Clinicians can improve sleep in older adults by screening more carefully for sleep apnea, starting with nondrug treatments for insomnia, and prescribing medications more selectively, experts said at the American Geriatrics Society (AGS) 2026 Annual Scientific Meeting.

Obstructive sleep apnea (OSA) becomes more common with age and is associated with chronic conditions, yet the breathing disorder frequently goes unrecognized, according to Sara Pasha, MD, medical director of the UK Sleep Disorders Center at the University of Kentucky in Lexington, Kentucky.

Untreated OSA disrupts breathing during sleep, which leads to drops in oxygen levels and frequent awakenings. Over time, these disruptions increase the risk for cardiovascular disease, stroke, diabetes, cognitive problems, and daytime fatigue. Pasha urged clinicians to think about OSA in patients with multiple conditions.

“Look at your patients with a lot of medical comorbidities and work your way backwards,” she said.

Home sleep tests have made diagnosis easier but have limitations. In-lab testing is necessary when suspicion of OSA is high.

Home tests “cannot be relied upon to rule out a diagnosis of sleep apnea,” Pasha said.

Although treatment with continuous positive airway pressure (CPAP) remains the standard, many clinicians hesitate to recommend the therapy because of the misperception of low rates of adherence in this population, Pasha said. Studies suggest that older adults often show higher adherence to CPAP therapy than younger adults.

“CPAP does help important medical outcomes and improves them,” Pasha said. “We should not write off our older patients as being inherently nonadherent to CPAP.”

Reducing High-Risk Medications

Clinicians should also reduce the use of higher-risk sleep medications, especially benzodiazepines and non-benzodiazepine receptor agonists, said Constance Fung, MD, professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

Stopping these medications takes planning and patient engagement, especially because many patients worry about what will happen to their sleep, said Fung.

“The first question many may ask is, ‘How will I sleep if I stop?’” she said.

“Deprescribing is not about denying effective treatment,” Fung said. “When done well, it’s patient-centered, uses shared decision-making, and is closely monitored.”

Withdrawal effects — such as rebound insomnia, anxiety, nausea, and headaches — differ depending on the drug, which makes individualized plans important.

Safer Medication Options

For patients who still need medication, newer options may be safer than older sedatives, said Brienne Miner, MD, assistant professor of geriatric medicine and sleep medicine at the Yale University School of Medicine in New Haven, Connecticut.

Clinicians should avoid benzodiazepines and non-benzodiazepine receptor agonists because they increase the risk for cognitive impairment, delirium, falls, fractures, and motor vehicle crashes, she said.

Miner highlighted alternatives with evidence in older adults, including low-dose doxepin, ramelteon, and a newer class called dual orexin receptor antagonists. These drugs include suvorexant, lemborexant, and daridorexant, which target the brain’s wake signals and can help with falling and staying asleep.

Even so, these medications require careful use. Daytime drowsiness can occur, and patients should be monitored closely, she said.

“Continue cognitive-behavioral therapy when possible, reassess benefit and next-day effects, [and] monitor fall risk, cognition, and polypharmacy,” Miner said.

Fung reported submitting an international patent application, receiving a donation from Daniel F and Z Drescher Kripke Revocable Trust, being a working-group member for clinical practice guidelines for management of chronic insomnia disorder and OSA, and consulting for AARP/Pillar 4.

Miner and Pasha reported having no relevant conflicts of interest.

Lara Salahi is a health journalist based in Boston.