BACKGROUND: To determine whether sleep quality and fatigue associated with 
breast cancer adjuvant chemotherapy treatments can be improved with behavioral 
therapy (BT) [Individualized Sleep Promotion Plan (ISPP)] including modified 
stimulus control, modified sleep restriction, relaxation therapy, and sleep 
hygiene.
METHODS: Randomized-controlled trial based on Piper Integrated Fatigue Model, 
219 stages I-IIIA breast cancer patients. Prior to the initial chemotherapy 
treatment, BT participants developed an ISPP plan that was regularly reinforced 
and revised. Controls received healthy eating information and attention. 
Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue 
Scale (PFS) data were collected 2 days prior, during the 7 days after each 
treatment, and 30 days after the last treatment. Repeated measures analysis of 
variance was used.
RESULTS: Prior to chemotherapy, participants reported mild fatigue and fairly 
poor sleep quality. All variables changed over time. A group by time interaction 
was found for sleep quality (PSQI) improving in the BT group. Diary revealed 
group differences on number of awakenings, minutes awake after sleep onset, and 
sleep efficiency. Fatigue (PFS) was similar between groups.
CONCLUSIONS: The BT group showed improved sleep quality over time and better 
sleep (diary). Perceptions of improved sleep quality over time are not 
consistently associated with diary or actigraph, or result in lower fatigue.