The Survivorship Sleep Program: Enhancing Sleep Health in Cancer Survivors

New research from the Health Promotion and Resiliency Intervention Research Program focuses on improving sleep interventions for cancer survivors.

We all need to sleep. Numerous studies have shown the correlation between sleep quality and mental health outcomes, such that improving sleep quality can lead to decreased depression, anxiety, and rumination. In light of sleep’s significant effects on mental health outcomes, research has also documented sleep’s effects on physical health. Extending beyond what occurs between our ears, sleep elicits major downstream benefits for the body . The observation of this important mind-body connection has catalyzed research delving into the relationship between sleep quality and quantity on mental and physical health outcomes.  In both clinical and non-clinical populations, sleep is a valuable domain to target in terms of  Improving future health.  

Cancer survivors frequently report issues with sleep quality and quantity. Seen most commonly as difficulty in  falling asleep or maintaining sleep, cancer survivors are more vulnerable to  depression, social impairment, and diminished quality of life. Affecting anywhere from 30% to 50% of cancer survivors, this clinical population is a prime candidate for sleep interventions.

Cognitive Behavioral Therapy for Insomnia (CBT-I) has been demonstrated as highly efficacious and an appropriate first-line treatment for cancer survivors living with insomnia.  Patients receiving CBT- I frequently report decreases in sleep latency (time to fall asleep) and increases in sleep duration persisting for several weeks post-intervention. Although, as one can imagine, delivering CBT-I can present unique barriers to cancer survivors living with physical limitations related to  their cancer diagnosis or other barriers, such as time and travel constraints. Consequently, additional research is needed to develop a more feasible and acceptable model of CBT-I for this patient population.  

The Survivorship Sleep Program Intervention for Cancer Survivors

In order to improve access  to CBT-I for cancer survivor (i.e., people who have had cancer and completed their primary cancer treatment), Daniel Hall, PhD, a clinical psychologist in the Health Promotion and Resiliency Intervention Research group (HPRIR) has piloted a new intervention: the Survivorship Sleep Program (SSP). The SSP is a virtual, synchronous, four week program includes the following elements:

Session 1: Stimulus control and efficient sleep (i.e.,Sleep Restriction Therapy)  

Session 2: Sleep hygiene and relaxation 

Session 3: Cognitive techniques, such as reframing thoughts and worry time

Session 4:  Insomnia relapse prevention 

In a pilot study, Hall and colleagues compared the SSP to enhanced usual care, analyzing sleep outcomes, including insomnia severity, sleep efficiency, latency, and quality. The SSP proved formidable in reducing insomnia severity and latency, while improving quality and efficiency of sleep. 

Furthermore, the SSP’s introduction was well received by participants, demonstrating significant feasibility (i.e., recruitability, deliverability, attendance, and retainship) and acceptability (i.e., intervention delivery). Insomnia severity significantly decreased from pre- to post-intervention, while simultaneously sleep efficiency improved, with both outcomes sustaining effects four weeks after the intervention. Participant exit interviews supported the findings: 

“I got results fairly quickly… My sleep pattern is a lot better, and my mood is better”

“I think all the strategies that were taught I will use”. 

Despite the program’s success there is still room for growth: 

“The least enjoyable [aspect] was not getting enough sleep based on the parameters of the study” 

“A lot kind of jammed into those sessions… Once I started to look better I was like oh it’s over now”. 

Qualitative responses such as these serve as reminders that optimization is needed for the SSP to fulfill its potential.  

 Next Steps

Sponsored by the National Cancer Institute Dr. Hall is doing just that. With an R21 grant, the trial seeks to optimize the SSP by implementing a 2×2 factorial randomly controlled design by recruiting cancer survivors within Massachusetts. Over an 8 week period, the project seeks to optimize the SSP by assessing delivery method (group vs. individual) and booster sessions (4 four sessions vs. 7 sessions) over 4 weeks. 

Dr. Hall is also the recipient of a Research Scholar Grant (RSG) sponsored by the American Cancer Society.  This will allow Hall and colleagues to further study and optimize the SPS and to broaden its scope,  recruiting not only cancer survivors who have completed treatment, but also patients who are currently receiving cancer treatment and those who are not in treatment.

The optimization of sleep interventions like the Survivorship Sleep Program not only aims to improve sleep quality but also to enhance the overall mental and physical well-being of cancer survivors. With better sleep quality, survivors are likely to experience reductions in anxiety, depression, and fatigue, which can significantly impact their emotional resilience and overall quality of life. Furthermore, interventions that improve sleep quality may also yield important benefits to physical health, such as improved immune function.  As ongoing research continues to refine these interventions, the potential for a more holistic approach to survivorship care becomes increasingly evident, focusing on both the mental and physical health of cancer survivors.

For those interested in learning more about or participating in this study, you can follow this LINK.

Hall DL, Arditte Hall KA, Gorman MJ, Comander A, Goldstein MR, Cunningham TJ, Wieman S, Mizrach HR, Juhel BC, Li R, Markowitz A, Grandner M, Park ER. The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors. Cancer. 2022 Apr 1;128(7):1532-1544.