Quetiapine (Seroquel) as a Sleep Aid
The Centers for Disease Control and Prevention (CDC) estimates that 70 million Americans suffer from chronic sleep problems.1 Although quetiapine is not approved by the Food and Drug Administration (FDA) for insomnia, doctors have been increasingly prescribing this drug to help with sleeping problems in recent years.
Quetiapine is an antipsychotic medication approved to treat schizophrenia and bipolar disorder.2 Drowsiness is a very common side effect of the drug, leading many to try it as a sleep aid.
Why Does Quetiapine Make You Sleepy?
Similar to first-generation antihistamines, like doxylamine (Unisom) and diphenhydramine (Benadryl, ZZZQuil), quetiapine blocks histamine (H1) receptors in the brain which blocks histamine’s effect on wakefulness, triggering your brain to transition into sleep mode. This may explain why it makes you sleepy.345
More than 10% of people taking quetiapine experience drowsiness as a side effect.2 This side effect makes quetiapine an attractive medication to try as a sleep aid.
Your doctor will likely prescribe a low dose of quetiapine to start with, around 25 mg, but may increase the dose from there.6 This is much lower than the recommended dose for schizophrenia or bipolar disorder, which is between 150 mg to 800 mg per day.2
Can You Drink While Taking Quetiapine?
You should not drink while taking quetiapine. Quetiapine can increase the effect alcohol has on you and alcohol can worsen the side effects of quetiapine.2 Additionally, alcohol can worsen your quality of sleep.7 If you plan to continue drinking while taking quetiapine, talk to your doctor.
Quetiapine Side Effects
Quetiapine may cause side effects.2 The most common include:
- Dry mouth
- Abdominal pain
- Sore throat
- Difficulty moving
- Weight gain
Some of quetiapine's side effects may be more serious. Talk to your doctor if you experience thoughts of suicide, new or worsening depression, anxiety, irritation, or other unusual changes in your mood.2
Quetiapine and Weight Gain
It is very common for people taking quetiapine to gain weight. Many studies show that people taking quetiapine at any dose, even the low doses used for sleep problems, gain weight.8 The weight gain usually takes place in the first 12 weeks.9 Even if you only use quetiapine for a short time, you may still experience weight gain.
Weight gain is probably due to the fact that quetiapine increases the amount of sugar in your blood, even if you do not have diabetes. Quetiapine can also increase the fat levels in your blood (cholesterol and triglycerides).2 You should monitor your weight and talk to your doctor about ways to control weight gain like exercise and eating healthy.
Can Quetiapine Make Your Sleep Worse?
Sleep apnea, a disorder that causes your breathing to stop or get very shallow during sleep, is strongly associated with obesity.10 Because quetiapine can cause weight gain even at low doses for a short time, research shows that quetiapine could make sleep worse by increasing the risk of sleep apnea.11
Quetiapine Lacks Evidence for Use as a Sleep Aid
Quetiapine is not currently approved as a sleep aid and the American Academy of Sleep Medicine does not recommend Seroquel for insomnia.212 Even though some clinical trials have shown improved quality of sleep in people with bipolar disorder, the effect on sleep alone has only been shown in a few clinical trials with few patients.131415 Experts also don’t yet fully understand the long-term effects of low-dose quetiapine treatment.16
Why CBT-I Might Be a Better Alternative Than Taking Quetiapine
Quetiapine is widely prescribed off-label as a sleep aid, but it is often only used as a short-term solution. Over time, your body may build up a tolerance to the drowsy effect of quetiapine and you may need a higher dose to get the same effect. Additionally, many of the side effects get worse with higher doses.
CBT-I is a clinically proven and evidence-based method for treating sleep disorders.17 It can help you reframe your thoughts, feelings, and behaviors to improve sleep. CBT-I may have a better balance of potential benefits to risks than medications like quetiapine. Because of this, the American Academy of Sleep Medicine recommends CBT-I as the first-line treatment for insomnia. This means that it is the first treatment that should be tried for people with sleeping problems.12
Interested in learning more about CBT-I? Dawn Health provides a comprehensive CBT-I program that can be accessed through an easy-to-use smartphone app. Get started with a quick questionnaire to help us better understand where you’re at on your journey to better sleep.
Centers for Disease Control and Prevention. (2017, June). Sleep and Sleep Disorders. https://www.cdc.gov/sleep/about_us.html
U.S. Food and Drug Administration. (2009, November). Seroquel (quetiapine fumarate) Tablets: Highlights of Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020639s045s046lbl.pdf
MedlinePlus. (2022, June 15). Doxylamine. https://medlineplus.gov/druginfo/meds/a682537.html
MedlinePlus. (2022, June 15). Diphenhydramine. https://medlineplus.gov/druginfo/meds/a682539.html
Reiner, P., Kamondi, A. (1994). Mechanisms of antihistamine-induced sedation in the human brain: H1 receptor activation reduces a background leakages potassium current. Neuroscience. 59(3):579-88. doi: 10.1016/0306-4522(94)90178-3
Coe, H., Hong, I. (2012). Safety of low doses of quetiapine when used for insomnia. Annals of Pharmacotherapy, 46(5):718-22. doi: 10.1345/aph.1Q697
Roehrs, T., & Roth, T. Sleep, Sleepiness, and Alcohol Use. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/arh25-2/101-109.htm
Cates, M., Jackson, C., Feldman, J., Stimmel, A., Wooley, T. (2009). Metabolic consequences of using low-dose quetiapine for insomnia in psychiatric patients. Community Mental Health Journal, 45(4):251-4. doi: 10.1007/s10597-009-9200-0
Brecher, M., Leong, R., Stening, G., Osterling-Koskinen, L., Jones, A. (2007). Quetiapine and long-term weight change: a comprehensive data review of patients with schizophrenia. Journal of Clincial Psychiatry, 68(4):597-603. doi: 10.4088/jcp.v68n0416
MedlinePlus. (2022, June 15). Sleep Apnea. https://medlineplus.gov/sleepapnea.html
Freudenmann, R., Sussmuth, S., Wolf, R., Stiller, P., Schonfelt-Lecuona, C. (2008). Respiratory dysfunction in sleep apnea associated with quetiapine. Pharmacopsychiatry, ;41(3):119-21. doi: 10.1055/s-2008-1058111
Sateia, M., Buysse, D., Krystal, A., Neubauer, D., Heald, J. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine, https://doi.org/10.5664/jcsm.6470
Calabrese, A., Keck, P., Macfadden, W., Minkwitz, M., Ketter, T., Weisler, R., Cutler, A., McCoy, R., Wilson, E., Mullen, J. (2005). A randomized, double-blind, placebo-controlled trial of quetiapine in the treatment of bipolar I or II depression. American Journal of Psychiatry, https://doi.org/10.1176/appi.ajp.162.7.1351
Tassniyom, K., Paholpak, S., Tassniyom, S., Kiewyoo, J. Quetiapine for primary insomnia: a double blind, randomized controlled trial. J Med Assoc Thai; 2010;936:729-734, 20572379.
Anderson, S., Vande Gried, J. Quetiapine for insomnia: a review of the literature. (2014). American Journal of Health-system Pharmacy, 71, (5), 394–402 https://doi.org/10.2146/ajhp130221
Thompson, W., Quay, T., Rojas-Fernandez, C., Farrell, B., Bjerre, l. (2016). Atypical antipsychotics for insomnia: a review. Sleep Medicine, 22,13-17.
Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of clinical sleep medicine, 17(2), 255–262. https://doi.org/10.5664/jcsm.8986
Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.