Sleep Aids After 60: What Helps, What Doesn't, and What to Watch Out For

Sleep changes as we get older.

We may sleep more lightly, wake more often, get sleepy earlier in the evening, or wake earlier in the morning. But that doesn't mean poor sleep is simply something we have to accept.

And when sleep becomes a problem, it's tempting to reach for something that promises a quick fix.

Melatonin.

A “PM” medication.

An antihistamine.

A prescription sleeping pill.

But here's the question worth asking:

What should an older adult know before reaching for a sleep aid?

Because some things that make you sleepy aren't necessarily good for you—and some medications become more problematic as we age.

First: Not Every Nighttime Awakening Is Insomnia

Older adults commonly experience changes in sleep architecture. Sleep can become lighter and more fragmented without necessarily meaning something is wrong.

The bigger question is what happens during the day.

If you're routinely exhausted, sleepy, struggling to concentrate, or unable to function normally because of poor sleep, that's different.

Persistent insomnia deserves more than simply reaching for a pill.

And sometimes the answer isn't a sleep aid at all.

Melatonin: Useful, but Widely Overhyped

Melatonin is a hormone your body naturally produces. Its primary job is helping regulate your sleep-wake cycle.

That makes melatonin particularly relevant when the timing of your internal clock is out of sync.

But melatonin isn't a traditional sedative. It doesn't simply knock you out.

For chronic insomnia, the evidence is much less impressive than the marketing sometimes suggests. Studies specifically involving adults 65 and older are also relatively limited.

So the reasonable conclusion isn't that melatonin is useless.

It's that melatonin isn't a magic sleep pill.

Some people may benefit from it, but more isn't necessarily better, and taking it doesn't address every cause of insomnia.

There's another problem: what's actually in the bottle?

Melatonin is sold as a dietary supplement rather than an FDA-approved drug.

That matters because supplement contents aren't necessarily as predictable as consumers assume.

In one U.S. study of 25 melatonin gummy products, 22 were inaccurately labeled. The amount of melatonin found in the products ranged substantially from what their labels claimed.

The study was small and looked only at gummies, so it doesn't prove that every melatonin product is inaccurately labeled.

But it does make one thing clear:

“Natural” doesn't necessarily mean standardized or precisely dosed.

Benadryl and Other Antihistamines: The Bigger Concern

This is where older adults should pay particular attention.

Many over-the-counter sleep products rely on sedating antihistamines, especially diphenhydramine or doxylamine.

They can make you sleepy.

But sedation isn't the same thing as healthy sleep.

And there's unusually strong guidance here.

The American Geriatrics Society's Beers Criteria identifies medications that are potentially inappropriate for adults 65 and older because their potential risks can outweigh their benefits in many circumstances.

Among the medications it flags are diphenhydramine and other first-generation antihistamines, as well as benzodiazepines and Z-drugs used for insomnia.

The concern isn't simply that they might leave you groggy.

These medications can contribute to problems such as impaired thinking, confusion, falls and other adverse effects that become increasingly important with age.

That doesn't mean every older adult who takes one will have a problem.

It means there's a much higher bar for using them routinely.

The “PM” Trap

There's another easy mistake.

A product may be marketed as:

PM

Nighttime

Nighttime Relief

Sleep Aid

But the important information is on the back.

Some of these products contain a sedating antihistamine that is making you sleepy as a side effect.

So don't judge a sleep product by the picture on the front of the box.

Look at the active ingredients.

Prescription Sleeping Pills Aren't All the Same

Prescription insomnia medications come in several different classes, including:

• benzodiazepines
• Z-drugs such as zolpidem, zaleplon and eszopiclone
• low-dose doxepin
• ramelteon
• dual orexin receptor antagonists such as suvorexant, lemborexant and daridorexant

They have different mechanisms, benefits and risks.

And age matters.

A 2025 systematic review and meta-analysis comparing adults 65 and older with younger adults found that some hypnotic classes may be less effective in older people, with differences between medication classes.

So the question shouldn't simply be:

“Does this drug help people sleep?”

It should be:

“Does its benefit outweigh its risks for someone my age, with my other medications and health conditions?”

Z-Drugs Have an FDA Boxed Warning

This is one of the most important things to know about certain prescription sleep medicines.

The FDA requires a boxed warning—its strongest warning—to be included for zolpidem, zaleplon and eszopiclone because of rare but serious “complex sleep behaviors.”

These can include sleepwalking, sleep-driving and other activities performed while not fully awake.

The FDA reports that these behaviors have resulted in serious injuries and deaths.

The risk appears to be rare, but that's exactly why it is worth knowing about.

If someone experiences a complex sleep behavior while taking one of these medications, the FDA says they should stop taking the medicine and contact their healthcare professional right away.

There's another issue, too: insomnia medications can cause next-morning impairment, even when someone feels fully awake.

That's especially relevant if you're driving or doing anything that requires sharp attention.

There Are Newer Prescription Options

The sleep-medication world isn't limited to traditional sleeping pills.

One newer class is the dual orexin receptor antagonists.

Orexin is part of the brain's wake-promoting system. These medications reduce wakefulness by blocking orexin signaling.

Examples include:

• suvorexant
• lemborexant
• daridorexant

Low-dose doxepin and ramelteon are other prescription options that may be considered for some older adults.

Some newer medications look promising, but the evidence in older adults isn't equally strong for every drug.

That's important.

Newer doesn't automatically mean better.

It means the risks and benefits need to be considered individually.

The Treatment That Doesn't Come in a Bottle

Here's the part that tends to get overlooked.

For chronic insomnia, the strongest evidence is not for a supplement.

It's for cognitive behavioral therapy for insomnia—CBT-I.

The American Academy of Sleep Medicine gives CBT-I a strong recommendation for chronic insomnia.

CBT-I uses specific techniques to change the behaviors and thought patterns that keep insomnia going. Depending on the program, it can include:

• stimulus control
• sleep restriction or carefully managing time in bed
• changing unhelpful beliefs about sleep
• relaxation techniques
• education about sleep

It's not simply “practice better sleep hygiene.”

It's an actual treatment program.

And unlike a sleeping pill, the goal isn't to sedate you.

The goal is to change the problem that is keeping you awake.

What About Sleep Hygiene?

Sleep hygiene still matters.

Keep a regular sleep schedule.

Limit caffeine late in the day.

Avoid excessive alcohol.

Exercise regularly.

Create a relaxing bedtime routine.

Make your bedroom comfortable.

All sensible advice.

But here's the catch:

Sleep hygiene by itself isn't considered an adequate treatment for chronic insomnia.

If you've been struggling for months, “turn off the TV and drink some chamomile tea” isn't the whole answer.

How Do You Actually Get CBT-I?

This is where CBT-I becomes practical.

Ask your doctor or healthcare system specifically about Cognitive Behavioral Therapy for Insomnia, rather than simply asking for “help sleeping.”

CBT-I can be provided individually, in groups, or through telehealth. Digital versions can also be useful when access to a trained therapist is limited.

There's also a free option worth knowing about.

The U.S. Department of Veterans Affairs offers Insomnia Coach, a CBT-I-based app designed for Veterans and civilians. It can be used as a self-care and education tool.

The VA also offers CBT-i Coach, but that app is designed to be used alongside CBT-I with a healthcare provider.

So you don't necessarily have to start with a prescription bottle.

You can start with a treatment designed to address insomnia itself.

Sometimes the Problem Isn't Insomnia

Before treating the symptom, consider what might be causing it.

Sleep problems can be related to:

Sleep apnea

Repeated interruptions in breathing can fragment sleep throughout the night.

Restless legs syndrome

An uncomfortable urge to move the legs can make falling asleep difficult.

Medications

Some medications interfere with sleep. Others cause excessive daytime sleepiness.

Pain

Arthritis, neuropathy and other painful conditions can disrupt sleep.

Depression or anxiety

Sleep and mental health can affect each other in both directions.

An irregular sleep schedule

Your body clock may simply be getting pushed around.

The answer isn't always another sleep aid.

Sometimes the thing disturbing your sleep needs to be identified and treated.

And Don't Stop a Prescription Sleep Medication on Your Own

If you've been taking a prescription sleep medication regularly, don't abruptly stop it without discussing it with the prescriber.

Some medications can cause withdrawal or rebound insomnia.

A pharmacist can also be extremely useful here. They can review your medications and supplements for interactions and identify drugs that may be contributing to sleep problems—or making a sleep aid riskier.

So What Actually Works?

There isn't one universally “best” sleep aid for older adults.

And there isn't one universally terrible one, either.

Melatonin may help some people, but it isn't a cure-all—and supplement quality can be unpredictable.

OTC antihistamine sleep aids can make you sleepy, but the AGS Beers Criteria gives older adults a good reason to avoid them in many circumstances.

Prescription sleep medications can help some people, but their benefits and risks vary—and some carry significant safety warnings.

And for chronic insomnia:

CBT-I deserves to be much higher on the list than it usually is.

The goal isn't simply to knock yourself out.

The goal is better sleep without creating a new problem in the process.

The Watchdog Takeaway

Before reaching for a sleep aid, ask a better question: “Why am I not sleeping?”

Melatonin can help some people, but it's not a magic pill—and supplements aren't necessarily as precisely regulated or labeled as medications.

Some popular OTC sleep aids contain antihistamines that the American Geriatrics Society considers potentially inappropriate for many older adults. Certain prescription sleep medications carry their own important risks, including an FDA boxed warning for rare but serious complex sleep behaviors with zolpidem, zaleplon and eszopiclone.

If insomnia has become a regular problem, don't automatically work your way up the ladder from melatonin to stronger sleep aids.

Consider CBT-I.

It has some of the strongest evidence behind it for chronic insomnia, and its purpose isn't simply to sedate you—it's to help change the problem.

Good sleep isn't just about getting more hours. It's about finding an approach that helps you sleep well without making the rest of your life less safe, clear or functional.