Elders with dementia experience a high prevalence of disordered sleep that can present as agitation, sleep-disordered breathing, or excessive daytime napping. One must also consider broader contextual issues in the evaluation and treatment of the demented elder with insomnia, such as the caregiver and staff, as well as the setting in which the patient resides. The treatment approach to the demented elder with insomnia is difficult and largely based on clinical experience rather than a broad evidence base. Using a "less is better" approach in attempting nonpharmacologic interventions before initiating a trial of drug therapy is the optimal first step.