From the Guidelines
Amitriptyline can be used to help with sleep, but its efficacy for this indication is not well established, and it is not FDA approved for insomnia. According to the clinical guideline for the evaluation and management of chronic insomnia in adults 1, certain antidepressants like amitriptyline are employed in lower than antidepressant therapeutic dosages for the treatment of insomnia. The guideline notes that the efficacy of these medications for insomnia is not well established.
Some key points to consider when using amitriptyline for sleep include:
- It is often prescribed off-label at lower doses (10-50 mg) for sleep difficulties
- It works by increasing levels of certain neurotransmitters in the brain, particularly serotonin and norepinephrine, which helps regulate sleep patterns
- Common side effects include morning drowsiness, dry mouth, constipation, and dizziness
- It's especially helpful for people who have both insomnia and chronic pain conditions, as it can address both issues simultaneously
- It's not recommended for everyone, particularly those with certain heart conditions, glaucoma, or those taking specific medications like MAO inhibitors, so a healthcare provider should always be consulted before starting this medication for sleep.
It's also important to note that the guideline advises caution when using sedatives/hypnotics, including administering them on an empty stomach, avoiding use during pregnancy or nursing, and exercising caution in patients with signs/symptoms of depression, compromised respiratory function, or hepatic heart failure 1.
From the FDA Drug Label
CNS and Neuromuscular: ... insomnia; restlessness; nightmares; drowsiness; Withdrawal Symptoms ... transient symptoms including ... dream and sleep disturbance.
Amitriptyline may actually worsen sleep as it can cause insomnia, nightmares, and restlessness. Additionally, withdrawal symptoms can include dream and sleep disturbance. 2
From the Research
Amitriptyline and Sleep
- Amitriptyline is sometimes prescribed off-label for insomnia, as seen in the study published in 3 and 4.
- The DREAMING study, a randomised, double-blind, placebo-controlled trial, aimed to assess the effectiveness of low-dose amitriptyline (10-20 mg/day) in patients with insomnia disorder, with results indicating that amitriptyline led to statistically significantly lower Insomnia Severity Index (ISI) scores compared to placebo at 6 weeks, but not at later time points 4.
- Another study compared the effects of trazodone on sleep in depressed patients to other sleep-promoting antidepressants, including amitriptyline, and found that sedative antidepressants like amitriptyline can improve sleep continuity and promote slow wave sleep 5.
- A study on nortriptyline, a related medication, found that it altered EEG sleep in a pattern similar to amitriptyline, with reduced REM sleep time and latency 6.
- Additionally, a review of dietary supplements used in the treatment of depression, anxiety, and sleep disorders mentioned that low-dose antidepressants like amitriptyline can be used to treat sleep disorders, and that some dietary supplements like melatonin and valerian may be used as alternatives 7.
Effectiveness of Amitriptyline for Sleep
- The effectiveness of amitriptyline for sleep disorders is still being researched, with some studies indicating that it can be beneficial in reducing insomnia severity, at least in the short term 4.
- However, the long-term effects of amitriptyline on sleep are less clear, and more research is needed to fully understand its potential benefits and limitations 4.
- Amitriptyline may be more effective for certain types of sleep disorders, such as sleep maintenance problems, rather than sleep initiation problems 3.