Abstract： Objective To investigate the effects of flupentixol and melitracen combined with alprazolam on sleep quality and neuroendocrine in elderly patients with insomnia and anxiety.Methods 72 cases of elderly insomnia with anxiety patients admitted to Luoyang Oriental People's Hospital were the study subjects(from October 2020 to October 2022),which were divided into the experimental group(36 cases)and the reference group(36 cases)based on the random draw method.The reference group was treated with alprazolam,and the experimental group was treated with flupentixol and melitracen combined with alprazolam.The two groups were compared in terms of clinical efficacy,levels of self-assessment scale of anxiety(SAS),Hamilton anxiety scale(HAMA),Pittsburgh sleep quality index(PSQI),self-assessment scale of depression(SDS),norepinephrine(NE),5-hydroxytryptophan(5-HT),brain-derived neurotrophic factor(BDNF)before and after treatment,and the occurrence of adverse reactions and adverse events.Results After treatment,the total effective rate of experimental group was 97.22%,which was higher than that of reference group(77.78%),and the difference was statistically significant(P＜0.05).After treatment,the scores of SAS,HAMA and SDS in experimental group were decreased more than those in reference group,and the difference was statistically significant(P＜0.05);the PSQI score of experimental group was lower than that of reference group,and the difference was statistically significant(P＜0.05).After treatment,the NE level of experimental groups was lower than that of reference group,and the BDNF and 5-HT levels were higher than that of reference group,with statistical significance(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions in the experimental group(19.44%)as compared to the reference group(16.67%)(P＞0.05).Conclusion Flupentixol and melitracen combined with alprazolam has a definite therapeutic effect on elderly patients with insomnia and anxiety.It can improve the level of neurotransmitters,improve sleep quality,alleviate anxiety,and promote recovery.