Z-drugs, including eszopiclone, zaleplon, and zolpidem, are generally avoided in older adults because they:

• A. Are superior to benzodiazepines and should be used widely.
• B. Have adverse effects similar to benzodiazepines and provide minimal sleep latency/duration benefits.
• C. Are recommended as first-line sleep aids for older adults.
• D. Have no risk of confusion or falls.

Answer: (B)

Z-drugs are avoided in older adults because, in this population, their downsides outweigh the benefits. They act on GABA-A receptors to promote sleep, but the sedative, amnestic, and psychomotor-impairing effects are amplified with aging. This means a higher risk of confusion, delirium, daytime drowsiness, dizziness, and especially falls and fractures. At the same time, the actual improvement in sleep onset or total sleep time tends to be modest and often not meaningfully better than placebo for many older patients. Because the adverse effects resemble those of benzodiazepines and the sleep benefits are limited, the overall risk–benefit balance is unfavorable, leading to the general avoidance of Z-drugs in older adults.