Z drug epidemic, for insomnia, generates dependence and sleepwalking

A video posted on a social network at the end of December raised an alarm among friends of Matias (fictitious name). It was the record of an unusual walk in the rain along the coast of Rio de Janeiro, narrated in a strangely broken voice.

“I took a zolpidem in the afternoon because I was very anxious and wanted to sleep, but I was messing with my cell phone, and that’s the last memory I have of that day”, he tells Sheet the 22-year-old business student, who was rescued by a friend and taken home.

Zolpidem is the name of one of the hypnotic drugs indicated for insomnia whose sales have exploded in Brazil in recent years. According to Anvisa, between 2019 and 2021, they grew 73% for the 5mg version, the same one that Matias took.

These drugs are known as Z drugs, because of the names the substances were given: zolpidem, zopiclone (or eszopiclone) and zaleplone. Ingested during any activity, they promote dissociated states, such as confusion and sleepwalking, which puts the person at risk. And they are addictive when used for long periods.

Social media is full of reports of people who, while high on zolpidem, made extravagant purchases beyond their means, made disjointed or embarrassing statements, and acted in confusing or even violent ways.

“The parasomnias, undesirable behaviors during sleep, are an important side effect of the use of Z drugs”, explains neurophysiologist Letícia Azevedo Soster, specialist in sleep medicine and coordinator of the postgraduate course in sleep at Hospital Israelita Albert Einstein.

“There are stories of people who got hurt, who bought things and who attacked other people, with forensic implications. It is quite dangerous”, he warns.

Several celebrities have blamed zolpidem for inappropriate behavior. In 2018, actress Roseanne Barr had her American TV show canceled after a racist tweet that, she claimed, was written while under the influence of medication. Sanofi, the manufacturer of the drug Barr claimed to have taken, issued a statement saying “racism was not a side effect” of her product.

Bizarre tweets by Elon Musk were also credited by the billionaire as the work of zolpidem. In 2017, golfer Tiger Woods was arrested and prosecuted after being found, unconscious, inside his car on a road, in an effect he attributed to the drug.

And, still in 2010, actor Charlie Sheen blamed the drug for the breakdown he promoted in a hotel room in New York. “It’s the devil’s aspirin,” he said a year later in an interview.

The Z drugs emerged about 20 years ago with the promise of fighting insomnia and promoting fast sleep with few side effects compared to the drugs available until then.

“Patients report that they are drugs that make the person close their eyes and sleep, as if it were an off switch”, says Soster. “The industry sold these drugs as if they didn’t promote the hangover effect of other medications or have side effects. It’s not true”, she warns.

The doctor points to risks and problems related to prolonged or excessive use of these substances.

“People are using increasing amounts of Z drugs because over time they become refractory to them. I already had a patient who was taking 40 pills a night of zolpidem to get to sleep.”

This was the case of Marcelo (fictitious name), 19, who started taking zolpidem at 15, after being diagnosed with anxiety and depression associated with difficulty sleeping. He took 30 pills a week and admits to using the drug not only to sleep, but to hallucinate while awake.

“Each week, I used more and more. I started to confuse what was a dream with what was reality, I was at odds with my family, it was destructive”, he says. To get enough medication, the now architecture student says he would forge copies of prescriptions and lie to psychiatrists.

Soster explains that, in the process of diffusion of Z drugs in Brazil, two factors complicate matters. “First, the fact that Brazilians tend to be anxious, which increases the occurrence of sleep problems”, he points out.

According to a study carried out by scientists from USP and Unifesp and published in the journal Sleep Epidemiology, 65% of Brazilians report having a problem related to sleep.

“The second is the fact that Brazil has a hybrid health system, half public and half private. So, the patient goes to one system, receives an indication of the medicine, goes to another, receives it too”, he says. “And as the systems are not interconnected, nobody notices this duplicity, which has happened a lot with Z drugs, which are controlled drugs. Not to mention the clandestine market.”

The doctor explains that sleep problems gained greater amplitude during the Covid-19 pandemic, when everyday energy expenditure was reduced with social distancing and the increased use of screens increased brain stimuli that keep us awake.

“This made the concern related to sleep increase, and this is the basis of chronic insomnia. The concern becomes greater than the problem itself, activating the alert mechanism and generating the desire to control sleep”, he explains. “People want to lie down and go to sleep immediately without taking responsibility for their own physical processes necessary to do so.”

Regulating bedtime and getting up, doing regular physical exercise, exposing yourself to light during the day, reducing screen time at night and ceasing it hours before going to bed are some of the responsibilities Soster takes on refer.

“It’s like a diet: the person wants to lose weight, but doesn’t want to cut fats or carbohydrates. And, then, he takes a medicine for that.”

The desire for absolute control over sleep with minimal effort, she says, is also behind the Z drug epidemic. “There is no greater absurdity than taking one drug to sleep and another to wake up. nowadays.”