Insomnia is an extremely prevalent condition, affecting large segments of the population. There is a broad spectrum of risk factors for this disorder, most of which are various types of social, economic, or interpersonal stressors. Risk factors include age, female gender (especially post- and perimenopausal women), divorce/separation/widowhood, psychiatric illness (mood and anxiety disorders), medical conditions, cigarette smoking, alcohol consumption, coffee consumption, and certain prescription drugs. It is important to recognize that the symptom of insomnia (ie, disturbed or poor quality sleep) may be due to the presence of another primary sleep disorder, such as restless legs syndrome, periodic limb movements in sleep, or sleep apnea.

While insomnia is common among men and women and across all age groups, older adults and women experience markedly increased risk for this disorder. Insomnia complaints in adults ≥65 years of age are very common. Foley and colleagues demonstrated in a study of 9,282 older adults (mean age of 74) an insomnia prevalence rate of ∼60%.

Approximately 57% of older adults have sleep complaints (Slide 1). Most of these are associated with comorbid conditions including depressed mood, respiratory problems, or poor physical health. The healthiest members of this population have far fewer sleep complaints.

Because a multitude of factors contribute to insomnia, the context of treatment can greatly impact treatment efficacy. Major depression or congestive heart failure, for example, can contribute to insomnia, and treatment of those conditions should exert a positive effect on insomnia symptoms. On the other hand, the treatment of other conditions, such as the use of selective serotonin reuptake inhibitors antidepressants, may have a negative effect on the quality of sleep. Clinicians, therefore, need to take a versatile, multifaceted approach for each patient when treating insomnia.