How can Sleeping Well help me? What the research says

The relationship between sleep and cancer outcomes is complex. Regularly sleeping more than nine hours can be a side effect of illness, but it may also possibly contribute to illness. Researchers often cannot tell whether excess sleep or illness comes first. We do have generally consistent evidence that too little sleep (less than seven hours) is not beneficial for most people. If you are concerned about the duration or quality of your sleep, we encourage you to consult your healthcare team and consider the practices and therapies we describe in Managing your sleep › and Sleep Disruption ›

We strongly emphasize that Sleeping Well, by itself, will not prevent, cure or control cancer or prevent recurrence. Like every other therapy or approach included on this website, Sleeping Well is one component of an individualized integrative plan rather than a stand-alone therapy.

We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).

Learn more about how we research and rate therapies.

Treating cancer

Is Sleeping Well linked to improved survival? Is it linked to less cancer growth or metastasis? Does it enhance the anticancer action of other treatments or therapies? We present the evidence.

Some studies throughout this section report an association between excess sleep and poor cancer outcomes. They do not show causation. It’s very possible that people who are sicker with advanced cancer sleep more, which doesn’t mean that sleeping caused an earlier death.

Cancer as a whole

Modest evidencesignificant effects in at least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of slightly higher cancer mortality among people with cancer with either too little (less than 7 hours) or too much (9 hours of more) sleep

Advanced cancer

Modest evidence of better survival among people with advanced cancer with better sleep at night or with different levels of activity or cortisol between day and night, indirect indicators of night-time sleep

Optimizing your body terrain

How does Sleeping Well promote an environment within your body that is less supportive of cancer development, growth or spread? We present the evidence.

Blood sugar and insulin resistance

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of better markers of blood sugar and insulin resistance among people with better reported sleep quality

Body weight

Strong evidence of moderately higher risk of obesity among people with inadequate sleep

Immune function

Weak evidence of altered immune rhythms among healthy young people with short-term sleep deprivation

Inflammation

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of higher markers of inflammation among people with cancer or healthy people with sleep disturbance or restriction

Your microbiome

Preliminary evidence of alterations in the fecal microbiome of people with sleep disturbance

Managing side effects and promoting wellness

Is Sleeping Well linked to fewer or less severe side effects or symptoms? Is it linked to less toxicity from cancer treatment? Does it support your quality of life or promote general well-being? We present the evidence.

Anxiety

Modest evidencesignificant effects in at least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of more anxiety among people with breast or lung cancer with poorer sleep quality

Body composition or cachexia

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of less unintentional weight loss among people with metastatic colorectal cancer with different day and night activity levels, an indirect marker of sleep at night

Changes in appetite

Preliminary evidence of less appetite loss among people with metastatic colorectal cancer with better sleep at night

Depression

Modest evidence of more depression among people with breast cancer or prostate cancer with poorer sleep quality

Fatigue

Modest evidence of more fatigue among people with metastatic colorectal cancer, lung cancer, or lymphoma with poorer sleep quality

Pain

Preliminary evidence of more pain after breast cancer surgery among women who had disturbed sleep before surgery

Preliminary evidence of more reported pain within 6 months of completing cancer treatment among people with ovarian cancer regularly going to bed after midnight, which was linked to shorter sleep duration

Quality of life and function

Preliminary evidence of better quality of life and function among people with metastatic colorectal cancer with activity levels indicating possibly better sleep at night

Preliminary evidence of better quality of life among people receiving chemotherapy with better sleep scores

Stress

Preliminary evidence of higher levels of stress among people with lung cancer with poor sleep quality

Other symptoms and side effects

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of lower diet quality within 6 months of completing cancer treatment among people with ovarian cancer regularly going to bed after midnight

Symptoms not specific to cancer

Modest evidence of a higher risk of gastroesophageal reflux disease (GERD) and sleep disturbance among adults

Reducing cancer risk

Is Sleeping Well linked to lower risks of developing cancer or of recurrence? We present the evidence.

Cancer as a whole

Preliminary (conflicting) evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of slightly higher cancer mortality among people without cancer at baseline with sleep durations of 6 hours or less

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (RCTs with an appropriate placebo or other strong comparison control or observational studies that control for confounds (this is the CancerChoices definition; other researchers and studies may define this differently) of slightly to moderately higher cancer mortality among people with long sleep durations

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on higher cancer mortality among people with insomnia symptoms or who take daytime naps in combined analyses of studies

Breast cancer

No evidence of an effect on risk of breast cancer among people with short sleep duration in a combined analysis of studies

Good evidence of lower risk of breast cancer among people with long sleep duration

Colorectal cancer

Preliminary evidence of a much higher risk of colorectal adenomas among people with short sleep durations

Good evidence of a moderately higher risk of colorectal cancer among people with long sleep durations

Gynecological cancers

Good evidence of moderately lower risk of gynecological cancer among people with with long sleep duration

Ovarian cancer

Good evidence of moderately lower risk of ovarian cancer among people with long sleep duration

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of invasive serous subtype ovarian cancer but not overall ovarian cancer among women with better sleep quality

Modest evidence of higher risk of invasive serous subtype ovarian cancer but not overall ovarian cancer among women with insomnia

Prostate cancer

Good evidence of moderately lower risk of prostate cancer among people with long sleep durations

Thyroid cancer

Good evidence of moderately lower risk of thyroid cancer among people with long sleep duration

How Sleeping Well relates to other practices and habits

Eating Well

Both what you eat and when you eat can promote or interfere with sleep.

Substantially more insomnia among people consuming energy drinks (good evidence)

Better sleep quality among people eating a diet rich in fruit, vegetables, whole grains, and foods high in omega-3 fatty acids (preliminary evidence)

Poor sleep quality among people eating late in the evening or at night (preliminary evidence)

Lower quality of diet among people with ovarian cancer going to bed after midnight, which is linked to less sleep (weak evidence)

Moving More

Less sleep disruption and better sleep among people participating in exercise without regard to treatment phase (strong evidence)

Better sleep among people participating in exercise, especially aerobic exercise, during treatment (strong evidence)

Better sleep among people participating in exercise after treatment (strong evidence)

Less insomnia among people with advanced cancer participating in exercise (good evidence)

Creating a Healing Environment

Better sleep quality and quantity among people with more exposure to green space (preliminary evidence)

Managing Stress

Stress—and its related anxiety and depressive symptoms—and sleep are all related. Interventions to improve sleep may possibly reduce depressive symptoms and stress. The reverse—that reducing depressive symptoms and stress may improve sleep—might also be true.

Poorer sleep quality among people with symptoms of stress (good evidence)

Higher levels of stress among people with lung cancer with poor sleep quality (preliminary evidence)

Healthy habits

Manage your body weight

Moderately higher risk of obesity among people with inadequate sleep (strong evidence)

Resources

Keep reading

Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewer

Whitney You, MD, MPH

Research Consultant
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Research Consultant

Last update: July 27, 2022

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

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