What Sleepless Nights Are Really Doing to the Aging Brain

Why Z Drugs Miss the Mark

Sleep gets harder as you age, and it happens to a lot of people. The frustrating part is that most older adults never bring it up with their doctor because they assume it’s just something they have to live with, but it isn’t.

According to the Sleep Foundation, somewhere between 10 and 30 percent of adults deal with insomnia. Among older adults, that number is closer to 50 percent. Understanding why helps, but so does knowing what you can actually do about it.

Why Older Adults Struggle More

Your body’s internal clock shifts as you get older. Think earlier bedtimes, earlier wake-ups, and less deep sleep. However, biology isn’t the whole story. New health conditions, new medications, and routine changes after retirement can all make things worse.

The list of conditions that disrupt sleep is long. It includes depression, anxiety, heart failure, arthritis, diabetes, asthma, chronic pain, sleep apnea, and more. A lot of older adults are dealing with more than one at the same time, which is part of why sleep problems become so stubborn.

Medications are worth looking at closely. Legacy pharmacist Ravi Gandhi points to several drug types that can quietly hurt sleep quality:

• Sleep aids like Ambien and Lunesta, known as Z-drugs
• Anti-anxiety medications called benzodiazepines
• Older allergy medicines like Benadryl (diphenhydramine)
• Older antidepressants called tricyclics, like amitriptyline and nortriptyline
• Sedatives called barbiturates

A major prescribing guide for older adults, called the 2023 AGS Beers Criteria, flags all of these as risky for older patients — raising the odds of falls, confusion, memory problems, and dependence. Many patients are never told that.

Gandhi adds that this doesn’t mean they’re completely off the table. “It should be a decision made together with the patient,” he said, “weighing the risks, their preferences, and their goals.”

Timing matters too, even beyond which medications are prescribed. “Something as routine as taking a water pill for blood pressure at the wrong time of day can cause enough nighttime bathroom trips to seriously break up sleep,” Gandhi said. A simple fix, like taking it in the morning instead, can make a difference.

The Consequences Go Beyond Feeling Tired

Feeling wiped out the next day is the obvious problem. But the longer-term risks are even more important. Medical News Today points to research connecting chronic insomnia with depression, anxiety, heart attack, stroke, and high blood pressure.

But perhaps the most serious risk is what’s happening in the brain. The Fisher Center for Alzheimer’s Research Foundation covered a study in the journal Neurology that found older adults with chronic insomnia were 40 percent more likely to develop dementia or mild cognitive impairment than people who slept well.

Researchers estimated that persistent poor sleep aged the brain by three to four years. That’s notable. The good news is that better sleep is achievable, and the path there doesn’t have to start with a prescription.

What Treatment Actually Looks Like

A lot of people reach for sleeping pills first, but for older adults, those are the very medications flagged as problematic.

Another option is cognitive behavioral therapy for insomnia, or CBT-I. Sailor Health calls it the most effective first-line treatment for chronic insomnia in older adults, and the Beers Criteria backs that up.

“CBT-I teaches people to change the thoughts and habits that get in the way of good sleep,” Gandhi said. “Things like lying in bed awake for hours or worrying about not sleeping enough.” It gets to the root of the problem instead of covering it up — typically through six to eight sessions with a trained therapist, adjusted for individual challenges like chronic pain or nighttime bathroom trips, with results that actually last and no side effects experienced.

If CBT-I isn’t enough on its own, medication can still be part of the picture, but the default choices aren’t always the best ones.

“There are FDA-approved options with a better safety record for older adults, including some newer medications that work by blocking the brain signal that keeps you awake,” Gandhi said. “The right fit depends on the person, but they’re worth bringing up if you and your doctor decide medication is the right call, typically for a short-term course rather than ongoing use.”

When to Seek Care

If you or someone you love has been struggling to fall asleep or stay asleep at least three nights a week for three months or longer, that’s chronic insomnia. Bring it up at your next appointment. Your provider can rule out any underlying issues and point you toward a CBT-I therapist if that’s the right fit. When medications come up, ask your pharmacist to review everything you’re already taking.

Sleep problems don’t have to be permanent. At Legacy Community Health, we’re here to help older adults get the all-around care they need, including a decent night’s sleep.

Sources

Insomnia and Older Adults — Sleep Foundation | What to Know About Insomnia in the Elderly — Medical News Today | How CBT Can Help Insomnia in Seniors — Sailor Health | Insomnia Can Age the Brain — Fisher Center for Alzheimer’s Research Foundation | Jaqua et al. (2023), The Permanente Journal | Garcia (2008), Clinics in Geriatric Medicine | Crowley (2011), Neuropsychology Review | 2023 American Geriatrics Society Beers Criteria® Update Expert Panel, J Am Geriatr Soc | Steinman MA (2025), J Am Geriatr Soc