How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?

Insomnia and other sleep disturbances are very common in individuals diagnosed with cancer, and it is often helpful for patients to hear this. A good history of other contributors to sleep disturbance can be helpful as well. Often, depression, anxiety, and pain, as well as other stimulant medications like steroids can contribute. Pharmacologic interventions for insomnia actually lack robust evidence in this population, and non pharmacologic interventions such as CBT-I as mentioned above have the strongest level of evidence. Stimulus control, sleep restriction, relaxation techniques at bedtime, and sleep hygiene are additional complementary strategies.

There is good evidence that CBT-I (Cognitive Behavioral Therapy for Insomnia) can be effective. It has been shown to work directly and remotely. Other options include acupuncture. In a randomized trial comparing acupuncture to CBT-I, both resulted in improvement, although the effects from CBT-I were greater.

Ensure it isn't a recent change related to medications. Steroids are notorious for disrupting sleep patterns, among other side effects, and tapering off the steroids as quickly possible will usually fix the problem.

Here is a good Q&A on managing insomnia from the perspective of sleep medicine.