Spotlighting a Program Aimed at Improving Sleep and Well-Being in Oncology

Sleep-wake disturbances and insomnia are highly prevalent among patients with cancer, often driven by the taxing nature of treatment, medicinal adverse effects, and the inherent psychological stress of a malignancy. While cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia in this population, access to these evidence-based behavioral interventions remains severely limited, even at major oncology centers.

At the 2026 American Psychosocial Oncology Society (APOS) Annual Conference, Erin Baurle, PsyD, associate professor of clinical practice, Medicine-Medical Oncology and medical director Oncology Counseling Services of the University of Colorado Anschutz Medical Campus, spoke with CancerNetwork® about a novel quality improvement initiative designed to bridge this access gap. The program utilized a dual-pronged approach: providing virtual training for oncology mental health clinicians and a 4-week virtual CBT-I-based group intervention for patients with moderate-to-severe insomnia. Preliminary findings from the feasibility pilot indicate high retention rates and significant self-reported improvements in sleep quality among participants across Colorado.

CancerNetwork: Why are insomnia and sleep-wake disturbances highly prevalent in patients with cancer?

Baurle: [There are] several reasons. One is cancer treatment is incredibly taxing on the body. I work with primarily solid tumors, and so when [patients] are going through chemotherapy, we give them steroids as part of their treatment regimen, which inherently is going to disrupt their sleep-wake cycle. It’s common for [patients] to not sleep a couple days after chemotherapy, when oftentimes we think of the inverse, that they’re sleeping all day, but then once the steroids wear off, people tend to need to catch up from sleep that they missed in the more active steroid treatment period. We’re not only [altering] their sleep-wake cycles with the different medications that we’re giving them, we also culturally or societally tend to tell people with cancer, “Oh, take it easy. You should rest.” They’re spending more time in bed or more time on the couch, when bodies of research show that it’s better for them to be as active as possible. Of course, that might look different than it did outside of cancer treatment. There’s societal as well as medical reasons that [patients] are seeing huge impacts in their sleep-wake cycles and sometimes developing insomnia. Then, of course, from where I sit as a psychologist, cancer tends to be inherently stressful, and stress is not a friend of sleep. [Patients] often are ruminating, having difficulty falling asleep, or they might wake up in the middle of the night and then have difficulty going back to sleep, which is probably what I hear most common, that their mind is racing. They’re thinking through the different logistics of cancer treatment, how this has impacted their lives, their relationships, [or] if the cancer comes back, and it tends to be just a runaway train.

How does insomnia impact a patient’s quality of life?

When you’re not sleeping well, you tend to not be the best version of yourself. If we add that into the mix of going through active cancer treatment and feeling physically poor, in some of our worst-case scenarios, be a trigger for depression. Certainly, anxiety is less well-managed when people are not sleeping well, so we’ll tend to see worsening of panic or rumination, which is strongly correlated with both anxiety and depression, and then [patients] might be sleeping during times that they would like to be with their family or be at work. It’s impacting what their usual day-to-day life looks like, even more so than cancer treatment alone.

What goes into cognitive behavioral therapy for insomnia?

Cognitive behavioral therapy for insomnia, or CBTI for short, involves looking at the way we think about our sleep, so the cognitive portion. Behavioral is the time we spend in bed, where we’re sleeping, our relationship with sleep, and then we’re also talking about feelings. However, we’re not good at adjusting our feelings. Cognitive behavioral therapy is effective for many different forms of behavioral concerns, anxiety, depression, etc., but for insomnia, in particular, for behavior, we try and reduce the time we’re spending awake in bed If we’re not sleeping. We get out of bed, we build a nest, and we try and think about Pavlov and classical conditioning, and get the person to associate their bed with sleep, rather than being awake and spending hours of time trying to sleep, which tends to lead to more frustration on the cognitive or the thought side of things. The way we think about our sleep can impact if we’re able to drift off to sleep.

If we get into bed and start to think, “Oh, this is going to be a bad night. I’m never going to fall asleep”, that’s probably not going to help us drift off. With CBT-I, we help people recognize those unhelpful thought patterns. And we have different phrases for recognizing different patterns of all or none thinking, catastrophizing, taking things too personally. We help that apply not only to sleep, but also other aspects of their life, which might help be a buffer against depression or anxiety or other unhelpful thinking patterns, and then teach them different ways of thinking that are more likely to happen. We’ll do thought challenging on a 1% to 100% chance of reality. How likely is it that if you don’t sleep tonight, you’re going to be a disaster tomorrow, and nothing’s going to pan out. People will usually realize that the percentage of those things is less likely than it feels emotionally in the moment. That is one way of demystifying some of those thoughts, or challenging or restructuring those thoughts, is what we call it.

There are also other modalities for managing our thoughts that can be effective in helping our emotional well-being more currently. One is called Acceptance and Commitment Therapy, and instead of changing our thoughts, it works more on recognizing that we’re having those unhelpful thoughts and building a different relationship with it. Can we hold hands with that thought? Can we see that thought as something outside of ourselves? Instead of the thought leading everything, we’re recognizing that we’re not good at controlling our thoughts; like if I tell you not to think about a white elephant, you think about a white elephant. Given that that’s our reality, how can we accept that and move forward in a different way? We use those cognitive strategies and behavioral strategies to lead to the best outcomes, in this case, in insomnia management.

Are you able to discuss the feasibility pilot study you are presenting at the conference? What were some of the findings?

We looked at 2 things as part of the feasibility pilot study. Here we’re talking about its impact on patients. We had [patients] fill out the Insomnia Severity Index prior to the class.It’s not large enough to get any statistical analyses, so these are all qualitative, but we did see an improvement, and then we’ve also received a lot of spontaneous positive feedback from participants. We use email, since the class is held virtually, so we can reach all across the state of Colorado, and [patients] will email us, even to this day, saying, “Hey, I’m sleeping so much better, or I followed up on that one thing you talked about, turns out it’s had this huge positive impact.”

We’ll also reach out and ask questions. I can tell that the [patients] engaged with the material and reported positive change. One of the things we learned between the first session and the second and we’re getting ready to launch our third in April, is we expanded the time between the initial intervention of compressing the amount of time that they’re spending in bed to being closer to the time that they’re sleeping, and then when we follow up with them to modify that personalized sleep prescription: that’s the hardest part. It’s the most effective part, but it’s also the hardest.

It’s in some ways, maybe comparable. It’s a chemotherapy or surgery, we know it’s going to work if you stick with it, however, you don’t feel well. [Patients] were coming back after the first week and saying, “I feel so bad. I wish I knew I was going to feel this bad.” By extending that middle portion out 2 weeks, nearly everyone that came back the second time had started to see improvement and made it through the worst part of that, which was nice to see. Then when they came back for our final session, they had also noticed the improvements, but they felt bolstered knowing, “Okay, this does work.”

What are the next steps for research?

We are hoping to expand this program and offer it more regularly as part of our psychosocial offerings for individuals and families facing cancer, we plan to offer it on a quarterly basis. An exciting future direction is to look at offering the same program, slightly modified for cancer caregivers. There’s recent research that shows that if a caregiver is not sleeping well, it negatively impacts the patients with cancer quality of life and sleep inversely. Right now, we’re targeting [patients] who have cancer, and this recent research points to the fact that the caregivers are probably also not sleeping well. If we can get both sleeping well, it’s a bit of a balm for them in a trying time.

Reference

Brewer B, Baurle E. Improving community access to behavioral sleep medicine: a novel quality improvement initiative targeting clinicians and patients. Presented at the 2026 American Psychosocial Oncology Society Annual Meeting; New Orleans, LA; March 18-20, 2026. Poster 75.