Multimodal Therapy for Sleep Disturbances

Inclusion Criteria:

1. Patients who are 18 years or older, with advanced cancer (defined as metastatic and locally advanced) and a positive screening for SD (>/=4/10 on a 0-10 scale).
2. Patients should have a Zubrod </= 2.
3. Patients with no pain and with stable pain(defined as pain under control and on stable doses of opioids for 1 week) are eligible.
4. Memorial delirium assessment scale </= 13.
5. Controlled pain and depression symptoms, if present (defined as no change in the Morphine equivalent dose of 30% or change in the dose of antidepressant medication in the past 2 weeks).
6. All patients who are receiving chemotherapy and/or radiation therapy are eligible for study if they have completed at least one cycle of chemotherapy or targeted therapy, or > 1 week of radiation therapy, and if they have been approved to go on study by their primary oncologist. The PI/designated research staff of this study will obtain and document approval from the primary oncologist and principal investigator of the clinical trial in case the patient is on another clinical trial as referenced in the patient's study documents.
7. Laboratory test results within these ranges: Serum creatinine </= 2.0 mg/dL, Total bilirubin </=1.5 mg/dL, and AST (SGOT) and ALT (SGPT) </=2 x ULN or </= 5 x ULN if hepatic metastases are present. ULN= upper limit of normal.
8. Patients on stable doses (defined as same dose for 1 month) of dexamethasone, mirtazapine, zolpidem, benzodiazepines, phenothiazines are allowed to participate in the study.

Exclusion Criteria:

1. Have a major contraindication to methylphenidate (MP) (e.g., allergy/hypersensitivity to study medications or their constituents), light therapy (e.g., currently receiving UVA/UVB therapy), cognitive behavioral therapy (e.g., schizophrenia), or conditions making adherence difficult as determined by the attending physician.
2. Currently taking MP or have taken it within the previous 10 days.
3. Patients with a diagnosis of polysomnographically confirmed obstructive sleep apnea or narcolepsy.
4. Regularly used cognitive behavioral therapy in the last 6 weeks.
5. Unable to complete the baseline assessment forms or to understand the recommendations for participation in the study.
6. Currently with a diagnosis of major depression, manic depressive disorder, obsessive-compulsive disorder, or schizophrenia).
7. Need monoamine oxidase inhibitors, tricyclic antidepressants, or clonidine.
8. Have glaucoma.
9. Symptomatic tachycardia and uncontrolled hypertension (determined to be clinically significant by the PI).
10. Currently receiving anticoagulants, anticonvulsants (phenobarbital, diphenylhydantoin, primidone), phenylbutazone, clonidine, and/or tricyclic drugs (imipramine, clomipramine, or desipramine).
11. Unable to speak and understand English.
12. Persons with congenital blindness and self-reported acquired blindness (independent of the cause) with no light perception.
13. Patients with a history of retinal disease.
14. Patients with >2 hours of direct exposure to outdoor natural light per day (light exposure diary - screening).
15. Patients with a diagnosis of obesity hypoventilation syndrome.
16. Negative pregnancy test for women of childbearing potential, as defined by intact uterus and ovaries, and a history of menses within the last 12 months. Pregnancy test to be performed no greater than 14 days prior to consent in study. In cases of women with elevated b-HCG, these candidates will be eligible to participate so long as the level of b-HCG is not consistent with pregnancy. Women of childbearing potential need to be on or use contraception, or be abstinent during the study period. Their male partners must also use contraception (condom) or maintain abstinence. Birth controls specifications: Women who are able to become pregnant must use birth control during the study and for 30 days after.
17. Women who are nursing.