Our conceptualization of insomnia has undergone a dramatic shift during the past few years, from an annoying but not particularly serious symptom to the recognition that 1) sleep loss from any cause has serious consequences, 2) chronic insomnia and the impaired sleep it represents are highly comorbid with (or indeed may cause) many other medical and psychiatric disorders, and 3) chronic insomnia in some cases may represent a separate medical disorder in itself, with an independent neurobiological basis. It has been suggested that certain chronic insomnias be considered on a par with depression as a serious disorder with a tendency toward chronicity whose treatment needs independent assessment and possibly long-term management (Jindal et al. 2004). This increase in complexity is in part offset by improved treatment options, both pharmacological and nonpharmacological. This chapter will review these areas in what we hope is a clinically useful manner.