Benzodiazepines (BZD) are mainly used in the elderly to treat insomnia and anxiety, but it is more important to distinguish the cause and type of insomnia than to simply use BZD. A common cause of sleep disorders in the elderly is nocturia, and in such elderly people, it should be recommended to reduce fluid intake at night and take diuretics during the day rather than at night. For lack of sleep caused by modifiable external factors, such as uncomfortable sleep environment, irregular habits, excessive daytime sleep, lack of physical activity, intake of alcohol, coffee, tobacco, etc.; unrealistic expectations of sleep quality, etc., non-pharmacological treatment may be equivalent or more effective. Elderly patients with insomnia, before using BZD, should ensure good sleep habits, especially those that are detrimental to falling asleep at night and continuous sleep, and naps should be limited to half an hour to one hour. Various potential modulations of the physiological rhythms of the time system can improve sleep-wake rhythms in older adults. These modulations include bright lights, control of body temperature, and physical activity, which have improved sleep modifications without significant side effects and improve mood, executive function, and quality of life. Cognitive-behavioral therapy is more effective for older adults with insomnia and has long-term improvements in sleep, including cognitive, behavioral, and sleep hygiene instruction. Li Changming, Department of Psychiatry, Sanming Fourth Hospital If non-pharmacological treatment does not significantly improve insomnia, BZD can be started, and it is recommended to be used in small doses for a short period of time, which is not more than 2 to 4 weeks in many countries, such as the Netherlands, where BZD is prescribed for 10 to 14 days, and should be based on an assessment of the severity of symptoms and the patient’s sleep quality. However, for generalized anxiety disorder, long-term low-dose BZD use should not be considered an abuse. Other benzodiazepine receptor agonists such as zopiclone, zolpidem, and zaleplon, which are not significantly tolerated and dependence is less likely to occur, can also be used for short periods of time to reduce BZD use. For the elderly, short-acting BZDs such as oxazepam, lorazepam, and alprazolam are recommended because short-acting BZDs are rapidly metabolized and have greater flexibility in dose, but note that this class of drugs has significant withdrawal symptoms and a higher potential for abuse. The use of low-dose hypnotics for 1 to 2 weeks is only applicable to short-term insomnia. For chronic insomnia caused by physical, psychological or psychiatric disorders, hypnotics are rarely indicated and should be used primarily to treat the primary cause. Because of the side effects associated with BZD use in the elderly and 5-HT antidepressants are equally effective in treating a wide range of anxiety and depression, there is now a declining trend in the use of hypnotics, while low-dose antidepressants for the treatment of insomnia are rapidly increasing and are gradually replacing benzodiazepines, which are safer and more effective for the treatment of long-term insomnia, with trazodone being the most commonly used variety. Tricyclic antidepressants have more side effects and should not be used in the elderly. Although BZD is used at the beginning to prolong sleep, it alters the normal sleep pattern: light sleep is prolonged, while slow-wave sleep and fast-acting eye sleep are reduced, so although some people have improved sleep quality and duration after medication, polysomnography shows abnormal sleep patterns and no improvement in sleep quality. After a few weeks of continued treatment, sleep latency and duration regress to pre-treatment levels, tolerance develops rapidly, and rebound (meaning that primary symptoms worsen beyond the original baseline level after discontinuation) may occur in about 14% – 20% of cases. BZD may worsen anxiety symptoms with long-term use, so BZD should be controlled for short-term use (no more than 4 weeks) or intermittent administration in the treatment of anxiety symptoms. BZD can impair learning function and can reduce the effectiveness of psychotherapy for anxiety disorders. BZD has a long half-life and tends to accumulate in the body in the elderly, resulting in increased sedation and potential psychomotor impairment, and an increased risk of falls and hip fractures. One study showed that BZD increased the incidence of hip fractures in the elderly by 50%, with hip fractures occurring mainly in initial and high-dose users, and that the likely mechanism of occurrence was increased risk of falls secondary to BZD-induced cognitive impairment, gait instability, and impaired balance. Another systematic review and data analysis showed that BZD increased the risk of falls in the elderly, with no significant difference between short- and long-acting BZD. Cognitive impairment was more likely to occur after BZD use in the elderly compared to the young, mainly manifesting as cognitive amnesia, short-term memory loss, and amnesia. The risk of delirium is significantly increased when high doses of long-acting BZD are administered. BZD can also impair psychomotor executive function, which is characterized by a longer transient response time and a higher risk of traffic accidents in drivers. In conclusion, the elderly should be cautious and thorough when using BZD.