Sleep plays a vital role in overall health.
A 2025 Long-Term Follow-Up Study (LTFU) report shows why good sleep is especially important for childhood cancer survivors.
The study found that poor sleep quality is linked to a health condition called frailty in adult survivors of childhood cancer. Frailty means your body does not have as much strength or energy as it used to. When someone is frail, their body cannot handle stress as well. Stress can include getting sick or facing physical or emotional challenges. This can make daily tasks feel harder or more tiring.
The good news: You can reduce frailty with healthy habits and support.
Sleep and frailty in childhood cancer survivors
Frailty often includes:
- Loss of muscle mass and strength
- Low energy or fatigue
- Reduced physical activity
Frailty is often linked to aging, but it can appear earlier in life for childhood cancer survivors. Cancer treatments and treatment-related health conditions can change your body in ways that make you feel weaker, more tired, and less active over time.
The cycle of poor sleep, mental health, and pain
In the study, survivors who showed signs of frailty were much more likely to report poor sleep quality, says Lauren Daniel, PhD, an associate professor of psychology and health sciences at Rutgers University and one of the study group’s leaders.
“Feeling weak or tired makes it harder to be active. Being less active makes it harder to sleep well. Poor sleep can make frailty and mood problems worse,” Daniel says.
Pain is a key factor in this cycle, says Tara Brinkman, PhD, chief of the division of pediatric health psychology at St. Jude Children’s Research Hospital and one of the study’s leaders.
Survivors who are in pain are less likely to engage in physical activity. Limited physical activity can lead to a loss of muscle strength and energy, which, over time, may result in frailty. Research is focusing on finding ways to prevent and treat pain to prevent frailty.
”We also know that pain can interfere with sleep,” Brinkman said. Effective pain management, which includes methods other than medication, is important to improve health overall.”
How you can improve sleep and health
You can take steps to prevent or reduce frailty. Your body can regain strength over time with the right habits.
Move your body—even a little every day
Physical activity is one of the best tools you have to support sleep and long-term health.
You do not have to do intense workouts or go to a gym. A simple daily routine like a morning walk, stretching, yoga, or light indoor exercise can help with:
- Sleep
- Mood
- Pain
- Muscle strength
If walking is hard, start small. Even light activity helps your body build “reserve,” which protects you from frailty. When you do activities that work your muscles—especially resistance training—you can build strength and help your heart stay healthy.
Resistance training is any activity that makes your muscles push against something. When you do this, your muscles get stronger over time.
Resistance training may include:
- Using hand weights or dumbbells
- Resistance bands
- Body weight exercises like squats, lunges, or wall push ups
- Lifting household items (like water jugs)
Get morning light
Sunlight in the first 2 hours after you wake up helps set your body’s natural clock. Taking a walk outside (without sunglasses) can be important for getting light exposure, which can improve mood and sleep.
Regular morning light can help you fall asleep at night and wake up feeling rested.
If you cannot go outside, open your blinds or curtains to let daylight in. Even light through a window can help.
Keep a consistent sleep routine
Your body loves routine. Try to:
- Wake up at the same time every day.
- Go to bed around the same time each night.
- Turn off phones or screens at least 30 minutes before bed.
- Create a calming wind‑down routine.
If you cannot fall asleep or if you wake up during the night, get out of bed for a few minutes and do something calm, like reading a familiar book. Return to bed only when you feel sleepy. This helps your brain think of your bed as a place for sleep, not stress.
Pay attention to snoring and sleep apnea
Snoring or pauses in breathing can be signs of sleep apnea, a common and treatable sleep problem. If you or a partner notice this, talk with your health care provider.
Try cognitive behavioral therapy for insomnia
If sleep problems continue, tools like cognitive behavioral therapy for insomnia (CBT‑I) can help.
CBT-I focuses on developing skills to improve your thoughts and behaviors around sleep. CBI-I typically takes a few sessions. It can be done in person with a psychologist or even through research-based apps. (See suggested apps below.)
“Cognitive behavioral therapy can be tailored to treat clusters of symptoms such as pain, anxiety, depression, and sleep,” Brinkman says. “It has been shown to be effective in treating a wide range of symptoms.”
Ask your health care provider to refer you to providers and other resources.
Resources
There are free resources available to help you. These include: