural therapy for insomnia" OR TITLE:"CBT-I" OR ABSTRACT:"CBT-I") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Cognitive behavioural therapy for insomnia (CBT-I), not a curated reading list.
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