This meta-analysis evaluates the benefits and risks of short-term treatment with sedative hypnotics in older people with insomnia. The study included 24 randomized controlled trials involving 2417 participants. The results showed that sedative use improved sleep quality (effect size 0.14, P < 0.05), increased total sleep time (mean 25.2 minutes, P < 0.001), and reduced the number of nighttime awakenings (0.63, P < 0.001) compared to placebo. However, adverse events were more common with sedatives than with placebo, including cognitive events (odds ratio 4.78, 95% CI 1.47 to 15.47, P < 0.01), psychomotor events (odds ratio 2.61, 95% CI 1.12 to 6.09, P > 0.05), and daytime fatigue (odds ratio 5.82, 95% CI 1.88 to 7.80, P < 0.001). The authors conclude that while sedative use improves sleep quality, the small magnitude of the effect is outweighed by the increased risk of adverse events, particularly in older adults at risk of falls and cognitive impairment. Non-pharmacological therapies, such as cognitive behavior therapy, may be a viable alternative for older patients with insomnia.This meta-analysis evaluates the benefits and risks of short-term treatment with sedative hypnotics in older people with insomnia. The study included 24 randomized controlled trials involving 2417 participants. The results showed that sedative use improved sleep quality (effect size 0.14, P < 0.05), increased total sleep time (mean 25.2 minutes, P < 0.001), and reduced the number of nighttime awakenings (0.63, P < 0.001) compared to placebo. However, adverse events were more common with sedatives than with placebo, including cognitive events (odds ratio 4.78, 95% CI 1.47 to 15.47, P < 0.01), psychomotor events (odds ratio 2.61, 95% CI 1.12 to 6.09, P > 0.05), and daytime fatigue (odds ratio 5.82, 95% CI 1.88 to 7.80, P < 0.001). The authors conclude that while sedative use improves sleep quality, the small magnitude of the effect is outweighed by the increased risk of adverse events, particularly in older adults at risk of falls and cognitive impairment. Non-pharmacological therapies, such as cognitive behavior therapy, may be a viable alternative for older patients with insomnia.