Background: Sleep disturbance is a common problem among individuals with advanced cancer. Distress and sleep disturbance are highly interdependent in spouses. Little research has examined dyadic effects of psychological distress on sleep in patient-caregiver spouses, most of whom sleep together. The goal of this study was to determine how anxiety and depression impact one’s own sleep and partner’s sleep in advanced cancer patients and their spouse caregivers. Methods: As part of a larger study, 86 advanced cancer patients and their spouse caregivers completed surveys on demographics and self-reported health, including sleep duration, and the HADS measure of anxiety and depression. A path analysis was conducted to determine the impact of patient and caregiver anxiety and depression on their own and their partner’s sleep. Results: The majority of dyads were white (n = 79) and all were heterosexual. The patient was female in 25 couples. The average age for patients was 67 and 65 for caregivers; couples had been together an average of 35 years. Patients reported sleeping 7.2 hours/night (SD = 1.7) and caregivers reported sleeping 6.72 hours/night (SD = 1.3). Patient and caregiver sleep was significantly correlated (r = .42, p < .01). Controlling for age, sex, and general health, one’s own anxiety was negatively associated with one’s own sleep duration (patient B = -.12, p = .04; caregiver B = -.13, p < .01), but patients’ anxiety was not associated with caregivers’ sleep duration or vice versa. Individuals’ depression was not associated with their own sleep duration, but patient depression was positively associated with caregiver sleep duration (B = .10, p = .05). Conclusions: This is one of the first dyadic explorations of psychological distress and sleep duration in advanced cancer patients and spouse caregivers. The increase in the caregivers’ reported sleep duration associated with patient depression may be an early indicator of caregiver depression. These findings strongly support further research of the dyadic effects of distress on sleep to identify longitudinal effects on holistic sleep outcomes for spouses coping with cancer.