From the Guidelines
Seroquel (quetiapine) is not recommended as a first-line treatment for sleep problems due to its potential risks and the availability of safer alternatives. While it can cause sedation as a side effect, it is primarily an antipsychotic medication approved for conditions like schizophrenia and bipolar disorder. According to the American Academy of Sleep Medicine clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults 1, pharmacotherapy should be considered mainly in patients who are unable to derive benefit from cognitive behavioral therapies for insomnia (CBT-I) or have specific treatment goals, comorbidities, or prior treatment responses that necessitate its use.
Key considerations for treating insomnia include:
- Starting with sleep hygiene improvements and non-medication approaches such as maintaining a regular sleep schedule, avoiding screens before bedtime, and creating a comfortable sleep environment.
- Considering short-term use of medications specifically designed for sleep like melatonin (0.5-5mg taken 1-2 hours before bedtime) or prescription options like zolpidem (5-10mg) or trazodone (25-100mg) at bedtime.
- Evaluating the potential for adverse effects of these drugs, as highlighted in the guideline 1, which includes a systematic review and meta-analyses to determine the efficacy and safety of individual prescription and non-prescription medications for treatment of insomnia.
The use of Seroquel for sleep is not supported by the guideline due to its risks, including metabolic effects, weight gain, and potential movement disorders, making its risk-benefit profile unfavorable for simple insomnia 1. The sedating effect of Seroquel comes from its antihistamine properties at low doses (25-100mg), but using an antipsychotic for sleep alone exposes patients to unnecessary risks when safer alternatives exist. If insomnia persists, it is essential to consult a healthcare provider for proper evaluation and treatment, taking into account the individual patient's history, preferences, and treatment availability, as recommended by the guideline 1.
From the Research
Seroquel for Sleep
- Seroquel, also known as quetiapine, is an atypical antipsychotic that is sometimes used off-label to treat insomnia 2.
- However, the evidence to support its use for this purpose is limited, and it is associated with significant risks, including weight gain and other metabolic effects 2.
- According to a 2009 study, atypical antipsychotic agents like quetiapine may be used to lessen agitation that disrupts sleep, but there is insufficient research on their use in severe insomnia 3.
- Cognitive behavioral therapy for insomnia (CBT-I) is a more effective and safer treatment option for insomnia, especially when combined with other therapies 4, 5, 6.
- A 2022 systematic review and meta-analysis found that CBT-I is an effective treatment for patients with insomnia and comorbid mental disorders, including depression, PTSD, and alcohol dependency 4.
- A 2017 study found that CBT-I, either alone or combined with zolpidem, produces durable sleep improvements up to two years after completion of treatment 5.
- A 2018 study found that combining CBT-I with eszopiclone is more effective than eszopiclone alone in treating sleep disorders in patients transferred out of the intensive care unit 6.