Sleep is an active physiological process to maintain health and wakefulness. Nowadays, the incidence of insomnia is high and affects people’s quality of life, and currently the main clinical treatment is medication, supplemented by other treatments. The use of pharmacological treatment should be strictly adhered to the principles of medication, for different types of sleep disorders to give individualized drug regimens. The use of phenobarbital for hypnosis has been eliminated. Currently, benzodiazepine agonists (both traditional benzodiazepines and non-benzodiazepine benzodiazepine agonists) are mainly used for hypnosis. These drugs bind mainly to the GABAA receptor complex. Ramelteon, a new melatonin receptor agonist, may have the greatest safety profile due to its selective agonism of hypothalamic M1/M2 receptors, but is not yet available in China. The antidepressants trazodone and mirtazapine and H1 receptor blockers may also be used for the treatment of insomnia in elderly patients, but they need to be used with caution. 1. Traditional benzodiazepines. BZ1 is associated with hypnotic and amnesic effects, while BZ2, BZ3 and BZ5 are associated with memory, cognition, muscle relaxation, antiepilepsy and anxiolysis. Therefore, traditional benzodiazepines have anxiolytic, anticonvulsant and muscle relaxant effects in addition to hypnotic effects. However, the muscle relaxation effect may lead to bruises and fractures in the elderly. Due to the presence of central respiratory depression, these drugs may aggravate the hypoxemia during nighttime sleep in patients with obstructive sleep apnea syndrome or chronic obstructive pulmonary disease. Elderly patients are sensitive to the hypnotic effects of benzodiazepines and are at increased risk of confusion when using them due to memory impairment, decreased drug clearance, and increased central nervous system sensitivity. Therefore, small doses should be started and the effects of the drug should be closely monitored. Since discontinuation of the drug usually leads to recurrence of insomnia, gradual dose reduction can minimize rebound insomnia. Non-benzodiazepine benzodiazepine agonists bind selectively to GABA-BZ1 and are only purely hypnotic. The sedative-hypnotic effect is similar to that of benzodiazepines, and is less likely to produce insomnia rebound and withdrawal syndrome at therapeutic doses, with less risk of abuse and memory impairment. Non-benzodiazepines have similar sedative-hypnotic effects to benzodiazepines, but with less dependence and withdrawal symptoms, and are considered to be suitable alternatives. However, the risk of drug abuse persists, especially in those patients with a history of alcohol or other drug abuse and psychiatric disorders. In general, zolpidem addresses both sleep difficulties and early awakening, and the recommended starting dose for older adults is 5 mg taken at bedtime. It is not tolerated by individual patients due to adverse effects. To date, no safety issues have been demonstrated for long-term use of zolpidem, so short-term use is recommended. It is used to induce and/or maintain sleep, but is not effective for early awakening symptoms in some patients. Dexrazopiclone has been approved by the U.S. Food and Drug Administration for unrestricted use in the short term, and long-term use for the treatment of chronic primary insomnia has not shown tolerance for induction and maintenance of sleep. However, this drug has some anticonvulsant, anxiolytic and muscle relaxant effects (stronger than zolpidem). Alcohol needs to be avoided during use. 2. Melatonin. Pineal gland secretion can adjust the circadian rhythm of the hormone, can effectively treat circadian rhythm disorders. It is hypnotic, sedative, and regulates the sleep-wake cycle. Melatonin is a high affinity receptor agonist and has a direct sleep-inducing effect. The newly introduced ramelteon is a highly selective agonist of melatonin receptors MT1 and MT2, which can significantly shorten the sleep latency and prolong the total sleep time with a short half-life and no significant next-day residual effects. The efficacy of this class is not exact, in excess of the physiological dose from the theoretical tendency to aggravate depression, will inhibit the secretion of endogenous melatonin. 3, sedative antidepressants. These drugs are mainly tricyclic antidepressants, trazodone, mirtazapine, they are used to improve sleep while treating depression, mainly for insomnia caused by depression, tricyclic antidepressants amitriptyline, doxepin, promethazine because of blocking histamine-H1 receptors can produce strong sedative effect, but easily cause postural hypotension and tachycardia, these adverse effects on patients with cardiac insufficiency, especially These adverse effects are extremely detrimental to patients with cardiac insufficiency, especially the elderly, and limit its clinical application. Trazodone, which selectively blocks 5-HT reuptake, has a moderate antagonistic effect on 5-HT2 receptors and has good anxiolytic and antidepressant effects. However, it is not usually used alone but as an adjunct to other antidepressants. Mirtazapine promotes the release of norepinephrine and 5-HT by blocking the central α2 adrenoceptors, and has antidepressant, anxiolytic and sleep improving effects.