A Newer Class of Sleep Medications Helped Older Adults Sleep Longer

CATEGORY: SLEEP & RECOVERY

Insomnia is common in later life, and the sleeping pills long used against it carry real risks at that age. A newer class of drugs works by a different route, and its effect has now been counted in minutes. Adults 65 and older taking orexin blockers slept roughly 20 to 34 more minutes a night than those given placebo, and spent up to 21 fewer minutes lying awake after first falling asleep. Those figures come from five randomized trials pooled together, covering more than 3,600 older adults, and published in the journal Sleep.¹

Blocking the Stay-Awake Signal

Orexin is a brain chemical whose job is to keep you awake, a built-in stay-alert signal. The drugs in this analysis, suvorexant, lemborexant and daridorexant, temporarily block it. Older sleeping pills work the other way around. Benzodiazepines and the related Z-drugs push the whole brain toward sedation, something like dimming every light in the house, and in older adults they are linked to next-day grogginess, confusion and falls. An orexin blocker aims at the single porch light that was keeping the house up.

Five Trials, a Sleep Lab and a Stack of Diaries

Each of the five trials handed out its pills at random. Drug or placebo, and nobody chose. Together they covered 2,235 adults aged 65 and older on an orexin blocker and 1,409 on placebo. Sleep was counted two ways: in a laboratory, where sensors record brain activity through the night, and at home, in participants’ own sleep diaries. The trials ran from about two weeks to six months, with the pooled results centered on the one-month mark. One caveat comes from the authors themselves. Most of the underlying trials enrolled adults of all ages, and the older-adult results had to be pulled out separately.

Twenty-One Fewer Minutes Awake, Half an Hour More Asleep

In the laboratory measurements, the higher dose of daridorexant cut time spent awake after first falling asleep by 21.2 minutes against placebo, and the lower dose by 13.0 minutes. Participants on the lower dose also fell asleep about 9 minutes sooner. Lemborexant added 34.1 minutes of recorded total sleep, roughly a sitcom episode. The diaries pointed the same way. By participants’ own reckoning, daridorexant added about 20.5 minutes of nightly sleep, and suvorexant between 16 and 23 minutes depending on dose. These are modest numbers. Measured in a laboratory, they are also a sturdier currency than a promise.

The Side Effects, and the Outcome Nobody Counted

Daridorexant’s side-effect rates looked much like placebo’s, a profile the authors called favorable. Lemborexant and suvorexant produced more side effects overall, though serious events did not increase. The authors are candid about what the pool will not support. Results varied considerably between studies on some measures, the trials lasted months rather than years, and evidence gathered specifically in older adults remains thin. What these trials counted was sleep. Falls and fractures over the long term, the outcomes that most worry clinicians about sedatives at this age, went unmeasured. Medication is also not the only approach here that has passed a randomized test. A 2025 trial of online cognitive behavioral therapy for insomnia, a structured course that resets sleep routines and the thought patterns keeping people awake, found that older adults who completed it were far more likely to see their insomnia lift than those given sleep education.² That route carries no drug side effects at all.

Key Takeaways

• Across five randomized trials of more than 3,600 adults aged 65 and older, orexin-blocking drugs added roughly 20 to 34 minutes of nightly sleep against placebo and cut time awake after falling asleep by up to 21 minutes.
• Daridorexant’s side-effect rates resembled placebo’s. Lemborexant and suvorexant caused more side effects overall, with no rise in serious events for any of the three drugs.
• The trials ran two weeks to six months and most were not designed solely for older adults, so long-term evidence specific to this age group is still limited.
• Structured online insomnia therapy, which uses no medication, also improved sleep in older adults in a separate 2025 randomized trial.

References

1. Rollo E, Antonioni A, Manzoli L, Di Lorenzo F, Flacco ME. Treatment of chronic insomnia in elderly adults with dual orexin receptor antagonists: a systematic review and meta-analysis. Sleep. 2026;49(8):zsag135. link
2. Ritterband LM, et al. A randomized controlled trial of a digital cognitive behavioral therapy for insomnia for older adults. npj Digital Medicine. 2025;8(1):458. link