I t is important to understand how crucial sleep is to anyone who is sick, undergoing arduous treatment or in a recovery phase, as well as to those under major stress. Consistent, high-quality sleep is essential for immune resilience, pain control, emotional stability and quality of life. Obviously, cancer patients need to be able to achieve regular, restorative sleep. Florence Nightingale said, “Sleep is all important to the sick.” However, in today’s medical settings, including doctors’ practices, treatment centers and hospitals, patients’ sleep disturbance is often unseen or overlooked. Perhaps because sleep is such an elemental health factor, or perhaps because the medical profession has traditionally been educated in a sleep-deprivation value system, the centrality of sleep in health has become downplayed. Our culture in general is trending toward undervaluing sleep, losing track of how much sleep we truly need at different life stages, and often considering people who get less sleep as strong and productive. Sleep medicine is a fairly new field; its experts have embarked on the uphill battle of getting the attention of health professionals and the general public. All too often, sleep is not asked about in case intakes and sleep problems are underdiagnosed and undertreated. While the prevalence of this blind spot is becoming more documented in the medical field, as massage therapists, we need to ask ourselves if we are doing much better for our clients. Experts tell us sleep must be viewed as a vital sign and given the same significance as such factors as blood pressure, diet and exercise. In the cancer context, numbers are emerging that reveal serious sleep issues. A systematic review published in Psycho-Oncology gives the incidence of sleep disorder in cancer patients as 30 to 50 percent. The National Cancer Institute pegs it at 45 percent; other sources suggest numbers up to 70 percent. This represents two to four times higher occurrence than in the general population. Sleep disturbance is a problem caused by the stresses of having cancer, but it is also a common side effect of cancer treatments; in fact, about one-third of all prescriptions given to cancer patients are for sleeping pills. It has also been noted that insomnia often persists in cancer patients long after treatments have ceased. In the Psycho-Oncology article, the authors state that disturbed sleep is the most common symptom reported by adults with cancer, and although there are many negative physical and mental health implications related to sleep disturbance, it receives much less attention than such symptoms as pain and nausea. Although there are a few specialized causes of sleep pathology in people with cancer—for example, brain tumors that affect hypothalamus function or positional challenges with neck or face cancers— when cancer patients sleep poorly, it is usually because of a high coincidence of common sleep impairers. These include anxiety, depression, physical discomforts, digestive upset, medication side effects, treatment duress, isolation from familiar supports, altered sleep or wake patterns, major life changes and financial stress. So, in most cases, cancer patients will respond to the same types of sleep-promoting approaches that work for others with disordered sleep. This is where massage therapy comes in. To be restorative, sleep must last long enough to allow for several cycles through the multiple stages of  Expert Advice sleep; must contain the deeper stages required for physiological, mental and emotional restoration; and must be efficient in that the person gets to sleep fairly easily and has as few waking interruptions as possible. In the presence of emotional factors, such as anxiety or depression, or physical distressors, such as pain, nausea or dyspnea, the brain does not allow itself to move into the deeper sleep phases, maintaining a more vigilant and less restorative light sleep pattern. Sleeping pills have limitations in that they can melatonin and commonly used herbs, such as St. John’s Wort and valerian. Along with meditation, yoga and hypnosis, massage therapy has joined the list of complementary practices recommended for sleep promotion. This is the result of a growing body of clinical observation and research evidence. There are three main dimensions to massage therapy’s efficacy in the cancer context. First, massage has demonstrated broad effectiveness in helping Clinical observation and research evidence have led to massage being recommended for sleep promotion. promote getting to sleep and sleep duration but cannot reproduce normal sleep cycling. This is considered so unhealthy that experts advise sleeping medication should not be used for longer than two weeks, at which point more viable long-term strategies must kick in. For cancer patients, such medications might also interact negatively with some treatments, as can reduce or manage a range of physical discomforts and mood symptoms, the types of factors that contribute to poor sleep. Second, massage therapy is itself a notable sleep promoter. A number of studies point to its ability to lengthen sleep duration and encourage more efficient and more restorative sleep in individuals with various types of sleep challenges.