Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 1;22(1):87.
doi: 10.1186/s12877-022-02757-6.

Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing

Vincenz Scharner  1 , Lukas Hasieber  2 , Andreas Sönnichsen  2 , Eva Mann  3
Affiliations

Efficacy and safety of Z-substances in the management of insomnia in older adults: a systematic review for the development of recommendations to reduce potentially inappropriate prescribing

Vincenz Scharner et al. BMC Geriatr. .

Abstract

Background: Z-drugs are usually prescribed as first line pharmacological therapy for insomnia. However, the benefits and risks of Z-drugs may differ for older adults. This systematic review investigated the available evidence on the efficacy and safety of Z-drugs in the management of insomnia in older adults.

Methods: The Cochrane database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE were searched for systematic reviews, meta-analyses, controlled interventional and observational studies using a pre-formulated search term. The target population was older adults (≥65 years old) with insomnia. Studies were included if they reported efficacy and/or safety outcomes of the use of Z-drugs for the management of insomnia compared to placebo, usual or no treatment, or other pharmacological agents.

Results: Eighteen studies were included (8 interventional and 10 observational studies). In short-term interventional studies, Z-drugs were similarly or better efficacious in improving both sleep and daytime parameters than placebo or other pharmacological treatments, while showing good results on measures of safety. However, in longer-term observational studies, Z-drugs significantly increased the risk for falls and fractures in comparison to no treatment or melatonin agonists.

Conclusions: Analyzing the evidence from short-term interventional studies, Z-drugs appear effective and safe for treatment of insomnia in older adults, but they may have unfavorable side effects when used for longer periods of time. We, therefore, recommend discontinuing Z-drugs, principally because of the high risk for falls and fractures. Nonetheless, quality and quantity of evidence are low. Due to the scarcity of data, especially concerning drug dependence after longer periods of treatment and due to the significantly increased risk for falls and fractures, further studies are needed to evaluate the benefit-risk profile of Z-drugs use in older patients, particularly for long-term use.

Keywords: Benzodiazepine-like medication; Elder; Elderly; Inappropriate prescribing; Insomnia; Older people; Systematic review; Z-drugs; Zolpidem.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
Zolpidem use and hip fracture risk
Fig. 3
Fig. 3
Any fracture and Zolpidem use
See this image and copyright information in PMC

References

    1. Association AP. Sleep-wake disorders. Diagnostic and statistical manual of mental disorders. DSM library. 5. Arlington: American Psychiatric Association; 2013.
    1. Buysse DJ. Insomnia. JAMA. 2013;309(7):706–716. - PMC - PubMed
    1. Rybarczyk B, Lund HG, Garroway AM, Mack L. Cognitive behavioral therapy for insomnia in older adults: background, evidence, and overview of treatment protocol. Clin Gerontol. 2013;36(1):70–93.
    1. Drover DR. Comparative pharmacokinetics and pharmacodynamics of short-acting hypnosedatives: zaleplon, zolpidem and zopiclone. Clin Pharmacokinet. 2004;43(4):227–238. - PubMed
    1. Siriwardena AN, Apekey T, Tilling M, Dyas JV, Middleton H, Ørner R. General practitioners' preferences for managing insomnia and opportunities for reducing hypnotic prescribing. J Eval Clin Pract. 2010;16(4):731–737. - PubMed

Publication types

Substances