Nonbenzodiazepines have demonstrated efficacy in treating sleep disorders.There is some limited evidence that suggests that tolerance to nonbenzodiazepines is slower to develop than with benzodiazepines.In extreme cases and, in particular, where severe addiction and/or abuse is manifested, an inpatient detoxification may be required, with flumazenil as a possible detoxification tool.The Journal of Clinical Sleep Medicine published a paper that had carried out a systematic review of the medical literature concerning insomnia medications and raised concerns about benzodiazepine receptor agonist drugs, the benzodiazepines, and the Z-drugs that are used as hypnotics in humans.Efficacy also did not differ between benzodiazepine and Z drug users. On rare occasions, these drugs can produce a fugue state, wherein the patient sleepwalks and may perform relatively complex actions, including cooking meals or driving cars, while effectively unconscious and with no recollection of the events upon awakening.While this effect is rare (and has also been reported to occur with some of the older sedative drugs such as temazepam and secobarbital), it can be potentially hazardous, and so further development of this class of drugs has continued in an effort to find new compounds with further improved profiles.
The nonbenzodiazepines are positive allosteric modulators of the GABA-A receptor.
Like the benzodiazepines, they exert their effects by binding to and activating the benzodiazepine site of the receptor complex.
Many of these compounds are subtype selective providing novel anxiolytics with little to no hypnotic and amnesiac effects and novel hypnotics with little or no anxiolytic effects.
The review found that almost all trials of sleep disorders and drugs are sponsored by the pharmaceutical industry.
It was found that the odds ratio for finding results favorable to industry in industry-sponsored trials was 3.6 times higher than non-industry-sponsored studies and that 24% of authors did not disclose being funded by the drug companies in their published papers when they were funded by the drug companies.