Millions of older adults in the United States grapple with insomnia, a chronic sleep disorder that significantly diminishes quality of life. Paradoxically, despite widespread recognition within the medical community about the risks associated with sleep medications, a substantial portion of this demographic relies heavily on prescription drugs like benzodiazepines and Z-drugs—commonly prescribed hypnotics including Ambien—to combat sleeplessness. A groundbreaking study from the USC Schaeffer Center for Health Policy & Economics now elucidates the profound health and economic disadvantages linked to these medications among the elderly, proposing that curtailing their use might yield extensive benefits across the population.
Sleep disturbances in older adults are frequently treated pharmacologically despite well-documented perils. Benzodiazepines and Z-drugs, while effective for short-term symptom relief, have been implicated in increased incidence of falls, fractures, cognitive decline, and dependency syndrome, which can exacerbate morbidity in an already vulnerable population. These adverse outcomes have prompted leading medical societies to advocate against routine or prolonged use of such medications in older patients. The dilemma arises because withdrawal symptoms mimic insomnia, leading both clinicians and patients to misinterpret dependency as therapeutic tolerance or efficacy, thereby perpetuating continued use.
Leveraging the advanced computational power of the Future Elderly Model, an innovative dynamic microsimulation developed at the USC Schaeffer Center, researchers systematically modeled the lifetime impacts of prescribed sleep medications on individuals aged 50 and older. By contrasting current prescription patterns with a counterfactual scenario in which no older adults consume these hypnotics, the model projected changes in incidence rates of key health-related events including falls, cognitive impairment, nursing home admissions, healthcare expenditures, and overall lifespan. This robust modeling approach integrates demographic trends, disease progression, and economic variables to yield a comprehensive assessment of long-term outcomes attributable to pharmacological sleep aids.
The findings are striking: avoidance of sleep medications among adults over 65 could decrease lifetime incidence of fall-related injuries by approximately 8.5% and reduce cognitive impairment by roughly 2.1%. Notably, such reductions translate into a tangible extension of life expectancy averaging 1.3 months per individual and aggregating to 1.7 million additional life-years across the elderly U.S. population. Importantly, these gains are largely composed of years spent in good health, underscoring that reducing sleep drug use not only prolongs life but enhances its quality.
An intriguing age-specific nuance emerged, highlighting that adults aged 65 to 74 would garner the most pronounced cognitive and physical health benefits from discontinuing sleep medication. This age group appears to be at a critical inflection point where mitigating medication-related risks can meaningfully alter subsequent health trajectories. Therefore, interventions aimed at reducing prescriptions should prioritize this cohort to maximize public health impact and cultivate sustainable improvements in healthy aging.
Economic analyses within the study revealed substantial cost savings linked to reduced prescription hypnotics. Each individual who avoids these medications could save nearly $6,600 in lifetime healthcare costs, including medical treatment for adverse events like falls and cognitive decline. When extrapolated nationally, these savings approach $101 billion, predominantly derived from diminished healthcare utilization and improved quality of life. This dual advantage of health enhancement and cost containment situates the reduction of sleep medication use as a high-value target for health policy and clinical practice reform.
The study’s authors emphasize professional guidelines advocating cognitive behavioral therapy for insomnia (CBT-I) as the superior first-line treatment. Unlike pharmacotherapy, CBT-I addresses the underlying behavioral and cognitive contributors to insomnia, promoting sustainable sleep hygiene improvements without the risk of side effects or dependence. Evidence indicates CBT-I matches or surpasses hypnotics in short-term efficacy and excels in long-term outcomes, embodying a paradigm shift in insomnia management for older adults.
Implementation of safer prescribing practices constitutes a critical next step. Strategies successfully applied to curbing inappropriate use of antibiotics and opioids—such as electronic health record prompts requiring justification for prescriptions, physician peer benchmarking, and dissemination of educational resources—are promising avenues for influencing prescriber behavior regarding sleep medications. Embedding clinical decision support tools can enable clinicians to align treatment strategies with current evidence, tailoring interventions to minimize risks.
The complexity of insomnia in older adults, characterized not only by difficulty falling or staying asleep but also coupled with increased prevalence of comorbidities such as depression and cardiovascular disease, necessitates nuanced treatment approaches. While pharmacological agents provide transient relief, their adverse effect profile in this population mandates cautious, limited use only when alternative therapies fail or are contraindicated. This study lends compelling quantitative support to clinical recommendations prioritizing non-pharmacological treatments.
USC Schaeffer Center researchers undertook this study in collaboration with Northwestern University and the University of Washington, ensuring multidisciplinary expertise in epidemiology, health economics, and geriatrics. Financial support from the National Heart, Lung & Blood Institute and the USC-Yale Roybal Center for Behavioral Interventions in Aging facilitated the rigorous data analysis and simulation modeling central to the investigation. The authors declared no influence from funding bodies on study design or manuscript preparation, underscoring the integrity of the findings.
Addressing insomnia safely in older adults represents a public health imperative given the aging global population. By demonstrating that reduced prescription of sleep medications could measurably improve health outcomes while substantially reducing healthcare costs, this research paves the way for policy interventions and clinical practice changes that prioritize patient safety and well-being. This shift holds promise not only to extend longevity but to enhance the vitality of millions of older Americans confronting chronic sleep disturbances.
In summation, the USC Schaeffer Center study unequivocally supports re-evaluating the current dependence on prescription hypnotics in older adults. Embracing cognitive behavioral therapies and enacting prescriber support mechanisms can transform insomnia management, mitigating the deleterious effects of sleep medications. With thoughtful implementation, these findings herald a paradigm shift toward safer and more effective insomnia care that aligns with geriatric health priorities.
Subject of Research: The health and economic impacts of prescription sleep medications on older adults and potential benefits of reducing their use.
Article Title: Reducing Sleep Medication in Older Adults: Health Benefits and Cost Savings
News Publication Date: 22-Oct-2025
Web References:
USC Schaeffer Center for Health Policy & Economics Future Elderly Model: https://schaeffer.usc.edu/data/future-elderly-model/
The Lancet Regional Health – Americas DOI: http://dx.doi.org/10.1016/j.lana.2025.101284
References:
Heun-Johnson, H., Thunell, J., Cloughesy, J., Tysinger, B., Linder, J., Persell, S., Sullivan, M., & Doctor, J. (2025). The health and economic impacts of reducing prescription sleep medication use among older adults. The Lancet Regional Health – Americas. https://doi.org/10.1016/j.lana.2025.101284
Keywords: Insomnia, Older adults, Sleep medications, Benzodiazepines, Z-drugs, Cognitive behavioral therapy, Falls, Cognitive impairment, Health economics, Aging, Prescription practices, Public health
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