Seroquel for Sleep: Risks and Benefits

Seroquel may be used for sleep issues such as insomnia and it can make you feel drowsy. However, it’s not approved by the U.S. Food and Drug Administration (FDA) for these conditions.

Seroquel (quetiapine) is a second-generation (or atypical) antipsychotic, a drug used to treat certain mood disorders, such as schizophrenia and bipolar disorder.

Some people prefer trying Seroquel for help with sleep or insomnia as it doesn’t have the same risk of dependency as other medications that can be addictive, but Seroquel can cause other side effects that you should be aware of.

Benefits of Seroquel

The FDA approved Seroquel (quetiapine) to treat:

• Schizophrenia in adults and adolescents 13-17 years of age
• Bipolar I disorder manic episodes, as the only treatment or in addition to other agents like lithium or Depakote (divalproex)
• Bipolar disorder depressive episodes

Seroquel is thought to work for mental health conditions by balancing dopamine and serotonin. It also acts on histamine receptors to make you feel sleepy.

Seroquel for Primary Insomnia

The sleep benefits of Seroquel may be related to the fact that once under treatment, someone with mental health conditions finds it easier to sleep well. This means it would not have benefits for someone only suffering from a sleep disorder.

Because of a lack of research on Seroquel’s effectiveness on primary insomnia or sleep disorders, it hasn’t been approved as a treatment for conditions not caused by medical or psychological reasons. Still, it is sometimes prescribed off-label in low doses for sleep problems.

Only limited studies have been conducted to determine Seroquel’s effectiveness in treating insomnia or improving sleep in otherwise healthy individuals. These include the following:

• Fourteen healthy males were treated for three nights with either a placebo, 25 milligrams (mg) of Seroquel, or 100 mg of Seroquel taken one hour before sleep. Seroquel significantly improved sleep quality, initiation, and duration.
• Thirteen people received a placebo or 25 mg of Seroquel every night for two weeks. The Seroquel group showed improved sleep, but the results were not considered statistically significant.
• Other trials have been done, but these did not provide sufficient data to recommend Seroquel for the treatment of primary insomnia.

Seroquel Dosage for Sleep

Seroquel comes in immediate-release (IR) and extended-release (ER or XR) tablets. Either form may be used off-label to help improve sleep within about an hour of taking the medication.

The most common doses of Seroquel used in clinical sleep trials ranged from 25 mg to 300 mg once daily before bed. Some clinical trials recommend a starting dosage range from 50 mg to 150 mg per day.

Higher doses of Seroquel are associated with a higher risk of side effects, but even lower doses have been associated with side effects such as weight gain and increased triglyceride levels.

Older people may experience more side effects and should start with a lower dose of Seroquel.

How to Take Seroquel Safely

Due to its sleep-promoting effects, avoid driving or other activities requiring focus or alertness after taking Seroquel until you know exactly how it will affect you.

For your first dose, try taking it at night when you don’t have to be awake too early the next day. This is because it can cause grogginess in the morning.

Before taking Seroquel, your healthcare provider should assess the following:

It’s best to avoid drinking alcohol while taking Seroquel, as it has the potential to worsen some side effects.

If you need to stop Seroquel, talk with your healthcare provider first. If you stop taking it suddenly, you may have a greater chance of side effects like trouble sleeping, nausea, and vomiting.

Seroquel and Risk for Misuse

Seroquel is not known to cause euphoric effects, but it may still be abused. It is sometimes added to other illegal substances or street drugs in an attempt to enhance them or to counter some of their side effects.

The risk of abuse or misuse of Seroquel is not as high as other drugs that are often used to treat insomnia, such as benzodiazepines or Z-drugs, but the risk of abuse should be weighed based on individual factors like past abuse or misuse of other drugs or addictive personalities.

Seroquel and the Risk for Rebound Insomnia

Seroquel, along with other antipsychotic drugs, may cause withdrawal symptoms, including rebound insomnia when you stop taking them. Rebound insomnia can sometimes be even worse than the insomnia you had before you started taking the medication.

This is why it’s important to talk with your healthcare provider before stopping Seroquel. It should be tapered slowly, meaning the dose you’re taking slowly gets decreased.

Side Effects of Seroquel

Seroquel tends to cause a wide range of side effects involving multiple systems in the body. This is a large part of why it is not the ideal drug for people who have insomnia without the presence of additional conditions that Seroquel is approved or used more often to treat.

Potential side effects include:

• Headache
• Agitation
• Somnolence
• Dizziness
• Dry mouth
• Constipation
• Metabolic changes such as high blood sugar, high lipid levels, and weight gain
• Tardive dyskinesia, involuntary movements of facial muscles
• Hypotension or low blood pressure
• Blood cell effects such as leukopenia, neutropenia, and agranulocytosis 
• Cataracts
• QT prolongation, which may make heart issues such as arrhythmias more likely to develop
• Seizures
• Hypothyroidism
• Potential for cognitive and motor impairment

Alternatives to Seroquel for Sleep

Before taking medication, you should try to practice the best possible sleep hygiene or sleep habits, which can help improve your insomnia. Some examples include:

• Maintain a consistent sleep and wake schedule
• Engage in regular exercise
• Avoid caffeine, alcohol, heavy meals, and excessive light exposure late in the day
• Try cognitive behavioral therapy (CBT)

There are some herbal remedies and dietary supplements that may also help you sleep. However, they should be used with caution. Some herbal agents interact with other herbals and prescription medications, so please make sure your healthcare provider knows all the herbal or dietary supplements and medications you take.

Herbal products are also not regulated by the FDA and may have variable quality control processes upon manufacturing, which may result in inconsistent and unpredictable effectiveness.

Some options to look into that could potentially help include:

Melatonin supplements, which contain a synthetic form of the naturally occurring sleep hormone your body produces in response to darkness, are commonly used as a sleep aid. However, data does not support their use for treating insomnia.

Finally, some medications that are either approved for sleep or are sometimes used off-label to help with sleep include:

• Z drugs such as eszopiclone, Sonata (zaleplon), and Ambien (zolpidem), which can be habit-forming and carry a moderate abuse potential
• Benzodiazepines, which also have a high abuse risk and are highly addictive
• Trazodone, a miscellaneous antidepressant
• Rozerem (ramelteon), a melatonin receptor agonist
• Belsomra (suvorexant), a dual orexin receptor antagonist

Summary

While Seroquel often causes sleepiness, it is not a sleeping pill. There isn’t enough evidence to recommend its use for treating primary insomnia. Still, it is sometimes prescribed off-label for sleeping problems, although it’s not the best choice for everyone.

Additionally, Seroquel doesn’t come without risks, as it has a broad side effect profile. These include metabolic, heart, and hematologic (blood) effects.

Seroquel may be helpful if it treats the underlying condition affecting your sleep. Otherwise, other options are available to help with sleep problems if you have insomnia and are otherwise healthy.

If you struggle with insomnia but can’t figure out the cause of your sleep issues, talk with your healthcare provider about other available interventions for improvement.