aka “{terminal insomnia}”
Most prevalent in {older} adults, whereas sleep-onset insomnia is more common in {younger} adults.
One common cause among older adults is insufficient light exposure and physical activity. There is weak evidence indicating the use of bright light treatment in the evening (Campbell et al, Lack et al), but there have been several null results for this practice as well (Morganthaler et al).
Another treatment is sleep restriction therapy, which aims to treat insomnia by consolidating sleep. The protocol is pretty simple: time in bed is restricted to the average estimated sleep time, plus 30 minutes. Then when sleep efficiency is >= 90%, time in bed is increased by 15m; if it’s < 85%, it’s decreased to the average sleep time.
Sleep maintenance insomnia is often associated with advanced sleep phase disorder, in which one’s sleep schedule is shifted a few hours earlier than culturally normal.
See Sleep regulation for discussion of mechanisms.
Campbell, S. S., Dawson, D., & Anderson, M. W. (1993). Alleviation of Sleep Maintenance Insomnia with Timed Exposure to Bright Light. Journal of the American Geriatrics Society, 41(8), 829–836. https://doi.org/10.1111/j.1532-5415.1993.tb06179.x
Fiorentino, L., & Martin, J. L. (2010). Awake at 4 a.m.: Treatment of Insomnia With Early Morning Awakenings Among Older Adults. Journal of Clinical Psychology, 66(11), 1161–1174. https://doi.org/10.1002/jclp.20734
Lack, L., Wright, H., Kemp, K., & Gibbon, S. (2005). The Treatment of Early-Morning Awakening Insomnia With 2 Evenings of Bright Light. Sleep, 28(5), 616–623. https://doi.org/10.1093/sleep/28.5.616
Morgenthaler, T. I., Lee-Chiong, T., Alessi, C., Friedman, L., Aurora, R. N., Boehlecke, B., Brown, T., Chesson, A. L., Kapur, V., Maganti, R., Owens, J., Pancer, J., Swick, T. J., & Zak, R. (2007). Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders. Sleep, 30(11), 1445–1459. https://doi.org/10.1093/sleep/30.11.1445
Spielman, A. J., Yang, C.-M., & Glovinsky, P. B. (2011). Sleep Restriction Therapy. In Behavioral Treatments for Sleep Disorders (pp. 9–19). Elsevier. https://doi.org/10.1016/B978-0-12-381522-4.00001-8