The prevalence of sleep disorders manifest as insomnia and fatigue of excessive daytime sleepiness in the general population; office practice is high. Poor quality sleep may pose a significant health risk for not only the patient but society in general. Sensitivity for potentially serious sleep disorders should be coupled with an organized approach to diagnosis and therapy. Differentiation of the principal complaint into insomnia versus hypersomnia and determination of duration are the key elements. Office-based management of the most common sleep-wake disorders and current diagnostic testing standards are discussed.