You may have heard of Lunesta, Ambien, or Sonata, frequently marketed on pharmaceutical commercials and prescribed to over 12 million Americans mainly for treating insomnia and anxiety. These are known as “Z-drugs” or “non benzodiazepines” and are a class of hypnotics that work similarly to benzos, such as Xanax, but with a smaller effect profile and lower risk of dependency [1].
Read on to learn more about this commonly prescribed class of drugs and how they compare to Xanax and other benzodiazepines.
What Are Nonbenzodiazepines (Z-Drugs)? Are They Safer Than Benzos?
Nonbenzodiazepines are a newer class of hypnotics or sedatives also known as “Z-Drugs,” which include zolpidem, zopiclone (not available in the US), zaleplon, and eszopiclone. They are used by millions of Americans for sleep and anxiety disorders and act as a sedative to slow brain activity. Although chemically different, they share similar mechanisms to benzodiazepines but with fewer side effects and risk of addiction [2].
These medications are FDA-approved and classified as a Schedule IV controlled substance.
In terms of “safety”, they do have a lower risk profile for dependence than benzos such as Xanax or Valium; however, they still carry a risk of abuse. Zolpidem (Ambien) is the most commonly prescribed “Z-drug”.
How They Work
These medications bind selectively to the GABAA receptor, leading to sedation but with much less intensity, side effects, and risk of addiction than standard benzodiazepines. Typical benzos bind less selectively to multiple GABA receptor subtypes; the selectivity in Z drugs for the α1 subunit is believed to cause less muscle relaxation and anticonvulsant effects [2].
Side Effects & Safety Flags
The most commonly reported side effects of “Z” drugs are headache, dizziness, nausea, and daytime drowsiness. Compared to benzodiazepines, non-benzodiazepines have fewer reports of dependency, abuse potential, rebound insomnia, overdose, and interactions with other medications. However, the risks are still there.
Some common safety red flags to be mindful of if you or a loved one is using a nonbenzodiazepine include [3]:
- Cravings for the drug, increasing doses to achieve an “ambien high”, continued use despite trying to cut down
- Impaired coordination, shortened attention, or memory loss while taking the drug
- Dangerous sleep-related behaviors can occur in some individuals, including sleepwalking, sleep driving, or making phone calls while asleep
- Physical side effects can include dizziness, dry mouth, nausea, headache, and slowed breathing
- Misuse such as crushing or snorting the drug to get stronger effects, or “doctor shopping” to get more doses
Dependence, Tolerance, and Withdrawal Basics
Long-term use of benzodiazepines results in dependence rates around 45%, while rates for Z drugs like zolpidem range between 20% and 30%. When tapering off Z-drugs under the supervision of a doctor, the effects may be milder than with benzodiazepines. Withdrawal from long-term use of Z-drugs or addiction can be similar to benzodiazepines, and supervised detox is recommended [4].
Common withdrawal symptoms of Ambien and other Z-drugs include:
- Anxiety, sweating, tremors
- Insomnia, changes in appetite
- Nausea, headaches
- Mood swings, irritability, hallucinations
- In severe cases, seizures or delirium
Ambien vs. Xanax (Uses, Onset, Duration, Risks)
Ambien and Xanax are two of the most commonly prescribed medications of the nonbenzodiazepine and benzodiazepine classes. Let’s see how they compare [5]:
| Ambien vs Xanax | Ambien | Xanax |
| Drug Class | Non-benzodiazepine, sedative-hypnotic (z-drug) | Benzodiazepine |
| Generic Name | Zolpidem | Alprazolam |
| Primary Use | Short-term treatment of insomnia | Anxiety and panic disorders |
| Mechanism of Action | Selective agonist at GABA-a1 receptor, induces sedation and sleep | Non-selective agonist for multiple GABA subreceptors, sedative and muscle relaxant effects |
| Onset and Duration | Works quickly to induce sleep, lasts 6 to 8 hours | Works in about 1 hour, can last a few hours up to 12 hours, depending on formulation |
| Risk of Abuse | Present but generally lower than | Higher risk of dependence and withdrawal |
Ambien Overdose: “How Much Is Too Much?”
The typical prescribed dose for Ambien is 5 to 10 mg, and anything above this increases the risk of overdose, especially when you get into the 50 to 100+ mg range. The risk for overdose on Ambien is also much higher when combined with other drugs such as Xanax or alcohol. If you suspect someone is overdosing on Ambien, call 911 immediately, as life-threatening complications such as coma or death can occur.
Signs of Ambien overdose include:
- Extreme drowsiness, difficulty waking up
- Confusion, memory loss
- Hallucinations, psychosis
- Slowed, shallow, or stopped breathing
- In severe cases, seizures
Residential Treatment for Benzodiazepines and Z-Drugs
At Rushton Recovery, our supervised medical detox and residential treatment center in Michigan offers a healing space to embark on your journey toward a drug-free life. Our compassionate team combines evidence-based therapies, medication management, and holistic healing activities in a serene environment to heal from substance abuse and mental health challenges.
We are also committed to providing education on commonly prescribed drugs to support healthy habits and safe practices. However, never take or stop any medications without speaking first with your doctor. Contact our admissions team today!
FAQs
Many people still have questions about Z-drugs as they continue to grow in prescribed use. Below are some commonly asked questions about Z-drugs and Ambien.
Who Should Avoid Z-Drugs?
People with a history of substance abuse, respiratory conditions, sleep apnea, or liver problems should avoid Z-Drugs like Ambien, Lunesta, and Sonata. Pregnant or breastfeeding women should consult their doctor before use.
Is Ambien a Benzo?
No, Ambien is not a benzodiazepine. It belongs to a class called non-benzodiazepine sedative-hypnotics, often referred to as Z-drugs.
Can you buy Ambien online?
Ambien is a prescription medication that should only be obtained legally through a licensed medical provider and pharmacy. Some online pharmacies may offer Ambien, although these are often unsafe, unregulated, and illegal.
Can you overdose on Ambien?
Yes, you can overdose on Ambien if taking more than the regular prescribed dose. If you notice the signs of an Ambien overdose, such as loss of consciousness, hallucinations, or slowed breathing, call 911 immediately to prevent a further medical emergency.
Sources
[1] Martins, S. et al. (2021). How do medical and non-medical use of z-drugs relate to psychological distress and the use of other depressant drugs?. Addictive behaviors, 112, 106606.
[2] Principles and Practices of Sleep Medicine. 2005. Nonbenzodiazepine.
[3] NHS. 2023. Side effects of zolpidem.
[4] Sidorchuk, A. et al. (2023). Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study. European journal of clinical pharmacology, 79(8), 1091–1105.
[5] Cuhna, J. Ambien vs. Xanax. RX List.
