Sleeping Pills for Seniors vs. CBT-I in Alberta

Poor Sleep Isn’t Just “Part of Getting Older”

If you’re over 65 and lying awake at night, waking at 4 a.m. for good, or feeling foggy all day, you’ve probably been told it’s just age. It isn’t, at least not entirely. Sleep does change as we get older, but chronic insomnia is a treatable condition, not something you have to put up with.

It’s also common for older adults to end up on sleeping pills, sometimes for years. This guide explains why sleeping pills are a risky long-term answer for seniors, why Cognitive Behavioural Therapy for Insomnia (CBT-I) is the recommended first choice instead, and how seniors (and the people who care about them) can access CBT-I here in Alberta.

How Sleep Changes With Age

A few changes are a normal part of aging:

• Lighter, more broken sleep. Older adults tend to get less deep sleep and wake up more often during the night.
• An earlier body clock. Many seniors feel sleepy earlier in the evening and wake earlier in the morning.
• More health factors in the mix. Arthritis and other pain, needing to get up to use the washroom, heart and lung conditions, and medications can all disrupt sleep.
• Changes in routine. Retirement, less daytime activity and less time outdoors can weaken the cues that keep your body clock steady.

What doesn’t change much is your need for sleep. Most older adults still do best with roughly seven to eight hours. The problem is usually getting good-quality sleep, not needing less of it.

Here in Alberta, our seasons add a twist. Long summer evenings can push bedtimes later, and short, dark winter days can leave you with too little morning light to keep your body clock on track.

The Problem With Sleeping Pills for Seniors

When sleep goes sideways, it’s understandable to reach for a pill. Medications like benzodiazepines (such as lorazepam) and “Z-drugs” (such as zopiclone) can help you sleep in the short term. But for older adults, the risks tend to be bigger and the benefits smaller. Guidance for prescribers, including the Beers Criteria and Choosing Wisely Canada, advises against using these medications as a first choice for insomnia in older adults.

The main concerns:

• Falls and fractures. Next-day drowsiness, dizziness and unsteadiness raise the risk of falling, especially on night-time trips to the washroom.
• Memory and thinking. Sedatives can affect memory, attention and alertness the next day.
• Dependence and rebound insomnia. The body adjusts to these medications, so they often seem to work less well over time, and stopping suddenly can make sleep worse for a while.
• Drug interactions. Many seniors take several medications, and sleep aids can add to the sedating effect of others, or of alcohol.
• Driving safety. Lingering sedation the next morning can affect reaction time behind the wheel.

Over-the-counter sleep aids aren’t automatically safer, either. Many contain sedating antihistamines, which can cause confusion, constipation and urinary problems in older adults. Ask your pharmacist before using them.

For a side-by-side look at the options, see our guide to CBT-I vs. sleeping pills.

Already Taking Sleeping Pills?

Please don’t stop them suddenly. Coming off sleep medication should be done gradually with your doctor or pharmacist, who can set up a safe tapering plan. CBT-I pairs well with a taper, since it gives you skills to rely on as the dose comes down.

Why CBT-I Is the Recommended First Choice

CBT-I is a short, structured therapy that targets the habits and thought patterns that keep insomnia going. It’s recommended as first-line treatment for chronic insomnia in adults, including older adults, and unlike medication, its benefits tend to last after treatment ends. (For the full explanation, see what CBT-I is and how it works.)

For seniors specifically, CBT-I has some real advantages:

• No falls risk, no next-day grogginess and no drug interactions.
• It works with health conditions, not against them. A clinician can tailor it around pain, medications and mobility.
• It addresses the worry. Lying awake fretting about sleep is common, and CBT-I helps break that cycle.
• The skills are yours to keep. If sleep slips again during an illness or a stressful stretch, you’ll know what to do.

How CBT-I Is Adapted for Older Adults

Sleep Scheduling (Sleep Restriction or Compression)

CBT-I temporarily matches your time in bed to the amount you’re actually sleeping, which builds up sleep drive and makes sleep deeper and less broken. Then your time in bed is gradually extended. Many seniors spend long hours in bed “resting,” which can actually make sleep more fragmented.

For older adults, clinicians often use a gentler version called sleep compression, which trims time in bed gradually rather than all at once. This keeps daytime sleepiness in check, which matters for falls and driving. It’s best done with a trained clinician, especially if you have a health condition such as seizures or bipolar disorder, or if you drive for a living.

Stimulus Control

This retrains your brain to link bed with sleep:

• Go to bed when you’re sleepy, not just because it’s a certain time.
• If you’re awake for what feels like 15 to 20 minutes, get up, go somewhere comfortable with dim light, and do something calm until you feel sleepy.
• Keep the bed for sleep and intimacy, not TV or worrying.
• Get up at the same time every day.

Safety tip for seniors: keep a night light or motion-activated light along the path from your bed, and have a comfortable chair and a blanket ready in the room you’ll go to.

Rethinking Thoughts About Sleep

Common beliefs like “I need eight hours or I’ll be useless tomorrow” or “waking up at night means something is wrong” can create pressure that keeps you awake. CBT-I helps you test these thoughts and replace them with more accurate ones, like “Waking briefly during the night is normal at my age.”

Working With Your Body Clock

If you’re falling asleep in your chair at 8 p.m. and waking at 4 a.m., your body clock may have shifted earlier. Bright light in the late afternoon or early evening, staying active after supper, and avoiding evening dozing can help nudge things back. Morning daylight still matters too, especially in an Alberta winter.

Daytime Habits That Support Night-Time Sleep

• Stay active. Regular movement during the day, even a walk around the block or a seniors’ fitness class, helps sleep.
• Keep naps short and early. If you need one, aim for 20 to 30 minutes in the early afternoon.
• Watch evening fluids, caffeine and alcohol. These can increase night-time washroom trips and broken sleep.
• Build a wind-down routine. A warm bath, reading or calm music in the hour before bed signals that sleep is coming.
• Keep the bedroom comfortable. Dark, quiet, cool and safe to get in and out of.

What to Expect in CBT-I Sessions

CBT-I usually runs about four to eight sessions over several weeks, in person or by video. You’ll start with an assessment of your sleep, health and medications, then keep a simple sleep diary (bedtime, wake time, how long it took to fall asleep and how often you woke up). Your clinician uses the diary to adjust your plan week by week. There’s “homework” between sessions, and the effort you put in is what makes it work.

Rule Out Other Sleep Problems

Insomnia isn’t the only cause of poor sleep in later life. Talk to your doctor if you have:

• Loud snoring, gasping or pauses in breathing (possible sleep apnea).
• Uncomfortable urges to move your legs in the evening (possible restless legs syndrome).
• Acting out dreams, such as shouting or kicking in your sleep.
• Low mood, loss of interest or ongoing worry, which often go hand in hand with insomnia.
• Frequent night-time urination, which may have a treatable cause.

CBT-I can still be helpful alongside treatment for these conditions, but it’s important to get them checked.

Sleep, Pain and Caregiving

Two situations come up often for older Albertans:

• Living with chronic pain. Arthritis, back pain and other conditions can make it hard to get comfortable and easy to wake up. CBT-I can be adapted to work alongside your pain treatment. See our guide to CBT-I for people with chronic pain.
• Caring for a spouse or family member. Many seniors are caregivers themselves, and night-time care plus constant worry takes a toll on sleep. Our CBT-I guide for caregivers covers how to protect your own sleep while caring for someone else. If you’re an adult child helping a parent with sleep, it’s a good read for you too.

Getting CBT-I as a Senior in Alberta

There are a few ways to access CBT-I in Alberta:

• Start with your family doctor. They can review your medications, rule out other sleep problems and make referrals.
• Ask your pharmacist. Pharmacists can review your medication list for anything that may be affecting your sleep and can help plan a sleeping pill taper with your doctor.
• See a psychologist or other clinician trained in CBT-I. Private psychology services generally aren’t covered by Alberta Health Care, but they’re often covered in part by retiree or extended health benefit plans, so it’s worth checking yours.
• Try virtual sessions. CBT-I works well by video, which is handy if you live outside a major centre, don’t drive at night, or would rather avoid winter roads.
• Call Health Link at 811 for advice and information about local services.

You’ll find more about local options on our Alberta CBT-I page. If you’d like help finding a CBT-I provider for yourself or a parent, contact us.

Common Myths About Seniors and Sleep

• “Older people need less sleep.” Most older adults still need around seven to eight hours. Sleep gets lighter, but the need doesn’t disappear.
• “Waking up a lot at night is just normal now.” Some brief waking is normal. Long, frustrating stretches awake most nights are not, and they’re treatable.
• “Sleeping pills are my only option.” CBT-I is the recommended first choice and tends to give longer-lasting results than medication.
• “I’m too old to change my habits.” CBT-I works well for older adults. It’s practical and step by step, and you don’t need to be tech-savvy.

Frequently Asked Questions

Are sleeping pills safe for seniors?

Sleeping pills can sometimes be used short term under a doctor’s care, but for older adults they carry real risks, including falls, next-day drowsiness, memory problems and dependence. That’s why CBT-I is recommended as the first choice for chronic insomnia in seniors.

Can I stop my sleeping pills as soon as I start CBT-I?

No. Never stop sleep medication abruptly. Work with your doctor or pharmacist on a gradual taper. Many people taper while doing CBT-I.

Does CBT-I work for people in their 70s and 80s?

Yes. CBT-I is effective for older adults, and clinicians adjust it for health conditions, mobility and safety, for example by using gentler sleep scheduling.

Is CBT-I covered by Alberta Health Care?

Sessions with a private psychologist generally aren’t covered by Alberta Health Care, though extended health or retiree benefit plans often cover part of the cost. Some publicly funded programs may be available in your area, so ask your family doctor or call 811.

How long does CBT-I take to work?

Most people do about four to eight sessions over several weeks, and many notice improvement within the first few weeks. Sticking with the plan, especially the sleep schedule, makes the biggest difference.

What if I have sleep apnea or another health condition?

CBT-I can usually still help, alongside treatment for the other condition. Make sure your doctor knows about all your symptoms so anything else going on gets checked.

Better Sleep Is Possible at Any Age

Restless nights aren’t something you have to accept as part of aging, and sleeping pills don’t have to be the answer. CBT-I offers a safer, lasting way to improve your sleep, and with virtual options available across Alberta, it’s easier to access than ever. Talk to your doctor, or reach out to us to get started.