Insomnia constitutes a significant source of suffering for patients with cancer as they move through the course of treatment and advanced illness. Practicing physicians and caregivers are challenged to address this troubling symptom without the benefit of an extensive literature specific to this population. There is evidence to suggest that the routine clinical management of patients with cancer with insomnia is discordant with best practices documented in the available literature. This paper reviews the literature to characterize the sleep disturbances experienced by patients with cancer. The evaluation and management of insomnia in patients with cancer is reviewed, and a management plan based on available literature is proposed.