Objective To investigate the influence of hypnotic usage on all-cause and cause-specific mortality in a middle-aged population. Methods A cohort of 1750 men and 1773 women aged 30–65 years who responded to a postal questionnaire in 1983. The questionnaire included questions about hypnotic usage, sleep duration, sleep complaints, medical conditions, depression, demographic and life style variables. Mortality data for the period 1983–2003 were collected. Results Regular hypnotic usage was reported by 1.7% of men and 2.2% of women, and was associated with short sleep, sleeping difficulties, several health problems and depression. During the 20-year follow-up period 379 men (21.5%) and 278 women (15.5%) died. After adjustment for potential risk factors in multivariate analyses regular hypnotic usage was associated with significantly increased risk of all-cause mortality in men (Hazard ratios [HR], 4.54; 95% confidence interval [CI], 2.47–8.37) and in women 2.03 (95% CI, 1.07–3.86). With regard to cause-specific mortality, regular hypnotic usage in men was a risk factor for coronary artery disease death, cancer death, suicide and death from “all remaining causes.” In women it was a risk factor for suicide. Conclusions Our results show an increased risk of all-cause mortality and cause-specific mortality in regular users of hypnotics.