A meta-analysis of 24 randomized controlled trials involving 2417 older adults with insomnia found that sedative hypnotics improved sleep quality, increased total sleep time, and reduced nighttime awakenings compared to placebo. However, sedatives were associated with a higher risk of adverse events, including cognitive impairment, psychomotor effects, and daytime fatigue. The number needed to treat for improved sleep was 13, while the number needed to harm was 6, indicating that adverse effects are more common than benefits. Sedatives were particularly risky for older adults, increasing the likelihood of falls and motor vehicle crashes. The study highlights that the small improvements in sleep may not outweigh the increased risk of adverse events, especially in those at risk for cognitive or physical impairment. Non-pharmacological treatments like cognitive behavioral therapy were found to be as effective as sedatives for insomnia in older adults. The study emphasizes the need to carefully weigh the risks and benefits of sedative hypnotics in older patients, considering the potential for serious adverse effects.A meta-analysis of 24 randomized controlled trials involving 2417 older adults with insomnia found that sedative hypnotics improved sleep quality, increased total sleep time, and reduced nighttime awakenings compared to placebo. However, sedatives were associated with a higher risk of adverse events, including cognitive impairment, psychomotor effects, and daytime fatigue. The number needed to treat for improved sleep was 13, while the number needed to harm was 6, indicating that adverse effects are more common than benefits. Sedatives were particularly risky for older adults, increasing the likelihood of falls and motor vehicle crashes. The study highlights that the small improvements in sleep may not outweigh the increased risk of adverse events, especially in those at risk for cognitive or physical impairment. Non-pharmacological treatments like cognitive behavioral therapy were found to be as effective as sedatives for insomnia in older adults. The study emphasizes the need to carefully weigh the risks and benefits of sedative hypnotics in older patients, considering the potential for serious adverse effects.