American Board of Psychiatry and Neurology (ABPN) Practice Exam

Which sleep agent has the longest half-life, increasing the risk of next-day drowsiness?

1. Zolpidem

2. Eszopiclone

3. Ramelteon

4. Zaleplon

The correct answer is: Eszopiclone

Eszopiclone is known to have the longest half-life among the sleep agents listed, typically ranging from 6 to 9 hours, although it can vary in individuals. This extended half-life can result in the drug remaining in the body longer than others, which increases the likelihood of experiencing next-day drowsiness and cognitive impairment. In contrast, other agents in the list have shorter half-lives: Zolpidem generally has a half-life of about 2 to 3 hours, making it less likely to contribute to next-day sedation. Ramelteon, a melatonin receptor agonist, also has a relatively short duration of action, which tends to minimize lingering effects the following day. Zaleplon has an even shorter half-life of approximately 1 hour, allowing it to be rapidly eliminated from the body and further reducing the risk of residual sedation the next day. Thus, due to Eszopiclone's longer half-life, it poses a higher risk for patients to experience next-morning drowsiness compared to the other options listed.