Sleep Hygiene in Patients with Early-Stage Breast Cancer: A Short Report

Sleep Hygiene in Patients with Early-Stage Breast Cancer: A Short Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Sleep Hygiene in Patients with Early-Stage Breast Cancer: A Short Report Ella Vallely, Catherine S. Weadick, Teresa Treacy, Seamus O’Reilly This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6635838/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background A previously conducted study reported that insomnia rates among oncology patients in Ireland are twice that of the general population, and that a breast cancer diagnosis was an independent predictor for clinical insomnia disorder. The aim of this study is to explore this interaction further in a larger cohort of breast cancer patients. Methods We evaluated sleep disturbance and sleep hygiene practices among adult breast cancer patients via questionnaires. Sociodemographic data, clinical characteristics, sleep history and attitudes towards sleep assessments were collected and analysed. Results The comprehensive 40-item questionnaire was completed by 315 patients. Of this cohort, 56% reported a change in their sleeping patterns since their cancer diagnosis, with over 55% of the study population having sub-threshold or clinical insomnia disorder. Although 64.2% of patients believed that questions regarding sleep should be part of breast cancer assessment, only 32% recalled being asked about sleep by a healthcare worker. Moreover, only 27.1% of respondents felt their sleeping difficulties were adequately dealt with since their diagnosis. Conclusion In summary, sleep disturbance is prevalent among breast cancer patients. Despite a majority of breast cancer patients recognising the importance of sleep assessment, a significant gap remains in healthcare providers addressing these concerns effectively. Figures Figure 1 Full Text Sleep disorders are frequently reported among cancer patients, both during treatment and in the post-treatment phase 1 , 2 . Reduced sleep duration and poor sleep quality is associated with an increased risk of cancer recurrence and decreased survival 3 , 4 , 5 , 6 . Sleep disturbance experienced by both patients and their partners are associated with increased levels of fear of cancer recurrence 7 . Additionally, there is a well-established relationship between cancer related fatigue and sleep deficiency, underscoring the importance of addressing sleep issues in this population 8 , 9 . A recent evaluation of sleep patterns in an Irish oncology population demonstrated an insomnia rate twice that of the general population 10 . In that study a breast cancer diagnosis was an independent predictor of insomnia syndrome 10 . Despite the significant symptomatic burden of sleep disturbances, these issues are often unrecognised and are inadequately addressed in clinical practice, particularly when compared to other symptoms such as pain and fatigue 11 , 12 , 13 . The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology advocate for specialised sleep assessment, acknowledging the increasing prevalence of related issues among cancer patients 14 . Nevertheless, a 2020 study revealed that only 34% of Irish oncology patients recalled undergoing assessment for sleep disturbance as part of their treatment 10 . Notably, breast cancer has been identified as an independent predictor of clinical insomnia disorder within the Irish oncology population 10 . This study aimed to explore this interaction further by quantifying the prevalence of sleep disturbance within a specific Irish cohort of breast cancer patients. Additionally, we aimed to examine patient’s opinions on sleep hygiene and evaluate sleep hygiene practices within this population. This was a cross-sectional questionnaire-based study conducted between September 2023 and March 2024 in adult patients diagnosed with breast cancer at Cork University Hospital/Univeristy College Cork Cancer Centre. A comprehensive 40-item composite questionnaire was formulated from a previously established questionnaire supplemented by additional questions devised by the authors 10 . The survey was circulated to patients attending the Outpatient Department. Institutional ethical board approval was obtained (Clinical Research Ethics Committee of the Cork Teaching Hospitals, ECM 01/2025/PUB), and all participants provided informed consent. Patients’ behaviours, attitudes and perceptions regarding sleep hygiene and assessment were examined. Clinical characteristics, sociodemographic and lifestyle data, were recorded. Sleep disturbance was assessed using the Insomnia Severity Index (ISI) as a baseline 15 . The ISI was selected as it is a validated instrument for identifying cases of insomnia within a population 15-17 . Data analysis was conducted using IBM SPSS V26. Descriptive statistics were employed to summarise the demographic and clinical characteristics of the participants. Pearsons’s and Spearman’s rank correlations were used to determine the association of clinical, lifestyle and demographic factors with ISI scores. Statistical significance was assumed by a p-value <0.05. A total of 315 questionnaires were completed, with baseline demographics summarise in Table 1 and clinical characteristics summarised in Table 2 . Among the total population, 56.8% (n=179) reported a change in their sleeping patterns since their cancer diagnosis, with 72.4% (n=228) stating they had not experienced sleep difficulties prior to diagnosis. An analysis of ISI scores revealed that 4.8% (n=14) of this population exhibited severe clinical insomnia, 18.2% (n=53) demonstrated moderate clinical insomnia, 33.2% (n=97) experienced subthreshold clinical insomnia, and 43.8% (n=128) reported no clinically significant insomnia, as shown in Figure 1. Only one-third of the patients expressed satisfaction with their current sleep patterns (33.3%, n=105), while more than half indicated that their sleeping patterns caused them at least some degree of distress (54.3%, n=171). High caffeine intake, alcohol consumption, low levels of physical activity, and the use of electronic devices before bed are all recognised as factors that adversely affect sleep 10 . At the time of the study, 87% (n=274) of participants reported caffeine consumption, 70.5% (n=222) reported alcohol consumption, and 96.2% (n=303) reported they used electronic devices before bed. Just under a quarter of our patients (n=78, 24.8%) indicated that they believed alcohol consumption could affect sleep and sleeping patterns. In our cohort, 62.5% (n=197) of patients believed that sleep assessment should be a component of cancer treatment; however, only 23.8% (n=75) felt that their sleeping difficulties had been adequately addressed since diagnosis. Under one-third of the study population recalled being asked about their sleep by a healthcare worker. Only 12% (n=8) of patients with moderate or severe insomnia felt that their sleeping difficulties had been sufficiently addressed since diagnosis. There was a statistically significant association between the patients aged over 65 and a higher ISI score (p <0.001). However, no statistically significant correlations between any other clinical, lifestyle or demographic factors were identified. Our findings highlight that there is a high prevalence of sleep disorders among this population, with more than half of the participants reporting changes in their sleep patterns since their cancer diagnosis despite over two-thirds lacking any prior history of sleep-related issues. This high level of prevalence aligns with findings from existing literature in similar populations 10 . There were high levels of consumption of caffeine and alcohol in our population, modifiable risk factors known to negatively affect sleep hygiene. One-fifth of patients reported using alcohol as a sleeping aid, yet only one-quarter recognised the potential impact of alcohol on sleep. This gap in patient awareness of sleep hygiene mirrors findings from previous studies 11 , 18 and further highlights the need for patient education, and the importance of the provision of sleep hygiene education information to this population in the clinical setting. The strengths of this study include a substantial data collection window, its large sample size, as well as a broad selection criterion, with no exclusion of particular demographic characteristics, current disease activity, or co-morbidities. This generated a study sample more representative of the ‘real-world’. Limitations include the use of a self-reported point prevalence questionnaire without objective measures of sleep disturbance and insomnia such as wearable devices 19 , 20 , 21 . Additional limitations include a lack of ethnic diversity 22 . In conclusion, there is a high level of sleep disturbance among breast cancer patients; despite a majority of breast cancer patients recognising the importance of sleep assessment, a significant gap remains in healthcare providers’ addressing these concerns effectively. This study underscores the urgent need for integrated sleep assessment into oncology care 23 . Further steps include exploring healthcare provider attitudes and knowledge of sleep disturbance and sleep assessment in oncology care. Recommendations for sleep assessment and information on sleep hygiene education should be integrated into oncology patient care plans and survivorship guidelines. The significant burden of sleep disturbance and clinical insomnia in oncology cohorts is reflected in contemporaneous nationally conducted research ; The Menopause after cancer (MAC) 24 and Sleepio after cancer (SAC) 25 studies have both examined large cohorts of women cancer patients with clinical insomnia disorder. Whilst identification and recognition of sleep disturbance amongst cancer patients remains a challenge, the provision of treatment to those diagnosed with clinical insomnia disorder also poses a problem, with limited access to cognitive behavioural therapy for insomnia being available. Various studies including both the MAC and SAC studies examined the efficacy of digital cognitive behavioural therapy for insomnia (dCBT-I), which could address current limitations in treatment access 24,25 , 26 . Declarations Conflicts of Interest: Seamus O’Reilly is a Deputy Editor of BJC Reports but did not have a role in peer review assessment of the manuscript. Funding Source: None Author Contribution ContributionsStudy design: EV, SORData Collection: EVData Analysis: all authorsManuscript writing EV, CSW, SORFinal draft approval: all authors Acknowledgement The authors are grateful to the patients who completed the study and to our nursing and administrative colleagues for their assistance with the conduct of the study Data Availability Data in the study available from the corresponding author at reasonable request References Roscoe JA, Kaufman ME, Palesh OG, et al. Cancer-related fatigue and sleep disorders. Oncologist 2007;12(SUPPL. 1):35-42, doi:10.1634/theoncologist.12-S1-35 Mogavero MP, DelRosso LM, Fanfulla F, et al. Sleep disorders and cancer: State of the art and future perspectives. Sleep Med Rev 2021;56(101409, doi:10.1016/j.smrv.2020.101409 Duzova US, Duzova M, Altinel B. The effect of sleep quality on attitudes toward death in breast cancer survivors. Support Care Cancer 2024;32(10):666, doi:10.1007/s00520-024-08865-w Weng YP, Hong RM, Chen VC, et al. Sleep Quality and Related Factors in Patients with Breast Cancer: A Cross-Sectional Study in Taiwan. Cancer Manag Res 2021;13(4725-4733, doi:10.2147/CMAR.S302966 Mormont MC, Waterhouse J, Bleuzen P, et al. Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clin Cancer Res 2000;6(8):3038-45 Lanza G, Mogavero MP, Salemi M, et al. The Triad of Sleep, Immunity, and Cancer: A Mediating Perspective. Cells 2024;13(15), doi:10.3390/cells13151246 Perndorfer C, Soriano EC, Siegel SD, et al. Fear of Cancer Recurrence and Sleep in Couples Coping With Early-Stage Breast Cancer. Ann Behav Med 2022;56(11):1131-1143, doi:10.1093/abm/kaac018 Thong MSY, van Noorden CJF, Steindorf K, et al. Cancer-Related Fatigue: Causes and Current Treatment Options. Curr Treat Options Oncol 2020;21(2):17, doi:10.1007/s11864-020-0707-5 Charalambous A, Berger AM, Matthews E, et al. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer 2019;27(7):2747-2753, doi:10.1007/s00520-019-04746-9 Harrold EC, Idris AF, Keegan NM, et al. Prevalence of Insomnia in an Oncology Patient Population: An Irish Tertiary Referral Center Experience. J Natl Compr Canc Netw 2020;18(12):1623-1630, doi:10.6004/jnccn.2020.7611 Fakih R, Rahal M, Hilal L, et al. Prevalence and Severity of Sleep Disturbances among Patients with Early Breast Cancer. Indian J Palliat Care 2018;24(1):35-38, doi:10.4103/IJPC.IJPC_137_17 Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 2001;19(3):895-908, doi:10.1200/JCO.2001.19.3.895 Mark S, Cataldo J, Dhruva A, et al. Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy. Support Care Cancer 2017;25(8):2485-2494, doi:10.1007/s00520-017-3655-2 Sanft T, Denlinger CS, Armenian S, et al. NCCN Guidelines Insights: Survivorship, Version 2.2019. J Natl Compr Canc Netw 2019;17(7):784-794, doi:10.6004/jnccn.2019.0034 Morin CM, Belleville G, Bélanger L, et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 2011;34(5):601-8, doi:10.1093/sleep/34.5.601 Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2(4):297-307, doi:10.1016/s1389-9457(00)00065-4 Savard MH, Savard J, Simard S, et al. Empirical validation of the Insomnia Severity Index in cancer patients. Psychooncology 2005;14(6):429-41, doi:10.1002/pon.860 Baranwal N, Yu PK, Siegel NS. Sleep physiology, pathophysiology, and sleep hygiene. Prog Cardiovasc Dis 2023;77(59-69, doi:10.1016/j.pcad.2023.02.005 Kreutz C, Müller J, Schmidt ME, et al. Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy. Support Care Cancer 2021;29(2):1015-1023, doi:10.1007/s00520-020-05580-0 Enderlin CA, Coleman EA, Cole C, et al. Subjective sleep quality, objective sleep characteristics, insomnia symptom severity, and daytime sleepiness in women aged 50 and older with nonmetastatic breast cancer. Oncol Nurs Forum 2011;38(4):E314-25, doi:10.1188/11.ONF.E314-E325 Grayson S, Sereika S, Harpel C, et al. Factors associated with sleep disturbances in women undergoing treatment for early-stage breast cancer. Support Care Cancer 2022;30(1):157-166, doi:10.1007/s00520-021-06373-9 Barber LE, McCullough LE, Johnson DA. Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer. Cancer Epidemiol Biomarkers Prev 2024;33(4):471-479, doi:10.1158/1055-9965.EPI-23-1117 Davidson JR. Boosting access to insomnia treatment for cancer patients. Sleep 2014;37(8):1277-8, doi:10.5665/sleep.3908 Donohoe F, O'Meara Y, Roberts A, et al. Multimodal, Technology-Assisted Intervention for the Management of Menopause after Cancer Improves Cancer-Related Quality of Life-Results from the Menopause after Cancer (Mac) Study. Cancers (Basel) 2024;16(6), doi:10.3390/cancers16061127 Treacy T, O'Meara Y, Galligan MC, et al. The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients - Trial protocol of a randomised controlled trial. Contemp Clin Trials 2024;136(107337, doi:10.1016/j.cct.2023.107337 Savard J, Ivers H, Savard MH, et al. Is a video-based cognitive behavioral therapy for insomnia as efficacious as a professionally administered treatment in breast cancer? Results of a randomized controlled trial. Sleep 2014;37(8):1305-14, doi:10.5665/sleep.3918 Tables Tables 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Jul, 2025 Reviews received at journal 13 Jul, 2025 Reviewers agreed at journal 09 Jun, 2025 Reviewers invited by journal 08 Jun, 2025 Editor assigned by journal 20 May, 2025 Submission checks completed at journal 16 May, 2025 First submitted to journal 10 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6635838","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":468667534,"identity":"ad4411d0-e047-43b1-97e6-5df5b48c290c","order_by":0,"name":"Ella Vallely","email":"","orcid":"","institution":"University College Cork","correspondingAuthor":false,"prefix":"","firstName":"Ella","middleName":"","lastName":"Vallely","suffix":""},{"id":468667535,"identity":"1c4c2e87-a71a-4668-8cdc-015ff098d700","order_by":1,"name":"Catherine S. 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Reduced sleep duration and poor sleep quality is associated with an increased risk of cancer recurrence and decreased survival \u003csup\u003e3\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e6\u003c/sup\u003e. Sleep disturbance experienced by both patients and their partners are associated with increased levels of fear of cancer recurrence \u003csup\u003e7\u003c/sup\u003e. Additionally, there is a well-established relationship between cancer related fatigue and sleep deficiency, underscoring the importance of addressing sleep issues in this population \u003csup\u003e8\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e9\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eA recent evaluation of sleep patterns in an Irish oncology population demonstrated an insomnia rate twice that of the general population \u003csup\u003e10\u003c/sup\u003e. In that study a breast cancer diagnosis was an independent predictor of insomnia syndrome \u003csup\u003e10\u003c/sup\u003e. Despite the significant symptomatic burden of sleep disturbances, these issues are often unrecognised and are inadequately addressed in clinical practice, particularly when compared to other symptoms such as pain and fatigue \u003csup\u003e11\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e12\u003c/sup\u003e\u003csup\u003e\u0026nbsp;,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e13\u003c/sup\u003e. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology advocate for specialised sleep assessment, acknowledging the increasing prevalence of related issues among cancer patients \u003csup\u003e14\u003c/sup\u003e. Nevertheless, a 2020 study revealed that only 34% of Irish oncology patients recalled undergoing assessment for sleep disturbance as part of their treatment \u003csup\u003e10\u003c/sup\u003e.\u0026nbsp;Notably, breast cancer has been identified as an independent predictor of clinical insomnia disorder within the Irish oncology population\u003csup\u003e10\u003c/sup\u003e. This study aimed to explore this interaction further by quantifying the prevalence of sleep disturbance within a specific Irish cohort of breast cancer patients. Additionally, we aimed to examine patient\u0026rsquo;s opinions on sleep hygiene and evaluate sleep hygiene practices within this population.\u003c/p\u003e\n\u003cp\u003eThis was a cross-sectional questionnaire-based study conducted between September 2023 and March 2024 in adult patients diagnosed with breast cancer at Cork University Hospital/Univeristy College Cork Cancer Centre. A comprehensive 40-item composite questionnaire was formulated from a previously established questionnaire supplemented by additional questions devised by the authors \u003csup\u003e10\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe survey was circulated to patients attending the Outpatient Department. Institutional ethical board approval was obtained (Clinical Research Ethics Committee of the Cork Teaching Hospitals, ECM 01/2025/PUB), and all participants provided informed consent. Patients\u0026rsquo; behaviours, attitudes and perceptions regarding sleep hygiene and assessment were examined. Clinical characteristics, sociodemographic and lifestyle data, were recorded. Sleep disturbance was assessed using the Insomnia Severity Index (ISI) as a baseline \u003csup\u003e15\u003c/sup\u003e. The ISI was selected as it is a validated instrument for identifying cases of insomnia within a population \u003csup\u003e15-17\u003c/sup\u003e. Data analysis was conducted using IBM SPSS V26. Descriptive statistics were employed to summarise the demographic and clinical characteristics of the participants. Pearsons\u0026rsquo;s and Spearman\u0026rsquo;s rank correlations were used to determine the association of clinical, lifestyle and demographic factors with ISI scores. Statistical significance was assumed by a p-value \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003eA total of 315 questionnaires were completed, with baseline demographics summarise in \u003cem\u003eTable 1\u003c/em\u003e and clinical characteristics summarised in \u003cem\u003eTable 2\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eAmong the total population, 56.8% (n=179) reported a change in their sleeping patterns since their cancer diagnosis, with 72.4% (n=228) stating they had not experienced sleep difficulties prior to diagnosis. An analysis of ISI scores revealed that 4.8% (n=14) of this population exhibited severe clinical insomnia, 18.2% (n=53) demonstrated moderate clinical insomnia, 33.2% (n=97) experienced subthreshold clinical insomnia, and 43.8% (n=128) reported no clinically significant insomnia, as shown in \u003cem\u003eFigure 1.\u0026nbsp;\u003c/em\u003eOnly one-third of the patients expressed satisfaction with their current sleep patterns (33.3%, n=105), while more than half indicated that their sleeping patterns caused them at least some degree of distress (54.3%, n=171).\u003c/p\u003e\n\u003cp\u003eHigh caffeine intake, alcohol consumption, low levels of physical activity, and the use of electronic devices before bed are all recognised as factors that adversely affect sleep \u003csup\u003e10\u003c/sup\u003e. \u0026nbsp;At the time of the study, 87% (n=274) of participants reported caffeine consumption, 70.5% (n=222) reported alcohol consumption, and 96.2% (n=303) reported they used electronic devices before bed. Just under a quarter of our patients (n=78, 24.8%) indicated that they believed alcohol consumption could affect sleep and sleeping patterns.\u003c/p\u003e\n\u003cp\u003eIn our cohort, 62.5% (n=197) of patients believed that sleep assessment should be a component of cancer treatment; however, only 23.8% (n=75) felt that their sleeping difficulties had been adequately addressed since diagnosis. Under one-third of the study population recalled being asked about their sleep by a healthcare worker. Only 12% (n=8) of patients with moderate or severe insomnia felt that their sleeping difficulties had been sufficiently addressed since diagnosis.\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant association between\u0026nbsp;the patients aged over 65 and a higher\u0026nbsp;ISI score (p \u0026lt;0.001).\u0026nbsp;However, no statistically significant correlations between any other clinical, lifestyle or demographic factors were identified.\u003c/p\u003e\n\u003cp\u003eOur findings highlight that there is a high prevalence of sleep disorders among this population, with more than half of the participants reporting changes in their sleep patterns since their cancer diagnosis despite over two-thirds lacking any prior history of sleep-related issues. This high level of prevalence aligns with findings from existing literature in similar populations \u003csup\u003e10\u003c/sup\u003e. There were high levels of consumption of caffeine and alcohol in our population, modifiable risk factors known to negatively affect sleep hygiene. One-fifth of patients reported using alcohol as a sleeping aid, yet only one-quarter recognised the potential impact of alcohol on sleep. This gap in patient awareness of sleep hygiene mirrors findings from previous studies\u003csup\u003e11\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e18\u003c/sup\u003e and further highlights the need for patient education, and the importance of the provision of sleep hygiene education information to this population in the clinical setting.\u003c/p\u003e\n\u003cp\u003eThe strengths of this study include a substantial data collection window, its large sample size, as well as a broad selection criterion, with no exclusion of particular demographic characteristics, current disease activity, or co-morbidities. This generated a study sample more representative of the \u0026lsquo;real-world\u0026rsquo;. Limitations include the use of a self-reported point prevalence questionnaire without objective measures of sleep disturbance and insomnia such as wearable devices\u003csup\u003e19\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e20\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e21\u003c/sup\u003e. Additional limitations include a lack of ethnic diversity \u003csup\u003e22\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, there is a high level of sleep disturbance among breast cancer patients; despite a majority of breast cancer patients recognising the importance of sleep assessment, a significant gap remains in healthcare providers\u0026rsquo; addressing these concerns effectively. This study underscores the urgent need for integrated sleep assessment into oncology care \u003csup\u003e23\u003c/sup\u003e. \u0026nbsp;Further steps include exploring healthcare provider attitudes and knowledge of sleep disturbance and sleep assessment in oncology care. Recommendations for sleep assessment and information on sleep hygiene education should be integrated into oncology patient care plans and survivorship guidelines. The significant burden of sleep disturbance and clinical insomnia in oncology cohorts is reflected in contemporaneous nationally conducted research ; The Menopause after cancer (MAC) \u003csup\u003e24\u003c/sup\u003e and Sleepio after cancer (SAC) \u003csup\u003e25\u003c/sup\u003e studies have both examined large cohorts of women cancer patients with clinical insomnia disorder. \u0026nbsp;Whilst identification and recognition of sleep disturbance amongst cancer patients remains a challenge, the provision of treatment to those diagnosed with clinical insomnia disorder also poses a problem, with limited access to cognitive behavioural therapy for insomnia being available. Various studies including both the MAC and SAC studies examined the efficacy of digital cognitive behavioural therapy for insomnia (dCBT-I), which could address current limitations in treatment access \u003csup\u003e24,25\u003c/sup\u003e\u003csup\u003e,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e26\u003c/sup\u003e. \u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflicts of Interest:\u003c/h2\u003e \u003cp\u003eSeamus O\u0026rsquo;Reilly is a Deputy Editor of BJC Reports but did not have a role in peer review assessment of the manuscript.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Source:\u003c/h2\u003e \u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eContributionsStudy design: EV, SORData Collection: EVData Analysis: all authorsManuscript writing EV, CSW, SORFinal draft approval: all authors\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors are grateful to the patients who completed the study and to our nursing and administrative colleagues for their assistance with the conduct of the study\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData in the study available from the corresponding author at reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRoscoe JA, Kaufman ME, Palesh OG, et al. Cancer-related fatigue and sleep disorders. Oncologist 2007;12(SUPPL. 1):35-42, doi:10.1634/theoncologist.12-S1-35\u003c/li\u003e\n\u003cli\u003eMogavero MP, DelRosso LM, Fanfulla F, et al. Sleep disorders and cancer: State of the art and future perspectives. Sleep Med Rev 2021;56(101409, doi:10.1016/j.smrv.2020.101409\u003c/li\u003e\n\u003cli\u003eDuzova US, Duzova M, Altinel B. The effect of sleep quality on attitudes toward death in breast cancer survivors. Support Care Cancer 2024;32(10):666, doi:10.1007/s00520-024-08865-w\u003c/li\u003e\n\u003cli\u003eWeng YP, Hong RM, Chen VC, et al. Sleep Quality and Related Factors in Patients with Breast Cancer: A Cross-Sectional Study in Taiwan. Cancer Manag Res 2021;13(4725-4733, doi:10.2147/CMAR.S302966\u003c/li\u003e\n\u003cli\u003eMormont MC, Waterhouse J, Bleuzen P, et al. 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Empirical validation of the Insomnia Severity Index in cancer patients. Psychooncology 2005;14(6):429-41, doi:10.1002/pon.860\u003c/li\u003e\n\u003cli\u003eBaranwal N, Yu PK, Siegel NS. Sleep physiology, pathophysiology, and sleep hygiene. Prog Cardiovasc Dis 2023;77(59-69, doi:10.1016/j.pcad.2023.02.005\u003c/li\u003e\n\u003cli\u003eKreutz C, M\u0026uuml;ller J, Schmidt ME, et al. Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy. Support Care Cancer 2021;29(2):1015-1023, doi:10.1007/s00520-020-05580-0\u003c/li\u003e\n\u003cli\u003eEnderlin CA, Coleman EA, Cole C, et al. Subjective sleep quality, objective sleep characteristics, insomnia symptom severity, and daytime sleepiness in women aged 50 and older with nonmetastatic breast cancer. Oncol Nurs Forum 2011;38(4):E314-25, doi:10.1188/11.ONF.E314-E325\u003c/li\u003e\n\u003cli\u003eGrayson S, Sereika S, Harpel C, et al. Factors associated with sleep disturbances in women undergoing treatment for early-stage breast cancer. Support Care Cancer 2022;30(1):157-166, doi:10.1007/s00520-021-06373-9\u003c/li\u003e\n\u003cli\u003eBarber LE, McCullough LE, Johnson DA. Eyes Wide Open: Sleep as a Potential Contributor to Racial and Ethnic Disparities in Cancer. Cancer Epidemiol Biomarkers Prev 2024;33(4):471-479, doi:10.1158/1055-9965.EPI-23-1117\u003c/li\u003e\n\u003cli\u003eDavidson JR. Boosting access to insomnia treatment for cancer patients. Sleep 2014;37(8):1277-8, doi:10.5665/sleep.3908\u003c/li\u003e\n\u003cli\u003eDonohoe F, O\u0026apos;Meara Y, Roberts A, et al. Multimodal, Technology-Assisted Intervention for the Management of Menopause after Cancer Improves Cancer-Related Quality of Life-Results from the Menopause after Cancer (Mac) Study. Cancers (Basel) 2024;16(6), doi:10.3390/cancers16061127\u003c/li\u003e\n\u003cli\u003eTreacy T, O\u0026apos;Meara Y, Galligan MC, et al. The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients - Trial protocol of a randomised controlled trial. Contemp Clin Trials 2024;136(107337, doi:10.1016/j.cct.2023.107337\u003c/li\u003e\n\u003cli\u003eSavard J, Ivers H, Savard MH, et al. Is a video-based cognitive behavioral therapy for insomnia as efficacious as a professionally administered treatment in breast cancer? Results of a randomized controlled trial. Sleep 2014;37(8):1305-14, doi:10.5665/sleep.3918\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bjc-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BJC Reports](https://www.springer.com/journal/44276) ","snPcode":"44276","submissionUrl":"https://submission.springernature.com/new-submission/44276/3","title":"BJC Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6635838/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6635838/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA previously conducted study reported that insomnia rates among oncology patients in Ireland are twice that of the general population, and that a breast cancer diagnosis was an independent predictor for clinical insomnia disorder. The aim of this study is to explore this interaction further in a larger cohort of breast cancer patients.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe evaluated sleep disturbance and sleep hygiene practices among adult breast cancer patients via questionnaires. Sociodemographic data, clinical characteristics, sleep history and attitudes towards sleep assessments were collected and analysed.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe comprehensive 40-item questionnaire was completed by 315 patients. Of this cohort, 56% reported a change in their sleeping patterns since their cancer diagnosis, with over 55% of the study population having sub-threshold or clinical insomnia disorder. \u0026nbsp;Although 64.2% of patients believed that questions regarding sleep should be part of breast cancer assessment, only 32% recalled being asked about sleep by a healthcare worker. Moreover, only 27.1% of respondents felt their sleeping difficulties were adequately dealt with since their diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn summary, sleep disturbance is prevalent among breast cancer patients. Despite a majority of breast cancer patients recognising the importance of sleep assessment, a significant gap remains in healthcare providers addressing these concerns effectively.\u003c/p\u003e","manuscriptTitle":"Sleep Hygiene in Patients with Early-Stage Breast Cancer: A Short Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-11 06:12:28","doi":"10.21203/rs.3.rs-6635838/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-13T18:20:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-13T12:07:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177600759753800992987986980059818425311","date":"2025-06-09T08:55:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-09T00:30:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-20T18:26:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-16T11:50:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BJC Reports","date":"2025-05-10T16:00:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bjc-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BJC Reports](https://www.springer.com/journal/44276) ","snPcode":"44276","submissionUrl":"https://submission.springernature.com/new-submission/44276/3","title":"BJC Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2298feee-c1b0-427b-86b2-c95a7d8d0fa6","owner":[],"postedDate":"June 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T11:46:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-11 06:12:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6635838","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6635838","identity":"rs-6635838","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}