From the Guidelines
Seroquel (quetiapine) should not be used as a first-line treatment for sleep problems due to its potential risks and the availability of safer alternatives. The American Academy of Sleep Medicine clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults recommends cognitive behavioral therapies for insomnia (CBT-I) as a standard of treatment, with a significantly favorable benefit-to-risk ratio 1. For patients who cannot derive benefit from CBT-I alone, pharmacotherapy may be considered, but dedicated sleep medications such as zolpidem (Ambien), eszopiclone (Lunesta), or low-dose doxepin are more appropriate first choices.
Some key points to consider when evaluating the use of Seroquel for sleep include:
- The potential risks associated with using an antipsychotic medication solely for its sedating properties, including metabolic effects, movement disorders, and anticholinergic effects 1.
- The availability of safer alternatives, such as non-medication approaches like sleep hygiene improvements, cognitive behavioral therapy for insomnia, or over-the-counter options like melatonin.
- The importance of a comprehensive initial evaluation, including a detailed history of sleep complaints, medical and psychiatric history, and medication/substance use, to select specific treatments for specific patients 1.
When considering pharmacotherapy for insomnia, it is essential to weigh the benefits and harms of each medication, taking into account patient-level factors such as optimal pharmacokinetic profile, past treatment history, and patient preferences 1. In general, the use of Seroquel for sleep should be avoided due to its potential risks and the availability of safer, more effective alternatives. If you're struggling with sleep issues, consult with a healthcare provider who can recommend appropriate treatments based on your specific situation and medical history.
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.