Being unable to fall or remain asleep can be frustrating. Tossing and turning at night may cause you to seek medical attention or ask for a prescription. There has been an increase in Seroquel off-label prescriptions over the last several decades, which may have you wondering if it works for insomnia.
Seroquel is a poor and perhaps risky choice for insomnia since research has failed to catch up with the rising prescription trend. Off-label uses for quetiapine include anxiety, autism, post-traumatic stress disorder, drug addiction, and obsessive-compulsive disorder.
However, it is also rapidly being prescribed for off-label use to treat insomnia, often in doses of 100mg or less daily.
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Quetiapine, marketed as Seroquel, is a medication used to treat schizophrenia and the psychotic characteristics of various mental diseases and mood disorders such as bipolar disorder. This medication belongs to a class of drugs known as atypical antipsychotics.
It functions by limiting the brain's dopamine receptors. This reduces dopamine activity and alleviates symptoms of certain disorders.
Quetiapine is available as a tablet that is taken orally. The tablet comes in two varieties. The immediate-release variant is immediately absorbed into circulation. The extended-release version enters your bloodstream gradually over time.
Seroquel interacts with different receptors to reduce electrical impulses in the brain, improve mood, soothe your body, and relieve psychotic impulses. However, experts are still unsure of its precise role inside the brain and body. Based on some research,¹ Seroquel decreases or inhibits dopamine and serotonin activation in the brain.
Too much dopamine can keep you awake and prevent falling asleep, but too much serotonin can cause alertness, delay sleep, and hinder you from falling deeper into sleep (REM sleep). In addition to enhancing your mood, lowering these levels helps you fall asleep soundly by calming your mind and body (reducing or eliminating distracting thoughts, anxiety, or depression).
Seroquel has been used to treat people suffering from severe psychiatric illnesses. Earlier trials revealed that it was handled well and regularly reduced symptoms of schizophrenia. It may help lessen hallucinations, typical in psychotic illnesses such as schizophrenia.
Seroquel also appears useful for children over the age of 10 with bipolar illnesses.
Seroquel's soothing qualities are one of its primary advantages. It can help you feel more balanced, happier, and at peace by relieving your anxieties and calming your thoughts. A "calm" mind and a peaceful body can contribute to deeper, more restful sleep.
Seroquel is occasionally administered "off-label" to insomniacs who are desperate for sleep since it can make them sleepy.
The ideal Seroquel dose for sleep has yet to be found. Lower dosages are known to provide the strongest sedative effects. Your doctor will most likely put you on a modest dose of quetiapine, about 25mg, and gradually raise the dosage.
This is far less than the prescribed dose for schizophrenia or bipolar illness, ranging from 150 to 800mg daily.
Seroquel is sometimes prescribed off-label by doctors when insomnia is caused by another psychiatric disease (secondary insomnia). Seroquel's sedative qualities have also increased its use as a stand-alone (primary) insomnia treatment.
A 2016 study² shows minimal evidence of Seroquel's efficacy and safety for primary insomnia. According to the findings, Seroquel should only be taken by people with insomnia-related mental problems. More research is needed to determine how reliable and safe Seroquel is for treating primary insomnia. This drug may cause several potentially serious adverse effects.
Despite a lack of scientific evidence supporting its efficacy in improving sleep, quetiapine is increasingly being recommended at low dosages to treat sleep problems.
Seroquel helps alleviate symptoms that may disrupt sleep, such as anxiety and depression. As a result, evaluating its efficacy as a sleeping aid can be difficult because the medicine is meant to alleviate symptoms that might lead to poor sleep. Therefore, trials with healthy participants who show no symptoms of psychiatric illness are necessary to see if Seroquel directly affects sleep.
In one trial,³ 14 healthy males were administered a placebo or Seroquel at 25mg and 100mg for three nights. Seroquel at both dosages led to statistically substantial improvements in objective and subjective sleep ratings, including:
total sleep duration
N2 stage sleep duration
Despite these positives, a dosage of 100mg was shown to diminish the quantity of REM sleep, which is vital for psychological well-being. The 100mg dosage also increased the number of periodic leg movements, and two of the quetiapine subjects developed orthostatic hypotension, or a dip in blood pressure when moving from sitting to standing.
In another trial⁴ of 25 persons with primary insomnia, either 25mg of quetiapine or a placebo was given. There were no substantial changes in how long a person slept, how fast they fell asleep, daily alertness, or sleep quality.
More recent research⁵ duplicated insomnia by keeping subjects awake with road sounds. A 50mg dose of quetiapine increased sleep continuity and total sleep duration compared to a placebo. There was an indication of morning hangover consequences, with quetiapine producing daytime fatigue and trouble focusing.
Although it's impossible to say how frequently quetiapine is given for insomnia and other sleep problems, evidence shows that it's used quite often.
Seroquel can result in many adverse effects that might interfere with your sleep. Side effects that appear in persons who use Seroquel include:
a dry mouth
increased appetite and weight gain
a fast or irregular heartbeat
constipation, stomach trouble, indigestion, and vomiting
swelling in the arms or legs
Two participants in one research trial⁶ who were using low-dose quetiapine for sleeplessness quit taking the medication. The cause was akathisia, a movement disease marked by a sense of inner restlessness and an inability to sit still.
Quetiapine is not officially licensed as a sleep aid, and Seroquel is not recommended for insomnia by the American Academy of Sleep Medicine.⁷ Although some clinical trials⁸ have revealed increased sleep quality in adults with bipolar illness, the impact on sleep alone has only been demonstrated in a few clinical trials with some people.
Experts are also unsure about the long-term implications of low-dose quetiapine therapy.
There are several therapy options for primary insomnia. These are some examples:
over-the-counter (OTC) medication
behavioral and complementary therapies
While some of these therapies have drawbacks, especially if taken long-term, others are recognized to be safe with little to no chance of adverse effects. Natural treatments are intended to move you closer to your ideal state of mental health. Relaxation practices and greater sleep hygiene are some natural alternatives to Seroquel that may aid in higher-quality sleep.
Even though sleepiness is one of Seroquel's side effects, the drug is not advised to treat insomnia or other sleep problems in light of the available research. There are several solutions available that can help you in finding relief and fall asleep.
Always remember that well-studied medicines are the safest choice. A healthcare practitioner can help you determine if the advantages exceed the dangers and can walk you through your alternative options.
International prospective register of systematic reviews | Research Gate
Treatment-resistant OCD: Strategies and novel treatment options | Psychiatric times