Insomnia and excessive daytime sleepiness
Two common sleep problems are insomnia and excessive daytime sleepiness.

Insomnia is characterized by challenges either falling asleep, staying asleep, waking up early, or experiencing poor sleep quality, leading to the perception of insufficient sleep or inactivity. Conversely, excessive daytime sleepiness refers to abnormal sleepiness or unplanned sleep episodes during daylight hours (see Sleep Overview for additional information).

Insomnia can appear as an independent disorder or serve as a symptom of other conditions, while excessive daytime sleepiness is not a disorder in itself but a symptom of various sleep-related problems.

Common symptoms among older adults include difficulty initiating and maintaining sleep, and waking up prematurely. Statistics indicate that about 10% of adults suffer from chronic insomnia, while 30 to 50% suffer from intermittent insomnia.

Did you know?
Nearly half of the population reports that they suffer from insomnia at some point.
Sleep aids, both prescription and over-the-counter, that contain diphenhydramine are ideal for treating insomnia.
Cognitive behavioral therapy is emerging as the most effective approach to treating insomnia, including behavioral modifications to improve sleep quality.

Disturbed sleep can interfere with daily functioning, leading to daytime sleepiness, fatigue, irritability, and difficulties concentrating for those with insomnia or excessive daytime sleepiness. These individuals may experience spontaneous sleep attacks while working or while driving.

There are different types of insomnia:

Difficulty sleeping (sleep-onset insomnia): This arises when an individual’s mind remains active, preventing them from relaxing before sleep. It can also result from the body’s failure to sync with the typical sleep time due to disturbances in the circadian rhythm.

Difficulty staying asleep and waking up early (sleep maintenance insomnia): People with this type of insomnia can sleep at first but have difficulty staying asleep, often waking up hours earlier than desired. Contributing factors include insomnia and sleep disturbances, which are more common in older people.

Causes of insomnia and excessive daytime sleepiness
These sleep problems may stem from internal or external factors, with some conditions contributing to insomnia and excessive daytime sleepiness. Chronic insomnia, which has no clear cause, may also have genetic influences.

Common causes:
Insomnia is often associated with:

Poor sleep habits, such as late consuming caffeinated beverages, late-night exercise, or irregular sleep patterns.
Mental health disorders, especially depression, anxiety and substance abuse.
Other disorders such as heart or lung problems, musculoskeletal disorders, or chronic pain.
Psychological distress resulting from events such as hospitalization, job loss, or death in the family (known as adjustment insomnia).
Psychophysiological insomnia, which is characterized by excessive worry about sleepiness and experiencing fatigue every day.
Taking a nap during the day or sleeping late after a night of poor sleep can exacerbate sleeping difficulties the following night.

Excessive daytime sleepiness is often due to:

Insufficient sleep despite adequate opportunities (inadequate sleep syndrome).
Obstructive sleep apnea, a condition in which breathing stops during sleep.
Various disorders, including mental health problems, brain or nerve disorders, and conditions affecting the muscles or bones.
Circadian rhythm disturbances that disrupt the internal sleep schedule, such as jet lag or conversion disorder.
Most mental health disorders are accompanied by both insomnia and excessive daytime sleepiness, with approximately 80% of individuals with major depression reporting these symptoms, and 40% of people with chronic insomnia having a mental health disorder.