In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving
Open accessAbstract
Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have prompted warnings on the prescription, dispensation, and use of Z-drugs. Psychomotor impairment, falls, and hip fractures are more likely to occur with Z-drugs that have longer half-lives, that are taken at higher-than-recommended doses and when mixed with other psychoactive substances including alcohol. Zopiclone and higher doses of zolpidem are more likely to cause anterograde amnesia than zaleplon. Z-drugs, especially zolpidem, are associated with complex behaviors such as sleepwalking, sleep-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation. The risk-benefit analysis of Z-drugs in the treatment of insomnia, particularly in the elderly, may not favor treatment due to the increased risks of falls and motor vehicle collisions. Prescribers should warn patients taking Z-drugs of minimum time thresholds before they operate machinery or drive motor vehicles.
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Sedative-hypnotics are the current mainstay of insomnia treatment, and many have abuse potential and side effects.
“Sedative-hypnotics, many of which are associated with abuse potential and a host of side effects, are the current mainstay of treatment (14,15).”
From Implementing computer-based psychotherapy among veterans in outpatient treatment for substance use disorders (2016) · cites this paper as [14]
The Introduction identifies benzodiazepines as traditional insomnia treatments and Z-drugs as approved insomnia treatments; the Effects on Psychomotor Performance section documents adverse effects of hypnotics. The paper does not establish that sedative-hypnotics are the current mainstay of treatment or address their abuse potential. (LLM, conf=0.84)
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- Authors
- Gunja, N.
- Affiliations
- Children's Hospital at Westmead (AU)
- Corresponding author
- Gunja, Naren
- ORCID
- Gunja, Naren
- Venue
- Journal of Medical Toxicology
- Published
- 2013-03-02
- Volume
- 9
- Issue
- 2
- Pages
- 163-171
- ISSN
- 1556-9039 (ISSN-L)
- 1937-6995
- PMC
- PMC3657033
- OpenAlex
- W1966792529
- Cited by
- 177
- References
- 85
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 5 · 2023: 14 · 2022: 16 · 2021: 11 · 2020: 35 · 2019: 19 · 2018: 13 · 2017: 12 · 2016: 13 · 2015: 11 · 2014: 16 · 2013: 1
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Medical Toxicology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Physical Sciences › Engineering › Safety, Risk, Reliability and Quality › Traffic and Road Safety
- Keywords
- Z-drugs, zolpidem, zopiclone, zaleplon, driving impairment, psychomotor performance, cognitive impairment, anterograde amnesia, sleepwalking, hallucinations, falls, hip fracture, traffic accidents, alcohol-drug interactions, insomnia treatment, elderly patients, benzodiazepine adverse effects, GABA agonists
- MeSH terms
- Zolpidem, Acetamides, Automobile Driving, Humans, Hypnotics and Sedatives, Piperazines, Psychomotor Disorders, Psychomotor Performance, Pyridines, Pyrimidines, Azabicyclo Compounds, GABA-A Receptor Agonists
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