Z Drugs and Insomnia

There are different types of sleep medications, which affect the brain and body in different ways. Most have limited benefits. Z drugs can help you fall asleep faster and stay asleep longer.1-5

How do Z drugs work?

Z-drugs work on the GABA receptor by slowing activity in the brain. They are nonbenzodiazepines, a class of short-acting hypnotics. They come in different formulations. One type helps people fall asleep faster (zaleplon), while others help you fall asleep faster and stay asleep longer (eszopiclone and zolpidem). Z drugs are commonly prescribed for women and younger people.1-3,5

Formulations of Z drugs

Formulations of Z drugs include:1-4

  • eszopiclone / zopiclone (Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien)
  • zolpidem (Edluar, dissolvable tablet)
  • zolpidem (Intermezzo, dissolvable tablet)
  • zolpidem (ZolpiMist, oral spray)

Z drugs are a first-line medication therapy for insomnia. Each affects the central nervous system and addresses a different aspect of insomnia.4

Zopiclone has the longest-lasting effects. It is good for people who wake up in the middle of the night and have difficulty falling back asleep. It should be used when you have at least 7 hours left to sleep. Without sufficient sleep time, some people may experience a sense of sleepiness the morning after use.4,5

Zaleplon is very short-acting. It can be taken during the night for someone with intermittent sleep disturbance. However, it should not be taken without having at least 5 hours before you need to drive or operate machinery.4,5

Zolpidem is absorbed quickly. It has a short duration of action and is appropriate for people who have difficulty falling asleep. It comes in pill form, as a dissolvable tablet and an oral spray.4,5

Z drugs and insomnia

If you have severe sleep problems, you may benefit from taking a prescription sleep drug for a short time. They are often prescribed for a few weeks along with other therapies like cognitive behavioral therapy for insomnia (CBT-I). The drugs are intended to help while therapy becomes effective. The objective is to manage sleep problems without medications.3

What are some of the possible side effects of Z drugs?

All sleep medications have some side effects and risks. The most common ones are drowsiness, dizziness, feeling less alert, confused, or unsteady the next day. Z drugs can minimize the feeling of a “daytime hangover.” 1-5

Talk to your doctor about all the medications you take, including vitamins, supplements, and herbal products before taking sleeping pills. There are common drugs, including antibiotics and antidepressants, that can interact with sleep medication. Read the medication guide to get the best results from your medication and to reduce the risks of negative side effects.

Anyone who has experienced complex sleep behavior such as sleepwalking, cooking or driving while asleep should tell their doctor and not take Z drugs.1

Many people take sleep medication more often or for longer than prescribed by their doctor. You should not take sleeping pills along with other sedative drugs, pain medications, antihistamines, or when drinking alcohol. Taking sleep medication can be habit-forming. Suddenly stopping after long-term use can lead to insomnia getting worse. This is called a rebound effect.3

Things to know about Z drugs

Z drugs are not indicated for most people over age 65. Research results suggest that older people are more likely to require hospitalization or emergency medical treatment because of side effects. This happens because as people age, they are likely to metabolize drugs more slowly. This can cause more medication to remain in the body and increase the risk of side effects. They are useful in insomnia treatment because they generally have a quick onset and a short duration of action. This results in a lesser risk of severe side effects or addiction.2,3

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Sleep medications should only be taken when you have enough time for a full night of sleep. All come with the caution not to drive or operate heavy machinery if you feel drowsy the next day. Sleep drugs should be used with caution if you need to be alert during the night because you are on-call or are the sole caretaker for young or disabled family members.1,3

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