Which is Better Zopiclone or Zolpidem?

The day has passed, and you have followed all the right steps to calm down your body and mind-no screens, a cup of camomile tea, a dark room but still, your brain doesn't want to rest. Do you relate to this nightly struggle of yours? Then it is probably your doctor who will recommend a sleeping drug to you next. In the UK, the two names you will get to hear the most are Zopiclone and Zolpidem.

The latter are often referred to indistinctly as 'Z-drugs,' which are a class of medications intended for insomnia relief. But if you have been given a choice or if you are trying to decode your prescription, the question that probably arises is: which one is better? The answer to this question is not that one is better for everyone; it is, rather, a matter of discerning certain key distinctions, such as the speed of onset, the duration of effect, and the likelihood of adverse reactions.

Let's clarify these two drugs for you and give you a chance to be completely aware of your choices.

How Does The Z-Drugs Work?

It is good to first know what the common ground is before discussing the differences. Zopiclone and Zolpidem share the same classification of non-benzodiazepine hypnotics, but they are still very much alike in their action to the older sleeping pills (benzodiazepines) scenario.

GABA (gamma-aminobutyric acid) is a calming chemical that the brain produces on its own. You can think of GABA as the "brake pedal" of the brain, so to speak. By slowing down nerve activity, it helps one relax and eventually fall asleep. Zopiclone and Zolpidem, however, are not outstanding in this regard; in fact, they enhance the effects of this GABA chemical. They indirectly (through the receptors) increase the potency of the GABA that you already have in your brain making the process extremely effective and thus resulting in a strong calming effect that gets you sleeping quicker.

Initially, it was believed that these new drugs would have lesser side effects and lesser risk of addiction due to their selectivity compared to older drugs. Over the years, however, the opposite has turned out to be the case, hence the reason for their prescription being limited to short-term use only.

The Big Difference: Speed and Duration

The primary difference between Zopiclone and Zolpidem can be found in their onset and duration of action. The difference in their action time is typically what leads your doctor to prescribe one over the other based on your sleeping problem.

Zolpidem: Very Fast Sleeper

Zolpidem, also known by the brand name Stilnoct in the UK, is, in general, quicker to act than Zopiclone.

• Speed: It is characterized by a very rapid time to effect, which is usually around half an hour.
• Duration: The elimination half-life of Zolpidem is fairly short, about 2-3 hours in most cases, which means that the total duration of action is typically around 6 hours.
• Who it might be better for: Zolpidem tends to be prescribed to patients with sleep onset insomnia, i.e., patients who cannot fall asleep. It can be easily eliminated from the body so not much of a 'hangover' feeling is experienced the next day, especially compared to more potent sleeping tablets.

Zopiclone: The Drug for Staying Asleep

Zopiclone, which is also a brand name, has a different profile.

• Speed: It is a fast-acting drug, too, but its activities are not so immediate when compared to Zolpidem, and the peak concentration is usually reached after about an hour.
• Duration: Its half-life is longer, generally from 3.5 to 6 hours. This indicates that the sedative effect is prolonged throughout the night.
• Who it might be better for: Zopiclone is at times the drug of choice for individuals who experience sleep maintenance insomnia, as its longer sedation keeps them deeper in sleep. It assists in falling asleep faster, but its long-lasting effect can occasionally lead to a higher chance of feeling sleepy the next morning.

Which is Better for Your Sleep Problem?

The simple table below summarises the comparison:

Feature	Zolpidem (Stilnoct)	Zopiclone
Primary Goal	Falling asleep fast (Sleep Onset)	Falling asleep and staying asleep (Sleep Maintenance)
Duration (Half-Life)	Shorter (Approx. 2-3 hours)	Longer (Approx. 3.5-6 hours)
Daytime Drowsiness	Generally lower risk	Slightly higher risk
Notorious Side Effect	Sleep behaviours (amnesia, sleepwalking)	Bitter/Metallic taste in the mouth

In case your primary concern is falling asleep, and you want the medication out of your body as soon as possible, Zolpidem might be proposed. In case you have difficulty remaining asleep all night long and can bear the risk of having a bitter taste, Zopiclone may be a more suitable choice.

Nevertheless, research that compared the two concluded that Zolpidem was at least as effective as Zopiclone in terms of sleep improvement and was usually better tolerated, with a notable reduction in the number of people who experienced side effects on Zolpidem. This is the reason why a straightforward personal trial, with a doctor's supervision, is frequently the only method to determine your 'better' option.

The Most Important Rule: Short-Term Only

Whichever Z-drug your doctor gives you, the first and foremost thing to keep in mind is that they are for the very short-term control of severe insomnia. Usually, the doctor writes the prescription only for a period of about 2 to 4 weeks.

What is the reason behind the strict time limit?

• Risk of Dependence: The body soon gets accustomed to them and won't sleep without them. If you stop using them all of a sudden after long-term use, you may suffer withdrawal symptoms and once again suffer from insomnia, but this time with more intensity than before.
• Tolerance: With the passage of time, the effect of the drug diminishes and the body becomes accustomed to the dosage. More will have to be given to obtain the same effect, which will in turn cause a rise in the number of side effects.

Usually, Cognitive Behavioural Therapy for Insomnia (CBT-I) and sleep hygiene are the most effective and long-term approach to insomnia. Z-drugs are just a means of breaking the immediate cycle of sleeplessness and providing you with an opportunity to recuperate and adopt those better habits.

In conclusion, neither Zopiclone nor Zolpidem can be declared as the winner. They present slightly different profiles of action and side effects. Talk to your doctor about the details of your insomnia and you can jointly select the treatment that gives you the highest chance of having a restful night.