Chronic insomnia is common among primary care patients and often necessitates long-term management. The available treatment options for the clinical care of such patients are limited. Medication management is the most common therapy for this condition; however, this practice was hindered until recently by clinical guidelines that discouraged the prescription of the medications approved by the Food and Drug Administration for longer than 4 weeks. Further, few research studies have been conducted on the longer-term medication management of insomnia that might allow clinicians to assess the expected risks and benefits of longer-term therapy. Recent research, however, indicates that longer-term treatment with some agents may be safe and effective. This article reviews these studies and discusses them in the context of the diagnostic steps to consider when deciding whether to initiate or continue pharmacotherapy for insomnia. © 2006 American College of Nurse Practitioners.