Background: Aging is considered a biological, natural, and inevitable phenomenon that is associated with common problems of sleep quality and falls. The aim of this study was to evaluate the relationship between sleep quality and falls among the elders of Amirkola. Methods: In this case-control study, 250 elders, who were exposed to the falling, and 500 people without the previous falling were randomly selected during 2016-2017. The data were collected according to demographic and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Results: There was a significant relationship between sleep quality and falling, while no significant relationship was found between demographic characteristics (e.g., gender, marital situation, age, educational level, occupation, and satisfaction of income) and falling. The mean of chronic diseases was 3.65±2.29 and 4.38±2.75 in control and case groups, respectively (P=0.0001). A significant difference was found between the two groups regarding the number of falls during the last 12 months (P=0.0001). There was a significant positive correlation between the score of poor sleep quality and the number of chronic diseases (P=0.001, r=0.352), the number of falls during the last 12 months (P=0.001, r=0.137), and the number of falling during the last 12 months with the number of chronic diseases (P=0.001, r=0.208). There was a significant negative correlation between poor quality sleep with the score of physical activity (P=0.001, r=-0.166) and the number of chronic diseases with the physical activity score (P=0.001, r=-0.259). After adjusting the other variables, the number of chronic diseases (P=0.002, OR=1.114) and history of smoking (P=0.018, OR=1.678) were the most effective factors of falling. Finally, a direct positive correlation was observed between the total scores of sleep quality and falling in terms of gender in the older woman of Amirkola (P=0.001, OR=2.080). Conclusion: Awareness of the factors of falls can help develop prevention strategies and appropriate health services.