Talking therapy tops the drug-free rankings for poor sleep after 60

Sleep problems are common in older age and are tied to a wide range of adverse health outcomes, which makes them more than a nightly annoyance. Concerns about sleep medication in this age group have pushed attention towards drug-free alternatives, from exercise programmes to talking therapies to music. The difficulty is that these options are usually tested one at a time against a control, so nobody could say which deserved to be tried first. This review used a network approach to compare and rank 21 different non-drug interventions for older adults' sleep quality.

The researchers searched six databases, including PubMed, Scopus, Embase, Web of Science, the Cochrane Library and CINAHL, for randomised controlled trials published between 2000 and 2024 in adults aged 60 or over. Thirty-four trials with 3078 participants qualified, spanning 21 different interventions. A network meta-analysis was then run, a method that lets treatments be compared even when they were never tested head-to-head in the same trial, with interventions ranked by their probability of being best. The protocol was registered in advance on PROSPERO. Results were also broken down by how poor participants' sleep was at the start and by whether the programme ran at home or elsewhere.

Eleven of the 21 interventions significantly improved sleep quality, so older adults are not short of options that beat doing nothing. Cognitive behavioural therapy for insomnia combined with positive mood strategies ranked top, with standard cognitive behavioural therapy for insomnia in second place. The subgroups added texture: music therapy worked better for people with milder sleep problems, while the enhanced talking therapy showed its largest effects in those with worse baseline sleep and in settings outside the home. Traditional Chinese health-promotion exercise, by contrast, did better when delivered at home.

This is one of the broader attempts to rank drug-free sleep interventions for older adults against each other rather than only against a control, putting scattered single-intervention trials into one comparative framework. The stratified results are the newer contribution, suggesting the best choice depends on severity and setting rather than one approach fitting everyone. The authors are explicit that the certainty of the evidence is low. That means the rankings should be read as a current best guess rather than a settled league table, and better trials could reshuffle them.

If your sleep has worsened with age, this is a reason to know that drug-free approaches have genuine trial support, and that a structured insomnia-focused talking therapy currently holds the strongest ranking. It is also a reason to think the right option may depend on your situation: milder problems responded well to music therapy here, while worse sleep responded most to the enhanced talking therapy. None of this is settled, given the low certainty the authors flag. But the menu of credible non-drug options is wider than many people assume.