From the Guidelines
Gabapentin is not recommended as a first-line treatment for sleep disturbances, but it may be considered for patients with certain conditions, such as chronic pain, restless legs syndrome, or neuropsychiatric disorders, at doses ranging from 100-900 mg taken 1-2 hours before bedtime. The evidence for gabapentin in improving sleep quality is moderate, and it appears to be most beneficial for patients with specific conditions, such as chronic pain, restless legs syndrome, alcohol withdrawal, and certain neuropsychiatric disorders 1. Gabapentin works by enhancing GABA activity in the brain and modulating calcium channels, which helps reduce neuronal excitability and promotes relaxation. Patients may experience improved sleep continuity, reduced nighttime awakenings, and increased slow-wave sleep. Common side effects include daytime drowsiness, dizziness, and potential morning grogginess, which typically improve with continued use. Elderly patients should start at lower doses (100-200 mg) due to increased sensitivity. It is essential to note that gabapentin is not recommended as a first-line treatment for primary insomnia without comorbidities, but it can be considered when other sleep medications have failed or are contraindicated. The medication should be tapered gradually when discontinuing to avoid withdrawal symptoms. In contrast, cognitive behavioral therapy for insomnia (CBT-I) is a recommended first-line treatment for chronic insomnia disorder, as it has been shown to be effective in improving sleep outcomes and has fewer harms compared to pharmacologic therapy 1.
From the Research
Gabapentin and Sleep
- Gabapentin has been studied as a potential treatment for sleep disturbances, particularly in patients with restless legs syndrome (RLS) or chronic neuropathic pain 2, 3, 4, 5.
- A randomized polysomnography study found that gabapentin enacarbil significantly reduced wake time during sleep and periodic limb movements associated with arousal per hour of sleep in patients with RLS 2.
- A systematic review and meta-analysis found that gabapentinoids improved sleep quality and reduced pain in patients with chronic neuropathic pain, but increased daytime somnolence 3.
- A study on the treatment effects of gabapentin for primary insomnia found that gabapentin increased sleep efficiency and slow-wave sleep, and decreased wake after sleep onset and spontaneous arousal index 4.
- Pooled analyses from three trials of gabapentin enacarbil found that it significantly improved sleep disturbance, pain, and mood in adult patients with moderate-to-severe primary RLS, regardless of baseline sleep disturbance level 5.
Mechanism of Action
- The exact mechanism of gabapentin's effect on sleep is not fully understood, but it is thought to involve the regulation of slow-wave sleep and the reduction of periodic limb movements associated with arousal 2, 4.
- Gabapentin may also have an impact on the body's pain processing systems, which can contribute to sleep disturbances 3.