Supporting sleep in cancer care: A practical guide for patients and families

Sleep loss is common during cancer care, yet its role in recovery is often overlooked. For individuals undergoing treatment, rest plays a functional role in how the body copes with therapy, responds to stress, and maintains resilience. Fatigue, inflammation, and emotional distress are part of the cancer experience. When sleep is poor, these symptoms tend to worsen.

Sleep is not a substitute for clinical treatment. But it is a physiological process that supports healing. Including it in care planning helps improve overall outcomes and quality of life.

Common Disruptions During Therapy

Many patients experience changes in sleep patterns during active treatment. These may include difficulty falling asleep, night-time waking, or a shift in daily rhythm. Factors include medication side effects, physical symptoms like pain or nausea, stress around procedures, and the sensory environment in hospitals or at home. In India, studies have reported that 60 to 80 percent of individuals receiving chemotherapy or radiation therapy report some form of sleep disturbance with longer hospital stays and delayed chemotherapy cycles. A 2019 study by AIIMS, Delhi found that 67% of breast cancer patients reported moderate to severe insomnia, with stress and pain as major contributors. These issues are often underreported and rarely addressed unless patients are specifically asked.

Sleep disruption may begin before treatment, especially around the time of diagnosis, and continue well after treatment ends. This cumulative effect places additional strain on the body’s capacity to recover.

The Role of Sleep in Immune and Physical Function

Sleep is involved in regulating immunity. Natural killer cell activity improves during sleep, allowing the body to identify and respond to abnormal or damaged cells. Inflammatory markers also tend to lower when sleep is consistent, which helps the body manage treatment-related stress. Lack of sleep contributes to prolonged inflammation, delayed tissue healing, and reduced tolerance to side effects. These effects do not directly interfere with cancer treatment, but they can make recovery more difficult. Patients reporting sleep problems during treatment took an average of 14 days longer to complete full chemotherapy cycles, with higher medication intolerance. For example, a patient with disrupted sleep may feel more fatigued, experience more pain, or take longer to regain strength between cycles.

In patients with pre-existing sleep disorders, these concerns may be amplified during cancer care.

Sleep and Emotional Wellbeing

Sleep supports emotional regulation. People who sleep well tend to report lower levels of anxiety and depression. They also experience better concentration, decision-making, and energy regulation throughout the day. When sleep is consistently poor, emotional symptoms become more pronounced. More than 25% of cancer patients experience symptoms of anxiety or depression, often correlated with poor sleep quality, according to Apollo Health of Nation Report 2024. Patients may feel easily overwhelmed, less engaged in their care, or unsure how to describe their experience. Over time, this can affect their relationship with treatment and with the care team.

Among survivors, chronic insomnia has been linked to longer-term mental health difficulties. In older adults, disturbed sleep may also contribute to memory changes or reduced cognitive stability.

What Patients Can Do to Support Rest

Small, consistent routines make a difference in how the body prepares for and sustains sleep. Keeping a regular waking time, limiting long naps during the day, and reducing caffeine intake after late afternoon can help restore natural rhythm. Exposure to early morning sunlight also supports circadian stability. Light and noise in the sleep environment should be managed as much as possible. Using cotton bedding, lowering screen time in the evening, and dimming lights an hour before bed may support better rest. Where bedrooms are shared, eye masks and earplugs may be helpful.

Discomfort caused by treatment side effects must be addressed for these strategies to work. Pain, nausea, itching, or gastric discomfort can all interfere with rest. Managing these symptoms with guidance from the care team is a necessary step toward improving sleep quality.

Clinical Support and Counselling

Sleep hygiene is not always enough. In many cases, patients benefit from additional clinical support. Behavioural therapy for insomnia (CBT-I) has shown measurable benefit in improving sleep among patients with chronic illness. It can be adapted for different care settings and delivered in brief formats. Where therapy is not available, clinicians can offer structured guidance during consultations. Reviewing medications that may interfere with rest, such as steroids or diuretics, may also be helpful.

In select cases, short-term use of sleep medication may be considered, especially when patients are unable to rest for more than a few hours each night. This decision should be individualised, regularly monitored, and integrated with symptom management.

Encouraging Routine Discussions

Patients may not mention sleep unless prompted. Many assume it is not medically relevant. Families may view rest as a side concern compared to medication, nutrition, or test results. Clinicians may prioritise tumour markers and vital signs, especially during high-pressure appointments.Including sleep in routine assessments can change this. A simple question about rest patterns can open space for more detailed discussion. Over time, tracking sleep can also help identify other issues that affect recovery, such as unmanaged pain or emotional strain.

Sleep does not resolve cancer. But it helps the body function more steadily under stress. It supports strength, memory, mood, and daily resilience. Including it in care planning is not a luxury. It is a basic need.

(The writer is a Sr. Consultant Radiation Oncologist, Apollo Cancer Centres, Visakhapatnam)