Insomnia is highly prevalent and is associated with significant personal and socioeconomic burden. However, it is largely underrecognized and is inadequately treated. Ruth M. Benca, M.D., Ph.D., reviewed the literature on insomnia and its treatment for the period 1970 to 2004 to understand why the treatment needs of people with insomnia continue to go unmet. Barriers to the appropriate recognition, diagnosis, and treatment of insomnia include misconceptions about its seriousness, about the advantages of treatment, and about the risks associated with using hypnotic medications to treat insomnia, the author notes. Both pharmacologic and nonpharmacologic therapies have demonstrated benefit, although pharmacologic treatment is of course associated with a greater risk of side effects. Commonly prescribed newer hypnotic medications have shown efficacy for sleep onset but limited efficacy for sleep maintenance; older agents, although effective for sleep maintenance, may produce substantial next-day residual effects. The author notes that treatment options that are currently available do not address the needs of difficult-to-treat patients with chronic insomnia, such as the elderly, and those with comorbid medical and psychiatric conditions (see page 332).