I ALWAYS use Z/X no matter the situation.
My trick for long streams is tapping my foot to the tempo of the song at the same time as hitting Z/X. Usually the way it works is, There should be 4 Hit circles between each time you tap your foot to the tempo.
So it goes like this:
FT = Foot Tap
# = hit circles
Z/X = Keys Z and X
FT-------------FT-------------FT-------------FT-------------FT-------------FT-------------FT-------------FT-----------
-1 - 2 - 3 - 4 - 1 - 2 - 3 - 4 - 1 - 2 - 3 - 4 - 1 - 2 - 3 - 4 - 1 - 2 - 3 - 4 - 1 - 2 - 3 - 4 - 1 - 2 - 3 - 4 - 1 - 2 - 3 - 4
-Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X - Z - X
I'm not sure if this illustration makes any sense to anyone but for some reason I can get through most streams this way.
If you have trouble tapping with your foot, try counting 1-2-3-4-1-2-3-4 to the tempo in your head repeatedly during the stream in question and alternate click 4 times on Z/X between each number you count.
That's my trick to beating those damn streams.