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Understanding the Population at Risk for Sleep Problems

Sleep problems affect millions of people worldwide, yet many underestimate how widespread and serious these issues can be. Certain groups face a higher risk of developing sleep disorders, which can lead to significant health challenges. Understanding who is most vulnerable and why helps us recognize the importance of addressing sleep problems early and effectively.


Insomnia is one common sleep disorder that can make it hard to fall asleep or stay asleep. It also can cause you to wake up too early with the inability to fall back asleep. You may feel tired when you wake up and insomnia can negatively impact your cognition, physical health and emotional health.



Check out my blog post for more evidence based information on how sleep deficiency impacts your cognition, physical and emotional health:





At some point in your adult life, I am sure that you have already experienced short-term insomnia. Even just one night of poor sleep due to stress or a distressing event is considered short-term insomnia (or acute).


For example, you are taking the plane tomorrow and you finally have everything packed. You head off to bed to get some sleep before the big day. However, you find yourself laying awake in bed mentally re-checking your packing list to make sure you did not forget anything. This keeps you up, you have trouble falling asleep. Then, finally you drift off, but you sleep lightly. You wake up frequently because you are afraid to miss your alarm clock - and consequently miss your flight! Sound familiar?



One bad night is common, but when it affects your day and happens regularly it can be really disruptive to your everyday life.


When people experience poor sleep for three or more nights a week for three or more months this becomes long-term insomnia or chronic insomnia. The longer an individual is stuck in this pattern the longer it takes to recover, and the more severe the physical and mental health consequences become. 



Who Is at Risk for Sleep Problems?


Some individuals are more at risk of developing sleep problems than others, making it crucial to identify these vulnerable groups to implement targeted interventions, improve, and prevent chronic health conditions. 


Here are some key populations at risk:


Demographics:

  • Woman: Twice as likely to experience insomnia as men, often due to hormonal changes (menstrual cycle, menopause, pregnancy).

  • Older adults (over 60): Sleep patterns change with age, increasing risk. Older adults experience more fragmented sleep, lighter sleep stages, and higher prevalence of insomnia. These changes can be due to several factors such as:

    • Natural shifts in circadian rhythms

    • Medical conditions such as arthritis or chronic pain

    • Medications that interfere with sleep

  • Individuals with low income: Linked to higher stress and potential environmental factors. 


Genetics:

  • Family history: A genetic predisposition can make some sleep disorders more likely. 


Mental Health:

  • High stress & emotional distress: Worry, or major life events can impact sleep. 

  • Depression: May lead to early morning awakenings or oversleeping. Approximately 40% of people with insomnia have clinical depression, and up to 80% of patients with depression experience bouts of insomnia (Bonnet & Arand, 2022). 

  • Anxiety: Can cause racing thoughts that prevent falling asleep. Insomnia is highly prevalent in people with anxiety, with symptoms occurring in approximately 70–90% of individuals diagnosed with anxiety disorders (Palagini et al. 2024).

  • Post Traumatic Stress Disorder (PTSD): Nightmares are recurring, distressing dreams that often replay or reflect a traumatic event, causing significant distress and sleep disturbance. An estimated 9 out of 10 individuals with PTSD suffer from insomnia (Department of Veterans Affairs and Department of Defense, 2017).

  • Schizophrenia: Sleep disturbances comparable with insomnia occur in up to 80% of people with schizophrenia. Sleep studies demonstrate that these individuals have increased time to fall asleep, reduced total sleep time, reduced slow-wave sleep, and reduced REM sleep (Wulff et al. 2012). Bidirectional link is present where poor sleep fuels psychosis and vice versa, increasing risks for relapse, cognitive decline, and suicide (Kaskie et al. 2017).

  • Medication: Certain allergy, heart, thyroid, depression (SSRIs), and ADHD drugs can interfere.

  • Substance abuse: Many people believe alcohol will help them sleep, but the opposite is true. Total sleep time, sleep efficiency, and slow-wave sleep are decreased by alcohol (Geoghehan et al. 2012).


.Neurological Disabilities:

  • Autism, sensory processing disorder, attention deficit-hyperactivity disorder (ADHD) and attention deficit disorder (ADD): These individuals often have difficulties regulating themselves during waking occupations and often have difficulties with initiating and maintaining healthy sleep. 

  • Brain injuries, blindness and low vision: These individuals often have circadian-rhythm disruption. 

  • Dementia: Sleep problems are commonly present and complex and may be exacerbated by coexistence of other medical conditions. These individuals also often have a condition referred to as sundown syndrome - which refers to a state of confusion at the end of the day and into the night, which can cause a variety of behaviours, such as confusion, anxiety, aggression, pacing or ignoring directions.

  • Parkinson's disease: Up to 90% of individuals with Parkinson's disease have a sleep problem. It has been suggested that the sleep-wake problems are a consequence of degenerative changes in the areas of the brain that regulate sleep and arousal. As well, symptoms of the disease and mediation used in its management might add to the difficulties.


Movement and breathing limitations: 

  • E.g. : chronic pain, cardiovascular accidents, spinal cord injury, and cerebral palsy may have difficulty maintaining comfort during sleep. 


Lifestyle and environmental factors:

  • E.g. : shift work, travel, poor sleep habits, bed sharing, parents with newborns or infants, electronics, light and noise. 




The Importance of Early Recognition and Treatment


Sleep problems often go unreported or untreated. Many people accept poor sleep as normal or unavoidable. Yet, early recognition and intervention can prevent worsening health outcomes.



Sleep Interventions that Work!


Treatments vary from improving sleep habits to medical therapies for specific disorders like sleep apnea or restless leg syndrome. Behavioral therapies have proven effective for insomnia and can be tailored to individual needs.


Occupational therapists (OTs) play a crucial role in managing sleep difficulties. OTs are licensed healthcare professionals that routinely address areas that have been strongly connected to poor sleep (e.g., cognitive performance, motor function, emotion regulation) and therefore, view sleep as foundational to overall health and well-being (Browning et al., 2024). Unlike traditional medical treatments that may focus on symptoms or medication, OTs look at the bigger picture. By evaluating and addressing an individual's physical and social surroundings, as well as their habits and cognitive and emotional aspects, OTs can improve sleep quality.



Visit my blog post for more information on how Occupational Therapists are key health professionals for intervening on sleep issues: 







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