Contribution of Cancer Symptoms, Dysfunctional Sleep Related Thoughts, and Sleep Inhibitory Behaviors to the Insomnia Process in Breast Cancer Survivors: A Daily Process Analysis

Study Objectives: Using a comprehensive cognitive-behavioral model of insomnia and a daily process approach, this study was conducted to examine the contribution of cancer symptoms and dysfunctional sleep related thoughts and behaviors to the process of insomnia in breast cancer survivors. Design: Within-group longitudinal research design. Setting: An academic medical center. Participants: 41 women with breast cancer who had completed their primary cancer treatment and met Research Diagnostic Criteria for primary insomnia or insomnia comorbid with breast cancer. Interventions: NA Measurements and Results: For 28 days, participants completed morning diaries assessing sleep, nighttime pain and hot flashes, and dysfunctional sleep related thoughts and behaviors during the day and night, and evening diaries assessing daytime pain, fatigue, hot flashes, and mood. All diaries were collected using an automated telephone-based system. Results revealed that poorer sleep was related to nighttime pain and hot flashes in breast cancer patients. Time-lagged effects were also found. The current study identified higher levels of dysfunctional sleep related thoughts and sleep inhibitory behaviors during the day and night as antecedents of insomnia, and higher levels of pain, fatigue, and hot flashes and lower levels of positive mood and dysfunctional sleep related thoughts as consequences of insomnia in this population. Conclusions: The current study found support for a comprehensive cognitive-behavioral model of insomnia, which has several theoretical, practice, and research implications.