Insomnia after 60: what changes and what helps

Insomnia after 60: what changes, and what helps

Sleep becomes lighter and more broken as we get older^[3]. But insomnia that affects your days is not something you simply have to live with: CBT-I is effective in older adults, including in digital form^[1]^[2], whereas sleeping pills carry significant risks at this age, especially falls^[5].

By Andy Leleux, sleep technologist · Updated on 28 October 2026

Key points

Sleep changes with age: falling asleep takes a little longer, and sleep is lighter^[3].
As a guide, after 65: 7 to 8 hours of sleep^[4].
CBT-I improves sleep in older adults, both face to face and online^[1]^[2].
The Belgian guideline sees no place for a sleeping pill as a first-line option after 65^[5].

What changes with age

A large meta-analysis of sleep recordings shows that as we age, it takes a little longer to fall asleep, light sleep takes up more of the night and REM sleep (when most dreaming happens) decreases^[3].

The National Sleep Foundation suggests 7 to 8 hours of sleep after 65, compared with 7 to 9 hours for younger adults^[4]. To find out more: how much sleep you really need.

Normal ageing, or insomnia?

Slightly lighter sleep or waking a little earlier is not an illness. We call it insomnia when the difficulties occur at least three nights a week for at least three months and affect your days: tiredness, concentration, mood^[6]. At that point it isn't “just age”: insomnia can be treated at any age.

In older people, some causes are worth looking into with your doctor: pain, needing to pass urine at night, sleep apnoea, restless legs, medicines, low mood. See Do I have insomnia? and waking up at night.

Sleeping pills: greater risks

After 65, sleeping pills (benzodiazepines, zolpidem, zopiclone) carry a higher risk of prolonged sedation, memory problems, confusion and falls, with a risk of hip fracture. The Belgian general practice guideline sees no place for a sleeping pill as a first-line option in older people: the benefit is too small to justify the risks^[5].

Never stop suddenly

If you have been taking a sleeping pill for a long time, don't stop it on your own: stopping suddenly can cause withdrawal. Talk to your doctor, who can plan a very gradual reduction. See Sleeping pills and CBT-I.

CBT-I works after 60 too

CBT-I is the first-line recommendation for chronic insomnia, whatever your age^[6]. In older adults, a meta-analysis of 14 studies shows a clear improvement in sleep efficiency (about 8 percentage points), with less time awake at night (about 23 minutes) and faster sleep onset^[1].

In digital form, 9 trials involving 760 people aged 60 and over show a drop of about 4 points in insomnia score, still present at follow-up. The authors point out that these results mainly apply to “younger seniors” and that follow-up is still limited^[2].

Gentler settings

For older adults, the authors of the method suggest more flexible adjustment thresholds for the sleep window^[7]. In ReSomnia, from age 65, cautious settings apply: the window never goes below 5 hours 30 minutes, and it widens as soon as sleep efficiency reaches 85% (instead of 90%).

To understand the method: sleep restriction and stimulus control. One extra precaution when you get up at night: a night light to show the way lowers the risk of falling.

Frequently asked questions

Is it normal to sleep worse as you get older?

Slightly lighter sleep and more frequent awakenings are part of normal ageing. But insomnia that affects your days is not “normal”: it can be treated at any age.

How many hours of sleep do you need after 65?

The National Sleep Foundation's guidance is 7 to 8 hours. What matters most is feeling rested during the day.

Is CBT-I suitable for older people?

Yes. Studies show it improves sleep in older adults, both face to face and in digital form. The sleep window settings are simply gentler.

Are sleeping pills dangerous after 65?

They carry a higher risk of next-day drowsiness, confusion and falls. The Belgian guideline does not advise them as a first-line option in older people. Never change your treatment without talking to your doctor.

Should I avoid naps?

A long or late nap reduces your drive to sleep in the evening. During CBT-I it is best avoided; if you feel very sleepy, talk to your doctor or clinician.

Sources

[1] Huang K, et al. Efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older adults with insomnia: a systematic review and meta-analysis. Australas Psychiatry. 2022;30(5):592-597. PubMed

[2] Liu M, et al. Digital cognitive behavioral therapy for insomnia in older adults: a systematic review and meta-analysis. Int J Behav Med. 2026. PubMed

[3] Ohayon MM, et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27(7):1255-1273. PubMed

[4] Hirshkowitz M, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-43. PubMed

[5] CBIP. Répertoire commenté des médicaments, chapitre 10.1 « Hypnotiques, sédatifs, anxiolytiques », rubrique « Patients âgés » (version du 22/10/2026), qui résume le guideline WOREL. Link

[6] Riemann D, et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035. PubMed

[7] Spielman AJ, Yang CM, Glovinsky PB. Sleep Restriction Therapy. In: Behavioral Treatments for Sleep Disorders. Academic Press; 2011. Link

This guide provides information and does not replace advice from a doctor or psychologist. If you are in distress, call your local crisis line at any hour: 1813 or 0800 32 123 in Belgium, 116 123 in the UK and Ireland, 988 in the US. In immediate danger, call 112 in Europe or your local emergency number.