Comparative analysis of z-hypnotics and benzodiazepines for insomnia

The Brazilian population has a 72% incidence of sleep disorders, the main one being insomnia. Furthermore, the use of z-hypnotics increased by 73% among Brazilians from 2019 to 2021. Based on this, this study aims to conduct a bibliographic review on the use of z-hypnotics, such as zolpidem and eszopiclone, and their repercussions compared to benzodiazepines. As a methodology, scientific articles from SciELO, Revista Neurociências, Revista Brasileira de Psiquiatria and Revista Brasileira de Neurologia cataloged in recent years were used. As a result, it was found that the use of benzodiazepines represents a high risk for memory consolidation when compared to z-hypnotics, in addition to being less safe for the elderly population and with a higher risk of chemical dependency. The new generation of hypnotics acts on GABA-A receptors, amplifying their action and causing rapid synaptic inhibition with hyperpolarization of the cell membrane. In other words, it causes a relaxing effect on the central nervous system, decreasing the latency to sleep onset without altering REM sleep, a phase related to memory consolidation. In benzodiazepines, in addition to the high tendency for dependence, there is an increase in the N2 phase of N-REM sleep and a decrease in the density of REM sleep. Cases of anterograde amnesia, motor-cognitive delay, daytime sleepiness and development of tolerance have been reported. In an analysis of data from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM 2022), a prevalence of 9.3% of benzodiazepine use in the elderly was reported, even with side effects of sedation, mental confusion, dependence and absence syndrome. It is concluded that the use of z-hypnotics, especially in the long term, is safer due to their high degree of selectivity for the alpha subunit of the GABAergic receptor, especially when compared to benzodiazepines, being considered the most appropriate replacement among hypnotics.