Sleep Fundamentals || Z is for Z-class drugs

Sleeping pills include drugs from a wide variety of classes; Z-class drugs are those developed specifically to treat sleep problems.

What are Z-class drugs?

The drugs generically known as zaleplon, zolpidem and eszopiclone are used to treat sleep disorders.

They were the first of the drugs known as non-benzodiazepine sedatives developed exclusively to treat insomnia.

They are called “Z drugs” or “Z-class” drugs because of the similarities in their generic names. You might know them better by their brand names.

Sleeping pills 101

Zaleplon (brand name: Sonata)

This prescription sleep aid is an oral hypnotic that interacts with certain areas of the brain to induce relaxation with the goal of inducing sleep.

It’s meant to be taken only in the short term, as needed, and is not considered safe as a long-term, maintenance medication, due to higher risks for addiction to this drug. It can also present dangerous side effects when used in tandem with alcohol.

Risks with using zaleplon include habituation (and unpleasant withdrawal symptoms) and adverse side effects, such as:

• Dizziness, drowsiness, incoordination, problems with short-term memory
• Shifts in mental/mood behaviors, such as hallucinations, confusion, agitation, or suicidal ideation
• Parasomnia behaviors such as sleep driving, sleepwalking, sleep eating, sleep texting, or sexsomnia

Zolpidem tartrate (brand name: Ambien)

This prescription sleep aid comes in both tablet and oral spray form. It belongs in a class of drugs known as sedative-hypnotics and works to produce a sense of calm in the brain.

Zolpidem is not a long-term medication, meant only to be used over the short course across a span of less than 2 weeks.

The current safe dosage is 10mg, but for women, a lower dose is typically prescribed because the drug is not as quickly metabolized by women as it is by men. Lower doses are also found to be safer, and with fewer sider effects, for older adults.

People should avoid consuming alcohol while using zolpidem.

Risks with using zolpidem include habituation (and unpleasant withdrawal symptoms) and adverse side effects, such as:

• Dizziness, daytime sleepiness, memory loss
• Shifts in mental/mood behaviors, such as depression, abnormal thought patterns, hallucinations, anxiety, aggressive behavior, confusion, agitation, or suicidal ideation
• Rebound insomnia (trouble sleeping the first few nights after stopping medication)
• Parasomnia behaviors such as sleep driving, sleepwalking, sleep eating, sleep texting, or sexsomnia

Eszopiclone (brand name: Lunesta)

This prescription sleep aid comes in oral form and is used to treat insomnia. It is considered a sedative-hypnotic designed to help with sleep onset, sleep maintenance, and achieving more and better sleep overall by producing a sense of calm in the brain.

This, too, is not a long-term medication, but should only be used over a period of up to 2 weeks. It should not be taken after before or after consuming alcohol.

Risks with using eszopiclone include habituation (and unpleasant withdrawal symptoms) and adverse side effects, such as:

• Dry mouth, unpleasant taste sensations, dizziness, daytime sleepiness, incoordination, memory loss
• Shifts in mental/mood behaviors, such as depression, abnormal thought patterns, hallucinations, anxiety, aggressive behavior, confusion, agitation, or suicidal ideation
• Rebound insomnia (trouble sleeping the first few nights after stopping medication)
• Parasomnia behaviors such as sleep driving, sleepwalking, sleep eating, sleep texting, or sexsomnia

Are Z-class drugs the same as benzodiazepines?

Benzodiazepines (referred to as “benzos” in the vernacular) belong to a class of drugs that are considered psychoactive.

You may recognize some of these drugs by their -pam or -am suffix, such as diazepam (Valium), lorazepam (Ativan), temazepam (Restoril), or clonazepam (Klonopin).

Other familiar benzos include alprazolam (Xanax), triazolam (Halcion), chlordiazepoxide (Librium), and a host of other drugs.

They work by manipulating neurotransmitter activity in the brain, particularly that related to gamma-aminobutyric acid (GABA).

GABA suppresses central nervous system activity. Enhancing the effects of GABA is one of the chief reasons why benzodiazepines are prescribed. This can help with anxiety, panic disorders, seizures, and psychological disorders.

Sometimes benzos are also used for insomnia, agitation during withdrawal, sedation, depression, or other conditions.

Z-class drugs do not work in the same way as benzodiazepines. They are chemically different from them, so they are not considered members of this class of drug.

However, Z-class drugs often have the same affect on the brain (calming, relaxation). They also share some of the same side effects and risks (dizziness, drowsiness, and addiction), so they are sometimes referred to as “nonbenzo benzos” or “non-benzodiazepine hypnotics.”

Are Z-class drugs safer than benzodiazepines?

The Z drugs have many of the same risks and side effects of benzodiazepine drugs, so they may or may not be any safer. They may also cause daytime anxiety due to withdrawal.

However, habituation or addiction to Z-class drugs may be slower to develop compared to habituation or addiction to benzodiazepines. This is partly why Z-class drugs are more commonly prescribed to treat temporary problems with insomnia over the short term.

Should I use a Z-class drug to treat my insomnia?

Up until recently, Z-class drugs were considered the most effective way to treat sleeplessness.

However, in light of growing problems with drug and alcohol addiction, benzo and non-benzo “Z” drugs have fallen out of favor.

Recent policy positions by multiple healthcare agencies cite a new nonpharmacological “gold standard” or “go to” therapy for treating insomnia: CBT-i (cognitive behavioral therapy for insomnia).

CBT-I presents reduced risk factors and side effects, compared to prescription sleep aids. This behavioral approach has also been found to provide better long-term effectiveness.

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Check out these 16 content links related to sleeping pills in SHC:

• Commentary: No, Roseanne, you can’t blame Ambien for a lifetime of bigoted narrative || May 30, 2018
• Ideas and Solutions for Sleeping in Times of Chaos & Anxiety || Apr 28, 2018
• National News: The vicious cycle of insomnia and sleeping pills || Oct 27, 2017
• YouTube takes on the use and abuse of the sleeping pill known as Ambien (zolpidem) || Oct 15, 2017
• From the American Sleep Apnea Association: “The fallible Tiger Woods” || Jun 28, 2017
• In the shadows of the Daylight Saving Time change, we observe #InsomniaAwareness: Sleeping Pills May Not Aid Insomnia || Mar 13, 2017
• What teens need to know about caffeine, smart drugs, sleeping pills and melatonin || Jan 24, 2016
• No, there are no magic pills for sleep apnea, and some magic pills just make it worse || Mar 29, 2015
• What is CBTi? A quick guide to non-drug therapy for insomnia || Mar 29, 2015
• The AASM gets more patient-centered on treatments for insomnia || Mar 27, 2015
• Sleep Disorders 101: What is insomnia? || Mar 26, 2015
• Ideas and Solutions for Sleeping in Times of Chaos & Anxiety || Mar 17, 2015
• If you have been taking Ambien (zolpidem) long-term (since before 2013), please read this || Mar 16, 2015
• Having nightmares? Maybe it’s your prescriptions || Oct 13, 2014
• Mother’s Little Helper: Things you should know || Sept 14, 2014
• SHC MAIN PAGE: DRUGS
  

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