Starting Z-drugs first line for insomnia, as the guidelines would have it, gets you into a whole host of problems: memory and learning problems, slower progress in psychotherapy, addiction, withdrawal and tolerance. Like alcohol, benzodiazepines and cannabis, they make people feel as if they are sleeping or getting better when they may not be.
Why we do not start with them
Following the guidelines and starting Z-drugs first line for insomnia gets you into a whole host of problems.
“And following these guidelines, if you start using Z-drugs first line for insomnia, you're going to get into a whole host of problems”
3:15Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 They have too many drawbacks: memory problems, learning problems, and slower progress in psychotherapy and in healing from psychiatric disorders. They are addictive, with withdrawal problems and tolerance too.
“too many drawbacks, memory issues, learning problems, slows your progress. Progress in psychotherapy and healing from psychiatric disorders. Addictive. Did I already say addictive? Withdrawal problems. Tolerance, too”
29:31Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
Pitfalls and myths
They belong in the same category as alcohol, benzodiazepines and cannabis: things that make people feel as if they are getting better or sleeping when they are not necessarily getting better or sleeping.
“Alcohol, you know, Z-drugs, benzos, cannabis, I would all put in the same category as things that make people feel as if they're getting better or sleeping when they're not really necessarily getting better or sleeping”
30:57Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025
It also comes up on
- Generalized anxiety disorder99% of the time, a benzodiazepine, a Z-drug or alcohol is not truly treating the anxiety disorder, and they are all about the same in that use.
- Sleep medicationsThe medications with regulatory approval for insomnia are benzodiazepines, Z-drugs, DORAs (dual orexin receptor antagonists), low-dose doxepin and ramelteon.
From these episodes
- Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 · 2 points
- Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.