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Sleeping tablets

Residents & families Aged care staff GPs & clinicians 6 min read

By Dr Josh Hatch, FRACGP

Sleep disturbance affects around 60% of people living with dementia 40. In Australian data, more than a third of residents were dispensed a benzodiazepine over a year, with a median of 240 days of supply 3. In older people, sleeping tablets improve sleep a little and cause side effects more often 39.

Numbers in the text link to the 4 sources listed at the foot of this page.

The evidence

Benzodiazepines and Z-drugs for insomnia in older people

Risk outweighs benefit

Sleep improves a little. Adverse effects on thinking and daytime alertness are several times more common.

The evidence

A meta-analysis of 24 randomised trials with 2,417 participants aged 60 and over with insomnia found that sedatives increased total sleep time by about 25 minutes, reduced night-time awakenings by 0.63 on average and improved sleep quality slightly (effect size 0.14). Adverse cognitive events were 4.78 times as common as with placebo (95% CI 1.47 to 15.47), and daytime fatigue 3.82 times as common (95% CI 1.88 to 7.80). The authors concluded that in people over 60 the benefits may not justify the increased risk 39.

In practice

The trials were short, in people free of psychiatric disorders, and not specific to residential care 39.

Written information and a tapering plan to help people stop

Promising, not yet proven

Giving older people clear information about the risks, with a step-by-step plan, led about a quarter to stop within six months in one trial. It was done in people living at home.

The evidence

In a Canadian cluster randomised trial of 303 long-term benzodiazepine users aged 65 to 95, recruited through 30 community pharmacies, an education booklet sent directly to participants led 27% to stop within six months, against 5% of controls (risk difference 23%, 95% CI 14% to 32%), and a further 11% to reduce the dose. About six in ten of those who received the booklet raised stopping with their doctor or pharmacist 41.

In practice

Participants lived in the community, not in residential care 41.

Z-drugs in people with dementia

Zopiclone and zolpidem are often thought of as gentler than benzodiazepines. In English primary care data, and in cohort studies from Norway, the United States and England, of people living with dementia, starting a Z-drug was associated with more fractures (hazard ratio 1.40, 95% CI 1.01 to 1.94), with risk rising with cumulative dose, and possibly more hip fractures (1.59, 95% CI 1.00 to 2.53). No excess of falls was detected 40.

The study was observational and examined many outcomes, which increases the risk of false-positive results. The authors recommended that any Z-drug prescription in dementia be reviewed regularly 40.

Other approaches

Non-drug approaches to sleep and the use of melatonin in dementia are discussed in the dementia care section.

Related pages on this site

Sources cited on this page

  1. 3 Kalisch Ellett LM, Kassie GM, Pratt NL, Kerr M, Roughead EE. Prevalence and duration of use of medicines recommended for short-term use in aged care facility residents. Pharmacy (Basel). 2019;7(2):55. (Department of Veterans’ Affairs claims data, 14,237 residents, 2015–2016; observational.) View source
  2. 39 Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331:1169. (24 randomised trials, 2,417 participants aged 60 and over.) View source
  3. 40 Richardson K, Savva GM, Boyd PJ, et al. Non-benzodiazepine hypnotic use for sleep disturbance in people aged over 55 years living with dementia: a series of cohort studies. Health Technol Assess. 2021;25(1):1–202. (Observational.) View source
  4. 41 Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174(6):890–8. (303 community-dwelling adults, Canada.) View source

See every source cited across the medicines and deprescribing section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. Evidence and Australian regulatory, PBS and program arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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