So far in our Hype vs. Reality: Sleep series, we’ve covered sleep hygiene and Cognitive Behavioral Therapy for Insomnia as first-line tools. This follow-up piece tackles the big question people ask next: Which sleep drugs actually help, and do any of them improve (or harm) long-term health and longevity?
Below, we cut through the hype and focus on real human trials, and what’s known (and unknown) about long-term outcomes.
The quick scoreboard
Most approved sleep medicines work as hypnotics to help you fall asleep faster and/or stay asleep longer in the short term. None are proven to extend lifespan:
- Older benzodiazepines/Z-drugs can help you sleep, but, in large population studies, they are linked to more falls, fractures, and even higher death rates, especially in older adults [1–7, 11].
- DORAs (dual orexin receptor antagonists like suvorexant, lemborexant, daridorexant) turn down the brain’s wake signal instead of broadly sedating the brain. They improve sleep and show less next-day driving impairment in controlled tests. [8–10, 12].
- A tiny dose (1–6 mg) of an older antidepressant used for sleep, doxepin, is good for staying asleep, with a generally favorable safety profile. [13–14].
- Over-the-counter antihistamines (e.g., diphenhydramine/doxylamine) are weak for chronic insomnia and carry anticholinergic side effects (confusion, constipation, dry mouth); therefore, it’s best to avoid using them in older adults [15–16].
- Trazodone remains widely used off-label, but evidence is mixed, and side effects (daytime grogginess, lightheadedness) are not rare [17–18].
- Melatonin is best as a body-clock (timing) tool and helpful for night owls or jet lag. For general insomnia, the benefits are modest, and new observational data urge caution with long-term, high-dose daily use [19–22].
Class-by-class truth serum
Benzodiazepines (e.g., temazepam) & “Z-drugs” (zolpidem, zopiclone, eszopiclone)
How they work: These drugs calm the brain by boosting a natural brake signal, so you feel sedated.
Efficacy: They can help you fall asleep faster and sleep longer in the short term. But with ongoing use, your body can adapt (tolerance), you may depend on them to sleep, and stopping can cause rebound insomnia.
Risks that matter for long-term health:
- Higher death rates (association): Large population studies link regular use of these sleep meds with higher all-cause mortality. It’s not proof of cause, but the signal shows up across multiple studies [1–3,14].
- Falls and fractures: A consistent finding, especially in older adults and at night, is more falls and broken bones with these medicines [4,6–7,18].
- Thinking and dementia: Research is mixed. Some analyses suggest a higher dementia risk, others don’t. Because of uncertainty (and other factors that can confuse results), it’s wise to avoid long-term use, particularly as you age [1,4,13].
- Guideline stance: The AGS Beers Criteria (expert guidance for older adults) recommend avoiding these drugs when possible because of delirium, cognitive side effects, and fall risk. [5,16]
Who they’re for: They are best reserved for short, specific situations (e.g., a brief crisis, supervised use for jet lag). They’re not longevity tools and not first-line for chronic insomnia.
Dual orexin receptor antagonists (DORAs): suvorexant, lemborexant, daridorexant
How they work: DORAs (suvorexant, lemborexant, daridorexant) turn down the brain’s “stay-awake” signal (orexin). That helps you fall asleep and stay asleep without broadly sedating the whole brain.
Efficacy: In clinical trials, people on DORAs fell asleep faster and slept longer than those on a placebo. Daridorexant 50 mg also improved daytime functioning in studies [8,11–12].
Early human lab work found that one dose of suvorexant (a DORA) made levels of two Alzheimer-related proteins in spinal fluid, amyloid-β and p-tau, drop a bit within hours. That’s an encouraging lab signal, but it’s not proof that it prevents dementia or Alzheimer’s. We still don’t have long-term studies showing DORAs lowering dementia risk or slowing decline [24,25].
Safety & performance: Compared with older sleeping pills (Z-drugs), DORAs show less next-morning driving/coordination impairment in controlled on-road tests (notably lemborexant up to 10 mg). The most common side effects are sleepiness and unusual dreams. So far, dependence risk appears lower than with older sedatives [8-12]
Who they’re for: If you truly need an ongoing prescription for insomnia, DORAs are often preferred over benzodiazepines/Z-drugs for many adults. Still use them with CBT-I, review regularly, and try tapering when sleep stabilizes.
Low-dose doxepin (1-6 mg)
How it works: At tiny doses, doxepin mostly blocks histamine (a wake-promoting signal in the brain). That helps you stay asleep without the heavy “dry mouth/confusion” effects seen with strong antihistamines.
Efficacy:In multiple clinical trials, 1–6 mg improved staying asleep and overall sleep efficiency, including in older adults. Side effects are usually mild sleepiness. [13–14]
Who it’s for: A solid option if you wake up in the middle of the night or have maintenance insomnia, especially for older adults, where benzodiazepines/Z-drugs can be riskier.
Trazodone (off-label)
How it works: Trazodone is an antidepressant that makes you sleepy by nudging serotonin and blocking certain receptors (histamine H1 and α1). The net effect is again sedation.
Efficacy: The research is mixed. Reviews find limited-quality evidence: some people report fewer awakenings or better-feeling sleep, but the better sleep-lab studies don’t show strong, consistent benefits. Moreover, side effects are common: daytime grogginess, lightheadedness on standing (orthostatic hypotension), and dry mouth. [17–18]
Who it’s for: It’s widely used out of habit and a sense that it’s “safer,” but the evidence doesn’t support it as a first choice for insomnia. Consider CBT-I or other targeted options first. [17–18]
Efficacy: The research is mixed. Reviews find limited-quality evidence: some people report fewer awakenings or better-feeling sleep, but the better sleep-lab studies don’t show strong, consistent benefits. Moreover, side effects are common: daytime grogginess, lightheadedness on standing (orthostatic hypotension), and dry mouth. [17–18]
Who it’s for: It’s widely used out of habit and a sense that it’s “safer,” but the evidence doesn’t support it as a first choice for insomnia. Consider CBT-I or other targeted options first. [17–18]
Melatonin (and ramelteon)
How they work: Melatonin is your body’s clock signal. It helps shift when you feel sleepy (great for night owls or jet lag), but it’s not a strong knock-out sedative. Ramelteon is a prescription drug that mimics melatonin at the same receptors.
Efficacy: Meta-analyses show modest benefits: a shorter time to fall asleep and a small increase in total sleep. They’re most useful for delayed sleep phase or travel; effects may top out around ~3–4 mg in dose–response work. Ramelteon reliably helps people fall asleep faster without next-day fog. [19,21-23]
Safety & longevity: Clinical studies suggest good long-term safety when used appropriately. But, a new large observational analysis (AHA 2025) linked year-plus over-the-counter melatonin use with higher heart-failure and mortality risks. That doesn’t prove causality (users may be sicker; OTC doses/purity vary), but it’s a caution flag: use melatonin on purpose (right timing, low dose), not by default every night. [15,22,23]
Who it’s for: Best as a timing tool, e.g., 0.5-3 mg in the early evening for delayed clocks. For general insomnia, expect modest help. Choose regulated products when you can, and avoid long-term high doses unless there’s a clear reason. [19,21–23].
Do any sleep meds extend life?
Sleep meds can ease symptoms, you may fall asleep faster, stay asleep longer, and function better the next day. DORAs also seem to have safer next-morning effects than older pills. But so far, no sleep drug has shown hard healthspan benefits or longer life. We don’t have trials proving that months or years on these meds reduce heart attacks, strokes, fractures, or dementia.
Several (notably benzodiazepines/Z-drugs) are associated with higher mortality and fractures in observational data, especially in older populations [1–7,14,18]. Newer DORAs look safer functionally (e.g., driving) in trials, but we lack long-term outcomes. Melatonin is promising for circadian issues with generally good clinical safety, yet the new large-scale observational signal around long-term supplement use argues for targeted, not habitual use [15,22].
Bottom line: improving sleep absolutely supports healthspan, but today the best-evidence path is fixing behaviors and disorders (CBT-I, apnea treatment, circadian alignment). Sleep drugs can be useful assistants, not proven healthspan therapies.
Practical playbook (science-first)
- Start with CBT-I. It outperforms hygiene alone and leads to durable gains without medication risks. Use meds as adjuncts, not substitutes.
- Match the medicine to the problem under medical supervision:
Important disclaimer: The following is general information, not medical advice. Sleep medicines have risks and interactions. Talk to a qualified clinician (sleep specialist or your doctor) before starting, stopping, or changing any treatment.
- Sleep maintenance → low-dose doxepin [13–14].
- Delayed sleep phase or jet lag → melatonin/ramelteon with precise timing [19,21–23].
- If a chronic Rx is needed → consider DORAs (suvorexant/lemborexant/daridorexant) and re-evaluate periodically [8–12].
- Avoid chronic benzodiazepines/Z-drugs, especially in older adults [4–7,16,18].
- Skip OTC antihistamines for routine insomnia; risk > benefit in older adults [15–16].
- Use the lowest effective dose, shortest duration, and have a plan to stop, so you’re not stuck on it indefinitely.
- Check for sleep apnea, restless legs, circadian misalignment, pain, medications, alcohol, caffeine, drugs won’t fix these root causes.
- Reassess regularly: function, side effects, falls risk, and driving safety, especially as people age.
Who to talk to (and where to start)
If you’ve made it this far, the next best step is finding the right teammate. Start with your GP to rule out meds/interactions and screen for apnea, restless legs, and circadian delay.
If insomnia’s been around ≥3 months, loop in a CBT-I clinician (behavioral sleep medicine) and, when meds are on the table or symptoms are complex, a board-certified sleep physician to weigh options like DORAs, low-dose doxepin, or ramelteon/melatonin and to set a taper plan.
Not sure where to look? Try the AASM directory for sleep doctors and labs, the Society of Behavioral Sleep Medicine for CBT-I providers, and official FDA/EMA medication guides for information about risks/benefits. And if you want a second brain on your plan, you can always reach out to us at the LSF. We are happy to help you navigate next steps. The aim isn’t just “more sleep”; it’s better days, safer nights, and a plan you can adjust as you go.
References
1. Kripke DF, et al. (2012). Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open, 2(1), e000850
2. Kripke DF, et al. (2016). Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. Sleep Medicine, 43, 103–109.
3. Kripke DF, et al. (2018). Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. Sleep Medicine, 43, 103–109. [Version 3]
4. Choi J-W, et al. (2018). Hypnotics' association with mortality or cancer: a matched cohort study. J Clin Sleep Med.
5. American Geriatrics Society. (2023). Beers Criteria (updated). d1xe7tfg0uwul9.cloudfront.net+2health.uconn.edu+2
6. Treves N, et al. (2018). Z-drugs and risk for falls and fractures in older adults—a systematic review and meta-analysis. Age and Ageing, 47(2), 201–208
7. Jiang Y, et al. (2019).Insomnia, Benzodiazepine Use, and Falls among Residents in Long-term Care Facilities. J Clin Med, 8(2), 219.
8. Kishi T, et al. (2015). Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. Neuropsychiatr Dis Treat, 11, 2489–2496.
9. Mignot E, et al. (2022). Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. Lancet Neurol, 21(2), 125–139.
10. Vermeeren A, et al. (2019). On-the-road driving performance the morning after bedtime administration of lemborexant in healthy adult and elderly volunteers. Sleep, 42(4), zsy260.
11. Treves N, et al. (2018). Z-drugs and risk for falls and fractures in older adults—a systematic review and meta-analysis. Age and Ageing.
12. Kishi T, et al. (2025). Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. Transl Psychiatry.
13. Roth T, et al. (2007). Use of ultra-low-dose (≤6 mg) doxepin for treatment of insomnia in older people. Sleep, 30(11), 1555–1561.
14. Krystal AD, et al. (2010). Insomnia in the Elderly: A Review. J Clin Sleep Med.
15. Culpepper L, et al. (2015). Over-the-Counter Agents for the Treatment of Occasional Disturbed Sleep or Transient Insomnia: A Systematic Review of Efficacy and Safety. Prim Care Companion CNS Disord, 17(6).
17. Jaffer KY, et al. (2017). Suvorexant Acutely Decreases Tau Phosphorylation and Aβ in the Human CNS. Innov Clin Neurosci, 14(7–8), 24–34.
18. Albanese A, et al. (2023). Effect of lemborexant on sleep architecture in participants with insomnia disorder and mild obstructive sleep apnea. Sleep Medicine
19. Ferracioli-Oda E, et al. (2013). Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One, 8(5), e63773.
20. Choi K, et al. (2022). Efficacy of melatonin for chronic insomnia: Systematic reviews and meta-analyses. Sleep Med Rev.
21. Cruz-Sanabria F, et al. (2024). Optimizing the Time and Dose of Melatonin as a Sleep-Promoting Drug: A Systematic Review of Randomized Controlled Trials and Dose-Response Meta-Analysis. J Pineal Res.
22. AHA Scientific Sessions 2025: Long-term OTC melatonin use linked to ↑ HF/mortality (EHR analysis; not peer-reviewed). News coverage summarizing methods/effect sizes.
23. Moline M, et al. (2021). Comparison of the effect of lemborexant with placebo and zolpidem tartrate extended release on sleep architecture in older adults with insomnia disorder. Sleep Med, 79, 28–40 (open summary).
24. Insomnia drug may lower levels of Alzheimer's proteins, accessed September 5, 2025,
25. Orexin Receptor Antagonists for the Prevention and Treatment of Alzheimer's Disease and Associated Sleep Disorders - PubMed, accessed September 5, 2025,