One in three people suffer from some form of insomnia during their lifetime. It can be experienced as difficulty falling asleep, difficulty staying asleep, waking up too early, or waking up feeling unrefreshed. There are many possible causes of insomnia, including stress, environment, mood/anxiety/depression, pain and discomfort, circadian rhythm issues, medical disorders such as sleep apnea, medication, substance side effects, or just plain bad sleep habits. Most often, there is a combination of factors involved. To determine how to help, we perform a careful review of your health history and habits in addition to asking you to keep a sleep diary. Sleep testing is sometimes needed but not always. Our goal for each insomnia patient is to first try to clear up medical, behavioral, and circadian rhythm issues. After that, we have a frank discussion about the pros and cons of different lifestyle, cognitive-behavioral, therapeutic, herbal/over the counter, and pharmaceutical approaches.