{"entity":{"id":"cbt-insomnia-cancer","kind":"technology","name":"Cognitive behavioural therapy for insomnia (CBT-I)","aka":[],"tldr":"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.","summary":"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.","status":"established","asOf":"2026-09-10","wikipedia":"https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia","links":[{"label":"Systematic review and meta-analysis of CBT-I in cancer survivors (Sleep Med Rev 2016)","url":"https://doi.org/10.1016/j.smrv.2015.07.001"},{"label":"Tai chi chih versus CBT-I for insomnia in breast cancer survivors (JCO 2017)","url":"https://doi.org/10.1200/JCO.2016.71.0285"}],"tags":["complementary","supportive-care","evidence:strong"],"related":["idea-nl-sleep-circadian-survivorship-rct"],"cancers":[],"sections":["supportive-care","rejuvenation"],"technologies":["sleep-circadian-interventions","psycho-oncology","survivorship-care-plan","cancer-related-fatigue-management","rejuv-mind-sleep-after-cancer","rejuv-mind-sleeping-tablets-after-cancer"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["quality-of-life","late-effects"],"trials":["nct01091974"],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":["paper-irwin-j-clin-oncol","paper-johnson-sleep-med-rev"],"journals":[],"dependsOn":[],"notes":[],"principle":"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.","strengths":["Large, durable effects in meta-analysis","First line in multiple guidelines","Effective digitally and in groups"],"limitations":["Requires effort over several weeks","Trained therapists are scarce","Less studied in advanced disease"]},"route":"/technologies/cbt-insomnia-cancer/","neighbours":{"idea":[{"id":"idea-nl-sleep-circadian-survivorship-rct","kind":"idea","name":"Treat insomnia in survivors and measure whether the cancer notices","route":"/ideas/idea-nl-sleep-circadian-survivorship-rct/"}],"section":[{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"cancer-related-fatigue-management","kind":"technology","name":"Fatigue after cancer treatment: what actually works","route":"/technologies/cancer-related-fatigue-management/"},{"id":"rejuv-mind-access-to-psychological-care","kind":"technology","name":"Getting psychological help after cancer: the stepped-care model, and what is actually commissioned","route":"/technologies/rejuv-mind-access-to-psychological-care/"},{"id":"psycho-oncology","kind":"technology","name":"Psycho-oncology and distress screening","route":"/technologies/psycho-oncology/"},{"id":"rejuv-mind-sleep-after-cancer","kind":"technology","name":"Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works","route":"/technologies/rejuv-mind-sleep-after-cancer/"},{"id":"sleep-circadian-interventions","kind":"technology","name":"Sleep and circadian interventions in cancer","route":"/technologies/sleep-circadian-interventions/"},{"id":"rejuv-mind-sleeping-tablets-after-cancer","kind":"technology","name":"Sleeping tablets after cancer: what they do and what they do not","route":"/technologies/rejuv-mind-sleeping-tablets-after-cancer/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"tai-chi-qigong","kind":"technology","name":"Tai chi and qigong","route":"/technologies/tai-chi-qigong/"},{"id":"cognitive-impairment-after-cancer-treatment","kind":"technology","name":"Thinking and memory after cancer treatment: what is measurable, and what helps","route":"/technologies/cognitive-impairment-after-cancer-treatment/"},{"id":"rejuv-frontier-what-works","kind":"technology","name":"What actually works after treatment","route":"/technologies/rejuv-frontier-what-works/"}],"term":[{"id":"late-effects","kind":"term","name":"Late effects and survivorship toxicity","route":"/terms/late-effects/"},{"id":"quality-of-life","kind":"term","name":"Quality of life","route":"/terms/quality-of-life/"}],"trial":[{"id":"nct01091974","kind":"trial","name":"Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy","route":"/trials/nct01091974/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-johnson-sleep-med-rev","kind":"paper","name":"A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors","route":"/key-papers/paper-johnson-sleep-med-rev/"},{"id":"paper-irwin-j-clin-oncol","kind":"paper","name":"Tai Chi Chih Compared With Cognitive Behavioral Therapy for the Treatment of Insomnia in Survivors of Breast Cancer: A Randomized, Partially Blinded, Noninferiority Trial","route":"/key-papers/paper-irwin-j-clin-oncol/"}],"roadmap":[{"id":"rejuvenation-roadmap","kind":"roadmap","name":"Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it","route":"/roadmaps/rejuvenation-roadmap/"},{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}