Pharmacologic management of insomnia: Assessing the nonbenzodiazepine hypnotics

The nonbenzodiazepine hypnotics zolpidem and zaleplon have more rapid absor ption, metabolism, and elimination compared with most benzodiazepines. Thes e proper ties contribute to shorter residual effects, which may make nonben zodiazepines preferable for insomnia patients who need to be alert due to s ocietal or occupational demands, who may have limited time before they must awaken, or who suffer from sleep-onset insomnia. Zalepion and zolpidem dif fer in several potentially important ways. While the two agents appear to r educe sleep latency and increase sleep duration to similar degrees, zaleplo n produces less pronounced and less long-lasting benzodiazepine agonist eff ects (psychomotor/memory impairment and sedation) than zolpidem. It can als o be taken after the patient has gone to bed and experiences difficulty fal ling asleep, provided the patient has 4 or more hours before resuming activ ity. Zolpidem, on the other hand, appeared to have some beneficial effect o n sleep continuity in most clinical trials, consistent with its somewhat lo nger half-life relative to zaleplon. The two agents also have differing dru g interaction profiles due to differing routes of metabolism.