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Objective: The aims of this study were to determine the true frequency of primary insomnia (PI), sleep disorder related to another mental disorder (SDMD) and sleep disorder due to a general medical condition (SDMC) in older adults and to establish their differentiating characteristics. Methods: This is a cross-sectional study. Participants were randomly selected samples of 951 subjects who are 65 years or older. Main measures were as follows: presence (according to DSM-IV-TR diagnostic criteria) of PI, SDMD, SDMC or other sleep disorders, co-morbidity and psychotropic consumption. Results: Of the subjects, 36.1% reported having sleep problems (95%CI:33.0–39.2) and 37.0% reported regularly consuming a psychotropic drug. The prevalence of PI was 8.9% (95%CI: 7.1–11.0), and according to the criteria for differential diagnosis, the prevalence of SDMD was 9.3% (95%CI: 7.5–11.4) and that of SDMC was 7.0% (95%CI: 5.4–8.9). A higher percentage of PI subjects had problems in falling asleep on most days (52.5%), had frequent night-time awakenings (66.3%) and early awakenings (51.3%). In subjects with any type of insomnia, the variables that showed a statistically significant association were female gender (OR: 2.21), consumption of psychotropic drugs (OR: 1.83), presence of four or more health problems (OR: 1.88) and being single, widowed or divorced (OR: 1.43). Conclusions: Our results provide a true picture of the prevalence of insomnia in older adults on the basis of diagnostic criteria and indicate that it is a widespread, significant health problem. The peculiarities of PI, SDMD and SDMC need to be appropriately differentiated in clinical practice, and each needs a different approach to obtain the best outcome. Copyright © 2011 John Wiley & Sons, Ltd.