Sleeping pills after 65: little extra sleep, more risk

General information, not medical advice. Never stop a sleeping pill on your own and always discuss any change with your GP or pharmacist first.

Sleeping pills after 65 are no exception in Belgium: almost one in five people over 65 took sleeping pills or sedatives in the two weeks before a recent survey. A review of studies in people over 60 found little extra sleep against clear risks, and the new Belgian guideline limits sleeping pills in older people to exceptional cases. That is no reproach to anyone who takes them. There is a better approach, and tapering off can be done step by step, with support.

How many people over 65 in Belgium take sleeping pills

In the fourth BELHEALTH survey by Sciensano, the Belgian public health institute, 7,127 adults filled in an online questionnaire at the end of 2023. Of them, 14 percent had taken sleeping pills or sedatives in the previous two weeks. Among people over 65 it was 19 percent, among 18 to 29 year olds 6.1 percent. In 88 percent of cases it was a prescription medicine, and in 80.5 percent benzodiazepines or Z-drugs, the classic sleeping pills and sedatives. Across all ages, 78 percent of these users said they had been taking them for more than a year. According to Gezondheid en Wetenschap, Belgium is one of the leading countries in Europe in the use of these medicines.

That contradicts the advice. Sciensano points out that the guidelines recommend tapering off after four consecutive weeks, because these medicines are linked to dependence, tolerance, falls and road accidents, especially in older people.

What sleeping pills after 65 really deliver

A meta-analysis from the University of Toronto, published in the BMJ, pooled 24 studies with 2,417 participants aged 60 or older with insomnia. With a sleeping pill they slept on average 25.2 minutes longer and woke up 0.63 times less per night. Sleep quality improved only slightly. On the other hand, the risk of side effects on memory and thinking, such as confusion, was 4.78 times higher, and the risk of daytime fatigue 3.82 times higher. The researchers concluded that the benefit may not justify the risk.

There are caveats. The studies were always short, from five consecutive nights, so they say little about years of use, and the analysis dates from 2005. The new Belgian guideline does reach a similar conclusion.

What the new guideline from June 2026 recommends

In June 2026 a revised guideline for GPs on sleep complaints and insomnia was published. According to Domus Medica, the association of Flemish GPs, sleep medication has a very limited place in it. The BCFI, the Belgian medicines information centre, summarises that a sleeping pill is only an option for acute, severe insomnia, for at most one week and at the lowest possible dose. In people over 65 it remains limited to exceptional cases, because of the risk of memory problems, falls and fractures. Melatonin, valerian and passionflower are not recommended either.

An older couple winds down in the evening with a book and dimmed light, without screens

The foundation is an approach without pills. First come fixed times for getting up, no alcohol as a nightcap and a dark, quiet and cool bedroom. What a regular rhythm does is explained in the article on a regular sleep rhythm, and screen time before bed also deserves attention. Next come relaxation exercises, physical activity and cognitive behavioural therapy for insomnia, a guided approach that is also available digitally. One part of it is stimulus control: if you lie awake, you get up after 20 minutes, according to KU Leuven researcher Kristien Coteur, and do something boring until you feel sleepy. The guideline gives older people the same approach, adapted to their situation.

Tapering off with your GP and pharmacist

Anyone who takes a sleeping pill for a long time gets used to it and can become dependent. According to Kristien Coteur, physical dependence already develops after 2 to 4 weeks, even at a low dose. Stopping suddenly can cause withdrawal symptoms and worse sleep, which is why tapering off is done very gradually. According to the BCFI, a repeat prescription is a good moment to discuss the use, with priority for older people who take many different medicines. Since 2023 there has been an official tapering programme: the pharmacist makes capsules with ever lower doses, fully reimbursed, over 50 to 360 days. Points to discuss with your GP or pharmacist:

A GP sketches a tapering plan for a 69-year-old woman who has come to the appointment with her son

Whether you still need this medicine, and which risks weigh most heavily for you.
A tapering plan and a realistic stop date that you agree on together.
Whether you are eligible for the tapering programme with capsules from the pharmacist.
Which steps without pills you can already try in the meantime.

Sources

Sciensano. Vierde BELHEALTH-enquête, bulletin 4 (in Dutch). March 2024 (online survey from 21 November to 15 December 2023).
Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 2005.
BCFI, the Belgian Centre for Pharmacotherapeutic Information. WOREL-richtlijn over slaapklachten en insomnie herzien (in Dutch). 15 October 2026.
Domus Medica, the association of Flemish GPs. Nieuwe richtlijn aanpak van slaapklachten en insomnia (in Dutch). June 2026.
Vlaams Instituut Gezond Leven, the Flemish health promotion institute. Slaapproblemen? Een gezondere leefstijl is beter dan medicatie (in Dutch). 16 January 2023.
Gezondheid en Wetenschap, a Belgian evidence-based health information site. Slaap- en kalmeermiddelen (in Dutch). Accessed in October 2026.