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Background: Sleep disturbance and benzodiazepines (BZDs)/Z-drugs use are known to be common during affective episodes. Hence, we identified the probable outcomes of bipolar disorder that correlate with BZDs/Z-drugs use, aside from mood symptoms. We conducted an open-label, prospective study to describe the current use of BZDs and Z-drugs by patients with bipolar disorder during affective episodes. We evaluated the difference of characteristics between bipolar patients with sleep disturbance who chose BZDs/Z-drugs, and those who did not chose the drugs during and after affective disorder. The influences of BZDs/Z-drugs use on suicide attempt and psychotic symptoms during affective disorder were also investigated. Results: Seventy patients with current affective episodes were studied. Among them, 61 had sleep disturbances. The amount of mood stabilizers use in the BZDs/Z-drugs group was significantly greater than that in the no BZDs/Z-drugs group (p=0.038) during affective episodes. After affective episode, sleep disturbances, especially midnight wakes, became more improved in BZDs/Z-drugs group compared to the no BZDs/Z-drugs group. By contrast, attention and decisiveness became more improved in the no BZDs/Z-drugs group than in the BZDs/Z-drugs group. Furthermore, we observed that BZDs/Z-drugs had an OR of 4.338 (95% CI 1.068-17.623, p=0.040), and other psychiatric drugs had an OR of 1.835 (95% CI 1.105-3.047, p=0.019) in relation to suicide attempt. After nine months, we found that BZDs/Z-drugs use was of no significant effect to depressive or manic severity, or to recurrence rate.Conclusion: BZDs/Z-drugs use have no significant influence on variations in depressive or manic severity during the course of an affective episode. Nevertheless, BZDs/Z-drugs users took a greater amount of mood stabilizers than no BZDs/Z-drugs users. Finally, BZDs/Z-drugs or other psychiatric drugs polytherapy was regarded as a risk factor of suicide attempt during an affective episode.