Insomnia is common in older people and can be associated with significant daytime dysfunction. Sleep problems, and the medications used to treat them, may contribute to the risk of falls and fractures in this population; however, the independent effects of disturbed sleep or the risk of hypnotic use are not well understood. Data arising from the Study of Osteoporotic Fractures (SOF) cohort of elderly women have confirmed the link between sleep problems (measured subjectively or objectively) and an increased risk of falls after taking into account the use of insomnia medications (benzodiazepines) in a community-dwelling population of older women. The data also suggest that benzodiazepine use is associated with increased risk of falls, although this association is less clear-cut when insomnia/sleep problems are taken into consideration. The risk of falls should be considered when prescribing benzodiazepines in this population. So far no data exist concerning whether the effective treatment of insomnia in the elderly may help prevent falls. Furthermore, studies are warranted to evaluate the efficacy and safety of the non-benzodiazepine BZRAs (benzodiazepine receptor agonists) in relation to risk of falls. In addition, there is a need to include fall risk factors such as postural sway and reaction time as outcomes for trials of new insomnia treatments.