Objectives: Insomnia, defined by sleep initiation or maintenance difficulties, is linked to fatigue, depression, and chronic diseases. Though non-pharmacological treatment approaches are preferred, drugs like benzodiazepines and Z drugs are commonly prescribed, despite significant risks. Hypnotics, used by 9% of the general population and 11.9% of older women, can lead to severe side effects, especially among the elderly, including falls and increased mortality. This study aims to assess sleep quality, hypnotic use, and their impact on mortality among Brazilian older adults.

Methods: Using data from 8,004 cases from the Brazilian Longitudinal Study of Aging and sleep measures were collected from the first wave (2015–2016), and mortality data from the second wave (2019–2021). A cox hazard model was performed to analyze self-reported sleep quality (Likert scale from very poor to very good, and one yes/no question evaluating whether the individual had restful sleep for the most part of the past week) and sleeping pill use (past month frequency) in relation to mortality risk. Covariates included age, sex, marital status, education, income, comorbidities, smoking, alcohol consumption, and physical activity level.

Results: We found no association between self-reported sleep quality or experiencing restful and mortality risk after 4-6 years. On the other hand, when compared to individuals who did not take sleeping pills during the past month, hazard ratios (HR) for death were, respectively, 1.79 (1.11–2.88, p = 0.016) and 1.31 (1.03–1.65, p = 0.026) for those who took medication 1–2 times a week and those who took medication 3 or more times a week. Taking sleeping pills less than once a week had no association with mortality. While the top 3 mortality causes for individuals who did not use sleeping pills were stroke, myocardial infarction and diabetes, the top 3 causes for heavy users were myocardial infarction, lung cancer and chronic obstructive pulmonarydisease.

Conclusions: Insomnia must be adequately treated, but awareness of medication risks is vital. This study highlights higher mortality risk with frequent sedative-hypnotic use in older adults. Warranting non-drug treatments and careful hypnotic use could enhance health outcomes.