Objective <p>This study evaluated whether combined sleep intervention and enhanced nutritional support improve postoperative recovery in gastric cancer patients, focusing on sleep quality, nutritional status, pain, psychological well-being, and quality of life. Methods: A single-center, prospective, randomized controlled trial was conducted at the First Affiliated Hospital of Soochow University between June 2021 and June 2023. A total of 290 patients undergoing gastric cancer surgery were randomly assigned to an Intervention group (n = 145), which received a structured sleep intervention (relaxation training, music therapy, environmental optimization, and optional short-term zolpidem 5–10&#xa0;mg nightly for up to 14&#xa0;days) plus enhanced nutritional support, or to a Control group (n = 145), which received standard care alone. Outcomes were evaluated at baseline and after 15&#xa0;days, including sleep quality (Pittsburgh Sleep Quality Index, PSQI), nutritional indicators (body weight, serum albumin, total protein, prealbumin, transferrin, and procollagen type III N-terminal propeptide), pain (Visual Analogue Scale, VAS), psychological state (Self-Rating Anxiety Scale, SAS; Self-Rating Depression Scale, SDS), and quality of life (EORTC QLQ-C30).</p> Results <p>Both groups showed significant postoperative improvements in PSQI, nutritional markers, pain, and psychological outcomes (all P &lt; 0.05). The Intervention group demonstrated greater benefits, with lower PSQI scores, greater gains in nutritional status, lower SAS and SDS scores, and more favorable quality-of-life outcomes compared with controls (all P &lt; 0.05).</p> Conclusion <p>Combined sleep intervention and nutritional support significantly enhance postoperative recovery in gastric cancer patients, improving sleep, nutrition, pain control, psychological well-being, and overall quality of life.</p> Graphical abstract <p></p>