Insomnia is the most common sleep disorder in older age, affecting an estimated 30 to 48% of community-dwelling older adults, and treating it is complicated by age-related changes and the risks of some sleep medications. A recent systematic review and meta-analysis set out to clarify which treatments work and which are safest.
What was reviewed. The review, published in the Medical Journal of Malaysia (September 2026), searched PubMed, Web of Science, Scopus and Google Scholar. After removing duplicates it screened 153 records and included 22 studies in its final synthesis, covering both medication and non-drug treatments. The authors say they appraised the studies for risk of bias, but the abstract does not report how the included studies were rated, so we cannot say how reliable the underlying trials are. It is a single review of studies that differ a lot from each other (for the main CBT-I result the heterogeneity was high, I² = 85%), so it works best as an overview, not as a final ranking.
CBT-I leads the way, but the trials vary a lot. Across 14 randomized trials, face-to-face cognitive behavioral therapy for insomnia (CBT-I) improved sleep efficiency by 8.36 percentage points (95% CI 5.96 to 10.76) and reduced time awake after falling asleep by 23.44 minutes (95% CI -32.41 to -14.47). The heterogeneity was high (I² = 85%). I² shows how much of the differences between trials reflects real variation rather than chance, so 85% means these averages cover very different results from trial to trial. The authors link this partly to sleep restriction therapy being adapted in different ways. They still call CBT-I the evidence-based first-line treatment.
Other behavioral strategies also show promise. According to the authors, digital CBT-I, music therapy (SMD -0.79) and structured exercise also gave substantial benefits. The abstract does not say how many trials each of these rests on.
When medication is necessary. Among the drugs, dual orexin receptor antagonists (suvorexant, lemborexant and daridorexant) showed the most favorable balance of benefit and safety in the randomized data. The effect on how quickly people fall asleep, as the patients themselves report it, was modest but consistent: SMD -0.28 (95% CI -0.41 to -0.15; I² = 22%). One review cannot settle which drug class is best for every older adult.
Benzodiazepines and Z-drugs carry significant risks. The review links these medicines to a higher risk of falls (risk ratio about 1.47) and to cognitive decline, and classes them as potentially inappropriate for older adults. If you or someone close to you takes one, do not stop on your own. Talk to a doctor about whether and how to reduce it.
The takeaway. The authors recommend an individualized approach that puts behavioral therapy first and uses carefully chosen medication only when it is really needed.
Medical note. This article provides general education and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment.