This paper reviews current knowledge of sedimentation patterns in the Arctic Ocean during the pronounced climatic cycles of the last several hundred thousand years, an especially relevant time period that provides long-term context for present climate change. The review is largely based on data collected during recent research icebreaker cruises to the Arctic Ocean, with a focus on the 2005 Healy-Oden TransArctic Expedition (HOTRAX) and 2007 Lomonosov Ridge Off Greenland (LOMROG) expedition. The sediment cores and geophysical seafloor mapping data collected enable reconstruction of past oceanic environments. Evaluation of these data suggests that the two major Arctic Ocean circulation systems, the Trans-Polar Drift and the Beaufort Gyre, persisted throughout most of the Late to Middle Quaternary, approximately the last 0.5 to 0.7 million years. Extreme conditions, nonanalogous to modern environments, also occurred in the past, especially during Pleistocene glacial intervals. Some of these intervals likely featured much thickened and/or concentrated sea ice and incursions of ice shelves and armadas of megasized icebergs from the margins to the center of the Arctic Ocean. In contrast, much warmer conditions with reduced sea ice extent existed during interglacial periods. Characterization of ice conditions during these intervals is critical for evaluating the present and projected future reduction of Arctic sea ice.