{"id":33878,"date":"2015-04-10T17:04:36","date_gmt":"2015-04-10T16:04:36","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=33878"},"modified":"2015-04-13T12:44:01","modified_gmt":"2015-04-13T11:44:01","slug":"jeffrey-aronson-when-i-use-a-word-zzzzzzzzzzzzzzzz","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/04\/10\/jeffrey-aronson-when-i-use-a-word-zzzzzzzzzzzzzzzz\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Zzzzzzzzzzzzzzzz"},"content":{"rendered":"

\"jeffrey_aronson\"<\/a>My patient Pat damaged a knee skiing abroad, had it fixed locally, and limped home. \u201cShould I keep on taking these tablets they gave me, Doc? They\u2019re to help me sleep.\u201d I suggested not. They\u2019d given Pat one of the so called \u201cz drugs\u201d\u2014zaleplon, zolpidem, or zopiclone, I forget which. Not for long enough, I hoped, to induce withdrawal symptoms<\/a>.<\/p>\n

They\u2019re all short acting agonists at GABAA<\/sub> receptors<\/a>, with actions\u2014including adverse effects\u2014similar to those of the benzodiazepines, which act allosterically via GABAA<\/sub> receptors by enhancing linked chloride channel activity.\u00a0Benzodiazepines are formed by joining a benzene ring and a diazepine ring. It\u2019s not therefore surprising that each has a z<\/em> in its name: most of them end in \u2013azepam or \u2013azolam. Flumazenil, a benzodiazepine receptor antagonist, follows suit. But of over 60 benzodiazepines in the World Health Organization\u2019s lists of recommended and proposed International Nonproprietary Names (INNs) only one begins with a z<\/em>: zolazepam.<\/p>\n

Zopiclone, which first appeared in 1978, is a cyclopyrrolone, and there is no apparent reason why its name should start with a z<\/em>. Zolpidem (1985) is an imidazopyridine and zaleplon (1993) a pyrazolopyrimidine; the z<\/em>\u2019s are there but not especially prominently. However, it cannot have done these hypnotics any harm to have names beginning with a z<\/em>. After all, in English the sound zzz is reminiscent of the snoring sound that occurs during sleep. The collective term \u201cz drugs\u201d started to emerge in 2004<\/a>.<\/p>\n

Hiss like a snake\u2014sssss. Now phonate as you do it\u2014zzzzz. The hissing phoneme s<\/em> is the voiceless alveolar fricative<\/a> and z<\/em> is the voiced version of s<\/em>. In his journal of 1852, Henry David Thoreau called the noise made by locusts \u201cz-ing.\u201d Later uses described noises made by bats and saws. The first recorded reference to a human noise, given in the Oxford English Dictionary<\/em>, is in H G Wells\u2019s novel Tono-Bungay<\/em> (1909), which is about a patent medicine (\u201cslightly injurious rubbish at one-and-three half-pence a bottle\u201d), doubtless catching the then current fashion for such nostra<\/a>. But it doesn\u2019t refer to sleeping. The narrator, George Ponderevo, describes his uncle Edward\u2019s way of speaking: \u201cI watched . . . the play of his lips\u2014they were a little oblique and there was something \u2018slipshod\u2019 . . . about his mouth so that he lisped and sibilated . . . He had a way of drawing air in at times through his teeth that gave a whispering zest to his speech. It’s a sound I can only represent as a soft Zzzz.\u201d Reminiscent perhaps of the unsettling sound made by Anthony Hopkins in Silence of the Lambs<\/em>. Not like the zzz produced by pushing air out.<\/p>\n

\u201cSnooze,\u201d \u201cdoze,\u201d and \u201cdrowse\u201d have the z<\/em> sound in them, but it was not until about 1920 that zzz came to be used to describe the sound made by snoring, or simply to indicate that a cartoon character is asleep. This convention is now international, even though not all languages pronounce z<\/em> the same\u2014German (ts) and Castilian Spanish (th), for example.<\/p>\n

The verb to zizz, to sleep, dates from the 1940s and to get\/bag\/cop\/catch some z’s from the 1960s. Zizz is usually intransitive (to zizz or zizz off), but there is a good example of the transitive use in Kyril Bonfiglioli\u2019s novel Don’t Point That Thing at Me<\/em> (1972): \u201cI zizzed away the worst of the afternoon, awaking some three hours later with a mighty thirst.\u201d Incidentally, if you found the recent movie Mortdecai<\/em>, with Johnny Depp, written by an unrelated namesake of mine, zizzingly soporific (\u201cAggressively strange and wilfully unfunny\u201d said critics<\/a>), be assured that Bonfiglioli\u2019s books are considerably better and very funny.<\/p>\n

Private Eye<\/em> on 4 November 1983, cited in OED<\/em>, published a 42-z<\/em> chain: \u201cOnce you have hit on a commercial product you just go on producing more of the same, over and . . . zzzz . . . over and . . . zzzz . . . over and . . . zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz.\u201d They could have been referring to the z drugs.<\/p>\n

The longest string of z<\/em>\u2019s I have found in the biomedical literature is in the title of an excellent commentary in Medical Economics<\/em><\/a> (figure). The odd thing about the title is that the z<\/em>\u2019s are shown getting smaller and dropping off, like someone dropping off to sleep. But surely the zizzing of sleep gets louder with time?<\/p>\n

That example had 15 z<\/em>\u2019s, which is why I decided to use 16 in the title of this piece :>)<\/p>\n

\"aronson_z\"<\/a><\/p>\n

From <\/em>Medical Economics 26 Apr 2002; 79(8):50<\/em><\/p>\n

Jeffrey Aronson<\/strong> is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests:\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

My patient Pat damaged a knee skiing abroad, had it fixed locally, and limped home. \u201cShould I keep on taking these tablets they gave me, Doc? They\u2019re to help me […]<\/p>\n

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