Millions of older Americans suffer from insomnia and rely on prescription sleep medications, yet these drugs carry serious side effects—including falls, broken bones, cognition loss, and dependence—leading medical societies to warn against their routine use.
A new investigation from the USC Schaeffer Center for Health Policy & Economics suggests that cutting prescriptions of sleep drugs for older people could bring significant health and financial gains.
By avoiding these medications, researchers estimate a 8.5% drop in lifetime falls and a 2.1% reduction in cognitive decline among seniors. Life expectancy would rise by 1.3 months, translating to about 1.7 million extra life‑years for the population, most of which would be lived in good health.
"Our findings imply that less sleep‑medication use could help older adults lead healthier lives with fewer restrictions," said lead author Hanke Heun‑Johnson, a research scientist at the Schaeffer Center.
The study appears in the December issue of The Lancet Regional Health—Americas.
An estimated 15.3 million adults aged 50 and older in the U.S. take prescribed sleep medications such as benzodiazepines and “Z‑drugs” like Ambien. Use increases with age and is more common among women and white adults.
Although clinical guidelines advise against long‑term use, doctors frequently prescribe these drugs over extended periods. For some patients, the main benefit becomes the avoidance of withdrawal symptoms, which can be misconstrued as ongoing effectiveness in a medical setting.
Insomnia itself poses serious risks for older adults, including depression, heart disease, and cognitive decline. Yet, prolonged use of sleep medications tends to do more harm than good.
To assess the impact of sleep‑medication use, researchers employed the Dynamic Microsimulation Model—Future Elderly Model—developed at the Schaeffer Center. They compared current use of the drugs with a scenario in which no one uses them, evaluating outcomes such as cognitive decline, fall risk, nursing‑home use, medical costs, and lifetime earnings.
People aged 65 to 74 showed the greatest potential benefit in cognitive function and physical health from withholding these drugs, indicating that efforts to reduce prescribing should focus on this group.
Beyond health advantages, the study found that avoiding sleep medications would generate lifetime savings of $6,600 per person, or roughly $101 billion nationwide. Most of these savings derive from improved quality of life.
Professional bodies such as the American Academy of Sleep Medicine recommend cognitive behavioral therapy for insomnia (CBT‑I) as the first‑line treatment instead of medication. CBT‑I helps patients adopt healthy sleep habits and can be delivered in-person, virtually, or via an app (e.g., the VA’s CBT‑I Coach). It is as effective as medication in the short term and superior in the long term, without the side effects.
Previous work by the Schaeffer Center identified practical methods for reducing inappropriate prescriptions of antibiotics, opioids, and other medications. Many of those approaches could be adapted to lessen sleep‑drug prescriptions and motivate physicians toward safer alternatives.
For instance, electronic health record systems could prompt doctors to justify sleep‑drug prescriptions for older patients and provide information about CBT‑I. Physicians might also receive periodic reports comparing their prescribing patterns to peers.
"Insomnia is a serious issue for many older adults, but regular use of sleep medication can pose real risks," said co‑author Jason Doctor, a senior scholar at the Schaeffer Center and the Norman Topping Medical Enterprise Chair in Medicine at the USC Price School of Public Policy. "Supporting physicians in reducing prescriptions and promoting safer, proven alternatives will ultimately benefit patients and society," he added.