Best Non-Med Therapy for Sleep in Older Adults

Combined aerobic and resistance training outperforms 18 other non-drug treatments for sleep

STUDY: Wang J et al, Arch Public Health. 2026 Apr 14.

STUDY TYPE: Systematic review and network meta-analysis

FUNDING: Shanghai University of Sport

Background

Sleep medications work — but in patients over 50, the risks add up: falls, brain fog, dependence, and dangerous drug interactions. So which non-med therapies are best?

The Study

This network meta-analysis pooled 132 randomized controlled trials with 10,872 adults aged 50+ with insomnia. The comparisons included 25 non-pharmacological interventions. Here’s what made a statistically significant difference:

1. Combined aerobic and resistance training had the largest effect (SMD effect size 1.56; 95% credible interval −2.08 to −1.03).
2. Acupressure (SMD 1.44)
3. Aerobic exercise alone (SMD 1.42)

CBT-insomnia, mindfulness, and resistance training alone all helped, but their effect sizes were smaller.

Benefits were largest in patients with moderately severe sleep disturbance (PSQI scores around 16) and with daily delivery. Patients stuck with these lifestyle approaches; only usual care reduced dropout compared to control.

Practice Implications

1. Combined aerobics-plus-strength training isn’t just “good for you.” It improves insomnia and sleep quality, with an effect size comparable to meds. Check for medical disorders that make exercise more risky.
2. If exercise isn’t feasible, acupressure is an underused, low-risk option
3. CBT for insomnia came up short here, but network analyses are prone to error, and it is is still the gold-standard
4. If using meds, here’s the latest recommendations (hint: orexin)