Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia

Psychooncology. 2012 Jul;21(7):695-705. doi: 10.1002/pon.1969. Epub 2011 Apr 29.


Objective: Insomnia is a common complaint among cancer survivors. Fortunately, cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be an effective treatment in this population. However, it is rarely implemented given its limited availability. To address this barrier, we examined the ability of an easily accessible online CBT-I program to improve insomnia symptoms in cancer survivors.

Methods: Twenty-eight cancer survivors with insomnia were randomly assigned to either an Internet insomnia intervention (n = 14) or to a waitlist control group (n = 14). The online program, Sleep Healthy Using The Internet, delivers the primary components of CBT-I (sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention). Pre- and post-assessment data were collected via online questionnaires and daily sleep diaries.

Results: Participants in the Internet group showed significant improvements at post-assessment compared with those in the control group in overall insomnia severity (F(1,26) = 22.8; p<0.001), sleep efficiency (F(1,24) = 11.45; P = 0.002), sleep onset latency (F(1,24) = 5.18; P = 0.03), soundness of sleep (F(1,24) = 9.34; P = 0.005), restored feeling upon awakening (F(1,24) = 11.95; P = 0.002), and general fatigue (F(1,26) = 13.88; P = 0.001). Although other group × time interactions were not significant, overall adjusted effect sizes for all sleep variables as well as for fatigue, depression, anxiety, and quality of life ranged from small to large.

Conclusions: CBT-I delivered through an interactive, individually tailored Internet intervention may be a viable treatment option for cancer survivors experiencing insomnia.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy / methods*
  • Fatigue / psychology
  • Fatigue / therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Internet*
  • Male
  • Middle Aged
  • Neoplasms / complications*
  • Neoplasms / psychology
  • Neoplasms / therapy*
  • Patient Education as Topic / methods
  • Quality of Life / psychology
  • Severity of Illness Index
  • Sleep Initiation and Maintenance Disorders / etiology*
  • Sleep Initiation and Maintenance Disorders / psychology
  • Sleep Initiation and Maintenance Disorders / therapy*
  • Stress, Psychological
  • Survivors / psychology*
  • Therapy, Computer-Assisted / methods*
  • Treatment Outcome