Cancer survivors' sleep outcomes across cognitive behavioral therapy for insomnia

Insomnia is a frequent and distressing concern for cancer survivors and is often associated with increased risk for depression and anxiety. Although cognitive behavioral therapy for insomnia (CBT-I) has been established as an effective treatment, brief, virtually delivered CBT-I with content targeted to survivorship may be more feasible and acceptable for cancer survivors. However, daily trajectories of change in key sleep parameters over the course of a brief, virtual CBT-I intervention have not been fully characterized in this population.it is not yet known how cancer survivors' insomnia changes over the course of a brief, virtual CBT-I intervention.

This secondary analysis aimed to explore daily patterns in sleep diary metrics during the intervention phase of a virtually delivered CBT-I program for cancer survivors.

Adult survivors (N = 20) treated for non-metastatic cancer with Insomnia Disorder (DSM-5 criteria and Insomnia Severity Index score ≥ 15) who were randomized to receive four 45-minute weekly sessions of interventionist-led CBT-I. Participants completed daily assessments to measure their total sleep time (TST), time in bed (TIB), sleep efficiency (SE), sleep onset latency (SOL), waking after sleep onset (WASO), and overall sleep quality (SQ). Linear mixed models were used to examine the trajectory of change in each sleep metric between sessions 1 and 4 (i.e. 21 days).

Across sleep metrics, linear growth models demonstrated better model fit than either quadratic or cubic growth models. Significant improvement was observed for SQ, SE, and SOL, but not TST, TIB, or WASO.

Our findings illustrate significant linear change in several key sleep metrics across 4 sessions of virtually delivered CBT-I. Although preliminary, these findings, provide support for all 4 sessions as necessary and may inform decisions around optimal delivery of brief, virtual CBT-I in cancer survivors.