Prevalence, risk factors, and lived experiences of insomnia among cancer caregivers: A mixed-method study

Insomnia affects 40-76% of cancer caregivers, yet prevalence estimates vary widely and evidence on associated factors and lived experiences remains limited. Guided by the 3P model of insomnia, this study estimated insomnia prevalence, identified associated factors, and explored caregivers' lived experiences and treatment preferences.

An explanatory sequential mixed-methods study was conducted among informal cancer caregivers in China. Insomnia was assessed using the Insomnia Severity Index (ISI), and associated factors were examined by stepwise multivariable logistic regression. Semi-structured interviews with caregivers experiencing insomnia were analysed using qualitative content analysis.

Among 427 caregivers, 52.0% reported clinically significant insomnia symptoms (ISI > 7). Predisposing factors included older age (aOR = 1.03), family history of insomnia (aOR = 3.12) and medication use for conditions other than insomnia (aOR = 0.41); higher anxiety symptoms (aOR = 1.30) were precipitating, and higher pre-sleep arousal (aOR = 1.03) perpetuating. Only 13.3% (57/427) of caregivers had ever used an insomnia intervention, and evidence-based psychological interventions were rarely used (9.4% of users). Qualitative findings showed that night-time caregiving demands, emotional distress and environmental disruptions contributed to insomnia onset and persistence, and caregivers preferred flexible, remotely delivered non-pharmacological interventions.

To our knowledge, this is the first mixed-methods study in China to apply the 3P model to insomnia among cancer caregivers while also exploring their lived experiences and treatment preferences. Insomnia was highly prevalent and undertreated. Routine sleep screening and scalable, caregiver-adapted non-pharmacological interventions should be prioritised to support caregivers' sleep health and caregiving capacity.