Implications for Further Research
Although several promising therapies are available, no single therapy has been proven effective for all patients experiencing insomnia. Further research is needed to guide an algorithm for clinical decision making. It is unclear when CBTi or medication should be used as initial therapy and, when ineffective, what should be used as second-line treatment. There is also a need for additional research on other nonpharmacological treatments, such as aromatherapy, as potential therapy.
Currently, there is a lack of evidence on the subject of insomnia in specific cancer populations. The future may hold knowledge of cancer-specific physiological, psychological, and behavioral factors that contribute to sleep disturbances during treatment and targeted approaches at symptom management.
Lastly, there is a lack of evidence regarding the effectiveness of CBTi in patients at the end of life. Advanced metastatic disease frequently results in polypharmacy, cognitive impairment, and poorly controlled symptoms. Cognitive Behavioral Therapy for Insomnia typically requires 4 to 6 weeks for noticeable results. Depending on prognosis, initiating this therapy may not be beneficial.