From the FDA Drug Label
Adverse reactions following the abrupt discontinuation of gabapentin have also been reported. The most frequently reported reactions were anxiety, insomnia, nausea, pain, and sweating. The FDA drug label indicates that insomnia is a possible adverse reaction following the abrupt discontinuation of gabapentin, but it does not provide information on the incidence of insomnia as a side effect of gabapentin treatment itself 1.
From the Research
Gabapentin can be an effective treatment for insomnia, particularly in patients with comorbid conditions such as restless leg syndrome, neuropathic pain, or anxiety, as evidenced by a study published in 2010 2.
Key Points to Consider
- The typical starting dose for insomnia is 100-300mg taken 1-2 hours before bedtime, which can be gradually increased to 600-900mg if needed.
- Patients should be aware that gabapentin may cause side effects including dizziness, daytime drowsiness, and unsteadiness, especially when first starting the medication.
- Gabapentin works by enhancing the activity of GABA, an inhibitory neurotransmitter in the brain that promotes calmness and relaxation, which helps facilitate sleep.
- Unlike some sleep medications, gabapentin doesn't typically cause tolerance or significant withdrawal when used appropriately, though it should still be tapered when discontinuing.
- It's particularly useful for patients who haven't responded well to traditional sleep medications or who have contraindications to them.
- However, gabapentin should be used cautiously in elderly patients and those with renal impairment, as dose adjustments may be necessary, as noted in a review of sleep medicines in older adults 3.
Comorbid Conditions and Gabapentin Use
- Gabapentin may be especially beneficial for patients with restless leg syndrome, as it has been shown to improve symptoms of RLS and sleep quality, as demonstrated in studies from 2002 4 and 2012 5.
- For patients with insomnia and comorbid anxiety, gabapentin's anxiolytic effects may also be beneficial.
- Cognitive behavioral therapy for insomnia (CBTI) is also an effective treatment for RLS patients with comorbid insomnia, as shown in a 2020 study 6, and can be considered in conjunction with or as an alternative to gabapentin.