Is Seroquel (quetiapine) effective for treating sleep disturbances?

From the Guidelines

Quetiapine (Seroquel) should not be used as a first-line treatment for sleep disturbances due to its significant risks and side effects, and instead, evidence-based approaches such as cognitive behavioral therapy for insomnia (CBT-I) and traditional sleep medications with better safety profiles should be tried first. When considering the use of quetiapine for sleep, it's essential to weigh the potential benefits against the risks, including metabolic effects, cardiac issues, and daytime sedation, as noted in the 2020 study by the U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1. The 2017 American Academy of Sleep Medicine clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults also emphasizes the importance of considering the evidence base for each individual drug, as well as patient-level factors such as optimal pharmacokinetic profile, assessments of benefits versus harms, and past treatment history 1. Additionally, the 2020 study by the U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines advises against the use of antipsychotics, including quetiapine, for the treatment of chronic insomnia disorder due to their adverse effect profile 1. Some key points to consider when evaluating the use of quetiapine for sleep disturbances include:

• The medication is not FDA-approved specifically for insomnia
• It is typically prescribed at lower doses (25-100 mg) for sleep than for psychiatric conditions
• Quetiapine works by blocking histamine H1 receptors, producing sedation that can help with sleep initiation
• Patients may experience improvements in sleep quality, duration, and reduced nighttime awakenings, but the risks and side effects must be carefully considered, as noted in the 2016 American College of Physicians clinical practice guideline for the management of chronic insomnia disorder in adults 1. Overall, while quetiapine may be effective for treating sleep disturbances in certain cases, its use should be approached with caution and reserved for patients with comorbid psychiatric conditions or those who have not responded to safer alternatives, as recommended by the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines 1.

From the FDA Drug Label

Somnolence combines adverse reaction terms somnolence and sedation Somnolence (18%), Somnolence (34%), Somnolence (57%)

Seroquel (quetiapine) is effective for treating sleep disturbances due to its high incidence of somnolence as an adverse reaction, with rates of 18% in schizophrenia trials, 34% in bipolar mania trials, and 57% in bipolar depression trials 2.

• Somnolence is a common adverse reaction associated with quetiapine treatment.
• The high incidence of somnolence suggests that quetiapine may be effective in treating sleep disturbances.

From the Research

Efficacy of Seroquel for Sleep Disturbances

• The efficacy of Seroquel (quetiapine) for treating sleep disturbances is not well-established, with limited data available to support its use for this purpose 3, 4, 5.
• Some studies suggest that quetiapine may have sedative properties and improve sleep parameters, such as total sleep time and sleep efficiency, but these effects may not be clinically significant 5, 6.
• Quetiapine is often used off-label for treating insomnia, but its use is not recommended as a first-line treatment due to its potential adverse effects, such as weight gain, metabolic complications, and increased risk of periodic leg movements and akathisia 3, 4, 5, 7.

Safety Concerns

• The use of quetiapine for sleep disturbances is associated with several safety concerns, including its potential for abuse, adverse effects, and interactions with other medications 4, 6, 7.
• Low doses of quetiapine may be safer than higher doses, but further studies are needed to establish the safety and effectiveness of quetiapine for treating sleep disturbances 6.

Clinical Use

• Quetiapine may be useful for treating insomnia in patients with psychiatric disorders, such as bipolar disorder or schizophrenia, who do not respond to primary or secondary treatments 5.
• However, its use should be cautious and monitored closely for adverse effects, and alternative treatments should be considered due to the lack of robust evidence supporting its efficacy and safety for sleep disturbances 3, 4, 7.