Problems sleeping with prostate cancer: exploring possible risk factors for sleep disturbance in a population-based sample of survivors

  • Rebecca MaguireEmail author
  • Frances J. Drummond
  • Paul Hanly
  • Anna Gavin
  • Linda Sharp
Original Article



This study aimed to investigate the prevalence of sleeping problems in prostate cancer survivors and to explore the role of predisposing, precipitating and perpetuating factors in this process.


Using a cross-sectional design, 3348 prostate cancer survivors between 2 and 18 years post diagnosis reported experiences of insomnia using the QLQC30, along with their sociodemographic characteristics, health status and treatment(s) received. The EQ5D-5L and QLQPR25 assessed survivors’ overall and prostate cancer–specific health-related quality of life. A hierarchical multiple regression analysis was constructed with three blocks: (1) predisposing (e.g. demographics at diagnosis), (2) precipitating (e.g. disease extent, treatment) and (3) perpetuating factors (e.g. side effects).


Nineteen percent of survivors reported significant problems sleeping. The final model accounted for 31% of the variance in insomnia scores (p < .001). In order of magnitude, associates of sleep disturbance were urinary symptoms (β = 0.22; p < .001), experiencing symptoms of depression/anxiety (β = 0.18; p < .001), hormone treatment–related symptoms (β = 0.12; p = .001), pain (β = 0.10; p < .001) and bowel symptoms (β = 0.06; p = .005). Having a lower education and more comorbidities at diagnosis also predicted sleep problems.


Results suggest that it is the ongoing adverse effects of prostate cancer and its treatment (e.g. urinary symptoms) that put survivors most at risk of sleep problems. Strong associations with symptoms of depression/anxiety were also observed. Findings highlight the need for health care practitioners to treat and manage adverse effects of prostate cancer treatment in order to mitigate sleep disturbance in survivors.


Prostate cancer Insomnia Adverse side effects Depression Anxiety Pain 



We would like to thank the men who took the time to complete and return the questionnaire, the health professionals who helped screen men for eligibility to participate in the study, Heather Kinnear who was involved in helping design the questionnaire and Sandra Deady.


This work was funded by the Health Research Board in the Republic of Ireland, (HRA_HSR/2010/17), Prostate Cancer UK (NI09-03 and NI-PG13-001), the R&D Office of the Public Health Agency in Northern Ireland and the National Cancer Control Programme in the RoI. This research received no specific grant from any funding agency in the commercial or not-for-profit sectors. The Northern Ireland Cancer Registry is funded by the Public Health Agency for Northern Ireland and the National Cancer Registry Ireland by the Department of Health.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare they have no conflict of interest.

Supplementary material

520_2018_4633_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 28 kb)
520_2018_4633_MOESM2_ESM.docx (29 kb)
ESM 2 (DOCX 28 kb)


  1. 1.
    Drummond F, Kinnear H, O’Leary E, Donnelly GA, Sharp L (2015) Long-term health-related quality of life of prostate cancer survivors varies by primary treatment. Results from the PiCTure (Prostate Cancer Treatment, your experience) study. J Cancer Surviv 9(2):361–372. CrossRefPubMedGoogle Scholar
  2. 2.
    Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358(12):1250–1261. CrossRefPubMedGoogle Scholar
  3. 3.
    Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Leach GE, Brook RH (1995) Quality-of-life outcomes in men treated for localized prostate cancer. Jama 273(2):129–135CrossRefGoogle Scholar
  4. 4.
    Drummond FJ (2016) Are we sleeping on the job? Insomnia among men with prostate cancer. Adv Mod Oncol Res 2:74CrossRefGoogle Scholar
  5. 5.
    Roscoe JA, Kaufman ME, Matteson-Rusby SE, Palesh OG, Ryan JL, Kohli S, Perlis ML, Morrow GR (2007) Cancer-related fatigue and sleep disorders. Oncologist 12(Suppl 1):35–42. CrossRefPubMedGoogle Scholar
  6. 6.
    Savard J, Ivers H, Villa J, Caplette-Gingras A, Morin CM (2011) Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol 29(26):3580–3586. CrossRefPubMedGoogle Scholar
  7. 7.
    Zhou ES, Partridge AH, Syrjala KL, Michaud AL, Recklitis CJ (2017) Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv 11(1):74–79. CrossRefPubMedGoogle Scholar
  8. 8.
    Dirksen SR, Epstein DR, Hoyt MA (2009) Insomnia, depression, and distress among outpatients with prostate cancer. Appl Nurs Res 22(3):154–158. CrossRefPubMedGoogle Scholar
  9. 9.
    Savard J, Simard S, Hervouet S, Ivers H, Lacombe L, Fradet Y (2005) Insomnia in men treated with radical prostatectomy for prostate cancer. Psychooncology 14(2):147–156. CrossRefPubMedGoogle Scholar
  10. 10.
    Mystakidou K, Parpa E, Tsilika E, Pathiaki M, Patiraki E, Galanos A, Vlahos L (2007) Sleep quality in advanced cancer patients. J Psychosom Res 62(5):527–533. CrossRefPubMedGoogle Scholar
  11. 11.
    Roth T, Franklin M, Bramley TJ (2007) The state of insomnia and emerging trends. Am J Manag Care 13(5 Suppl):S117–S120PubMedGoogle Scholar
  12. 12.
    Savard J, Ivers H, Savard MH, Morin CM (2015) Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer 121(10):1703–1711. CrossRefPubMedGoogle Scholar
  13. 13.
    Savard J, Hervouet S, Ivers H (2013) Prostate cancer treatments and their side effects are associated with increased insomnia. Psychooncology 22(6):1381–1388. CrossRefPubMedGoogle Scholar
  14. 14.
    Miaskowski C, Paul SM, Cooper BA, Lee K, Dodd M, West C, Aouizerat BE, Dunn L, Swift PS, Wara W (2011) Predictors of the trajectories of self-reported sleep disturbance in men with prostate cancer during and following radiation therapy. Sleep 34(2):171–179CrossRefGoogle Scholar
  15. 15.
    Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Cartoni C, Pizzuto M, Caruselli A, Parsi R, Cortegiani A, Masedu F, Valenti M, Ficorella C, Porzio G (2015) Sleep disturbances in patients with advanced cancer in different palliative care settings. J Pain Symptom Manag 50(6):786–792. CrossRefGoogle Scholar
  16. 16.
    Singareddy R, Vgontzas AN, Fernandez-Mendoza J, Liao D, Calhoun S, Shaffer ML, Bixler EO (2012) Risk factors for incident chronic insomnia: a general population prospective study. Sleep Med 13(4):346–353. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Spielman AJ, Caruso LS, Glovinsky PB (1987) A behavioral perspective on insomnia treatment. Psychiatr Clin 10(4):541–553Google Scholar
  18. 18.
    Fiorentino L, Rissling M, Liu L, Ancoli-Israel S (2011) The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: severity of the problem and treatment options. Drug Discov Today Dis Model 8(4):167–173CrossRefGoogle Scholar
  19. 19.
    Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19(3):895–908CrossRefGoogle Scholar
  20. 20.
    Savard J, Villa J, Ivers H, Simard S, Morin CM (2009) Prevalence, natural course, and risk factors of insomnia comorbid with cancer over a 2-month period. J Clin Oncol 27(31):5233–5239CrossRefGoogle Scholar
  21. 21.
    Garland SN, Barg FK, Cakouros B, Gehrman P, DuHamel KN, Mao JJ (2018) A qualitative examination of the factors related to the development and maintenance of insomnia in cancer survivors. Palliat Support Care:1–6.
  22. 22.
    Sivertsen B, Salo P, Mykletun A, Hysing M, Pallesen S, Krokstad S, Nordhus IH, Overland S (2012) The bidirectional association between depression and insomnia: the HUNT study. Psychosom Med 74(7):758–765. CrossRefPubMedGoogle Scholar
  23. 23.
    LeBlanc M, Merette C, Savard J, Ivers H, Baillargeon L, Morin CM (2009) Incidence and risk factors of insomnia in a population-based sample. Sleep 32(8):1027–1037CrossRefGoogle Scholar
  24. 24.
    Maguire R, Hanly P, Drummond FJ, Gavin A, Sharp L (2018) Expecting the worst? The relationship between retrospective and prospective appraisals of illness on quality of life in prostate cancer survivors. Psychooncology 27(4):1237–1243. CrossRefPubMedGoogle Scholar
  25. 25.
    Drummond F, Kinnear H, Donnelly C, O’Leary E, O’Brien K, Burns R, Gavin A, Sharp L (2015) Establishing a population-based patient-reported outcomes study (PROMs) using national cancer registries across two jurisdictions: the prostate cancer treatment, your experience (PiCTure) study. BMJ Open 5(4):e006851. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376CrossRefGoogle Scholar
  27. 27.
    Steentjes L, Siesling S, Drummond FJ, van Manen JG, Sharp L, Gavin A (2016) Factors associated with current and severe physical side-effects after prostate cancer treatment: what men report. Eur J Cancer Care (Engl) 27.
  28. 28.
    van Andel G, Bottomley A, Fossa SD, Efficace F, Coens C, Guerif S, Kynaston H, Gontero P, Thalmann G, Akdas A, D’Haese S, Aaronson NK (2008) An international field study of the EORTC QLQ-PR25: a questionnaire for assessing the health-related quality of life of patients with prostate cancer. Eur J Cancer 44(16):2418–2424. CrossRefPubMedGoogle Scholar
  29. 29.
    O’Leary E, Drummond FJ, Gavin A, Kinnear H, Sharp L (2015) Psychometric evaluation of the EORTC QLQ-PR25 questionnaire in assessing health-related quality of life in prostate cancer survivors: a curate’s egg. Qual Life Res 24(9):2219–2230. CrossRefPubMedGoogle Scholar
  30. 30.
    Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20(10):1727–1736. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Pickard AS, De Leon MC, Kohlmann T, Cella D, Rosenbloom S (2007) Psychometric comparison of the standard EQ-5D to a 5 level version in cancer patients. Med Care 45:259–263CrossRefGoogle Scholar
  32. 32.
    Juul T, Petersen MA, Holzner B, Laurberg S, Christensen P, Grønvold M (2014) Danish population-based reference data for the EORTC QLQ-C30: associations with gender, age and morbidity. Qual Life Res 23(8):2183–2193CrossRefGoogle Scholar
  33. 33.
    Waldmann A, Schubert D, Katalinic A (2013) Normative data of the EORTC QLQ-C30 for the German population: a population-based survey. PLoS One 8(9):e74149CrossRefGoogle Scholar
  34. 34.
    Li X, Wong W, Lamoureux EL, Wong TY (2012) Are linear regression techniques appropriate for analysis when the dependent (outcome) variable is not normally distributed? Invest Ophthalmol Vis Sci 53(6):3082–3083CrossRefGoogle Scholar
  35. 35.
    Scott NW, Fayers P, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Sprangers MA (2008) EORTC QLQ-C30 reference values manualGoogle Scholar
  36. 36.
    Drummond FJ, Gavin AT, Sharp L (2017) Supportive medications and interventions received by prostate cancer survivors: results from the PiCTure study. J Community Support Oncol 15(6):e309–e313CrossRefGoogle Scholar
  37. 37.
    Knutson K (2015) Sleep and pain: summary of the 2015 sleep in America poll. Sleep Health 1(2):85. CrossRefPubMedGoogle Scholar
  38. 38.
    Hoyt MA, Bower JE, Irwin MR, Weierich MR, Stanton AL (2016) Sleep quality and depressive symptoms after prostate cancer: the mechanistic role of cortisol. Behav Neurosci 130(3):351–356CrossRefGoogle Scholar
  39. 39.
    Sharp L, O’Leary E, Kinnear H, Gavin A, Drummond FJ (2016) Cancer-related symptoms predict psychological wellbeing among prostate cancer survivors: results from the PiCTure study. Psychooncology 25(3):282–291. CrossRefPubMedGoogle Scholar
  40. 40.
    Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S, Lewith G (2014) Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open 4(3):e003901. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Maguire R, Hanly P, Drummond F, Gavin A, Sharp L (2017) Regret and fear in prostate cancer: the relationship between treatment appraisals and fear of recurrence in prostate cancer survivors. Psycho-Oncology 26(11):1825–1831. CrossRefPubMedGoogle Scholar
  42. 42.
    Cordova MJ, Riba MB, Spiegel D (2017) Post-traumatic stress disorder and cancer. Lancet Psychiatry 4(4):330–338. CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Pigeon WR, Campbell CE, Possemato K, Ouimette P (2013) Longitudinal relationships of insomnia, nightmares, and PTSD severity in recent combat veterans. J Psychosom Res 75(6):546–550. CrossRefPubMedGoogle Scholar
  44. 44.
    Johnson JA, Rash JA, Campbell TS, Savard J, Gehrman PR, Perlis M, Carlson LE, Garland SN (2016) A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev 27:20–28. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyMaynooth UniversityMaynoothIreland
  2. 2.Cancer Research @ UCCUniversity College CorkCorkIreland
  3. 3.National College of IrelandDublin 1Ireland
  4. 4.Queens University BelfastBelfastUK
  5. 5.Newcastle UniversityNewcastle upon TyneUK

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