Help-seeking behavior for the sleep disturbance in these age groups is limited, and thus
corroborative report may be elic ited from a parent, caregiver, or teacher. Older individuals
take more medications and are at increased risk for developing a substance/medication-
induced sleep disorder. They may interpret sleep  disturbance as part of normal aging and
fail to report symptoms. Individuals with ma jor neurocognitive disorder (e.g., dementia)
are at risk for substance/me dication-induced sleep disord ers but may not report symp-
toms, making corroborative report from  caregiver(s) particularly important.
Risk and Prognostic Factors
Risk and prognostic factors involved in subs tance abuse/dependence  or medication use
are normative for certain age groups. They are relevant for, and likely applicable to, the
type of sleep disturbance encountered (see th e chapter “Substance-Related and Addictive
Disorders” for descriptions of resp ective substance use disorders).
Temperamental. Substance use generally precipitates or accompanies insomnia in vul-
nerable individuals. Thus, presence of insomnia in response to stress or change in sleep en-
vironment or timing can represent a risk for developing substance/medication-induced
sleep disorder. A similar risk may be present for individuals with other sleep disorders
(e.g., individuals with hypersomnia who use stimulants).
Culture-Related Diagnostic Issues
The consumption of substances, including pres cribed medications, may depend in part on
cultural background and specif ic local drug regulations. 
Gender-Related Diagnostic Issues
Gender-specific prevalences (i.e., females affected more than males at a ratio of about 2:1) exist
for patterns of consumption of some substances  (e.g., alcohol). The same amount and duration
of consumption of a given substance may lead to highly different sleep-related outcomes in