I just installed Bilstein 5100's on my crew cab Z71 Sierra last night. I was a little nervous about the ride quality after reading some of the bad reviews but I am happy to report that the ride was vastly improved over the stock Rancho shocks. Mine are set to the top notch. Aside from having issues getting the spring compressed far enough to use stock top hat retaining nut, the install went relatively smooth. I did end up using the Bilstein supplied top hat nut.
My truck has 44,000 miles on it. Switching to the 5100's resulted in a firmer, more planted feel at highway speeds. Body roll in curves is drastically reduced, and the harshness and chatter that I would feel when the Rancho's would rebound is gone. At low speeds you will feel small bumps and expansion joints in the road, but they are not harsh or jarring at all. Honestly, I'm not sure I notice much of a difference between the shocks driving straight line at lower speeds.
Thanks to all those that provided info in this thread. It made the installation a breeze. It took me about 3.5 hours to do the swap. If I had to do it again, I'm guessing I could cut 45 minutes to an hour off that time. I have a set of 33" Falken Wildpeak A/T3W's on order. I'll be sure to post some before and after photos after those are installed.