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The newer generation of insomnia mediations, zaleplon (Sonata), zolpidem (Ambien), eszopiclone (Lunesta), and zopiclone (Imovane), or "Z" drugs, act on specific subsets of the GABA receptor. They are commonly called "non-benzodiazepine" medications, but that the name is misleading, since they bind to the same GABA-benzodiazepine receptor complex in the brain that the benzodiazepines and alcohol bind to. The difference is that they bind to a different part of the same receptor complex. They have been marketed as having less dependency and fewer side effects than the older generation of benzodiazepine medications, and some argue that these drugs have less potential for abuse than the benzodiazepines.
So which of the Z drugs are the best? A recent review by the UK National Institute for Clinical Evidence (NICE) in 2004 showed no difference between the different Z drugs (Sonata, Lunesta, Ambien, or Imovane) in efficacy, next day impairment, or risk of withdrawal or dependence. In addition, there were no benefits in terms of efficacy or side effects compared to benzodiazepines. At one hour Sonata has a much shorter half-life than Ambien (2.5 hours) and Lunesta (6 hours), and is therefore promoted as being associated with less drowsiness the next day. Lunesta is a pure "mirror version" of the same molecule of its parent zopiclone, and appears to have been developed as a marketing effort to leave behind the negative marketing that was associated with studies of zopiclone (done before the latest Z drugs were released) showing an increase in traffic accidents with its use. Until studies are performed to specifically address the issue, we have to assume that all of the Z drugs will eventually be found to be associated with an increase in driving accidents.
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