Does amitriptyline work for sleep?

Everyone experiences the occasional restless night from time to time. However, if you frequently lie awake, struggling to fall asleep or stay asleep, you aren’t alone. In fact, approximately 70 million people in the United States deal with chronic sleep problems, according to the Centers for Disease Control and Prevention (CDC). And while there are many different underlying reasons that people may struggle to get a good night’s sleep, many find themselves turning to prescription sleep aids.

Amitriptyline is a prescription medication that is commonly used off-label to treat chronic insomnia. Read on to learn more about amitriptyline, including what it is, common dosages prescribed for sleep disorders, side effects, and alternative options.

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What is amitriptyline?

Amitriptyline hydrochloride (HCL), commonly referred to by its brand name Elavil, is a prescription medication that’s been approved by the Food and Drug Administration (FDA) for the treatment of depression. 

There are many off-label uses for amitriptyline as well, including:

• Neuropathic pain, including diabetic neuropathy and postherpetic neuralgia
• Fibromyalgia
• Migraines
• Interstitial cystitis (bladder pain syndrome)
• Irritable bowel syndrome
• Chronic pain, including back pain
• Anxiety
• Insomnia

How does amitriptyline work?

Amitriptyline is in a drug class known as tricyclic antidepressants. It works by altering the levels of certain chemicals in the brain. 

“Amitriptyline increases the serotonin and norepinephrine in our brains, which can have a sedative effect, as well as reduce anxiety, and improve mood,” explains Puja Aggarwal, MD, a board-certified neurologist and founder of Zenful Brain. “It also may work by blocking histamine, which can cause drowsiness.”

It increases the levels of serotonin and norepinephrine by blocking their reabsorption, which leads to increased activity of these neurotransmitters. Increased concentrations of these neurotransmitters are believed to help improve mood, reduce feelings of pain, and ultimately help you fall asleep quicker.

While amitriptyline may start to work as soon as one to two hours of the first dose for some individuals, others may not see improvements until one to two weeks of daily usage, as the drug builds up in their system. Continue taking the medication as prescribed and tell your healthcare provider if you don’t see improvements after a few weeks. 

Amitriptyline for sleep

“Amitriptyline can be prescribed to people who have had insomnia for longer than one month, those with depression and insomnia, or people with insomnia and anxiety,” Dr. Aggarwal says. 

However, according to some research, the use of amitriptyline may have variable effects on sleep quality—specifically on the stages of slow wave sleep (SWS) and rapid eye movement (REM) sleep.

• Slow wave sleep (SWS): SWS includes stages 3 and 4 of non-REM sleep. This is the period when you are in your deepest sleep, and when the body physically recovers and grows. Your immune system is also strengthened during this time. 
• Rapid eye movement (REM) sleep: REM sleep follows after SWS. The majority of your dreams will occur in this stage. REM sleep plays an important role in memory consolidation, emotional processing, and brain development. This is when your brain processes everything you learned and experienced during the day.

Amitriptyline, and many other antidepressant medications, may suppress REM sleep and have variable effects on SWS. When REM sleep is shortened, you may experience problems with mood and memory, which can lead to a decline in mental health and cause feelings of anxiety or depression in some individuals. Your body also may not have time to repair itself. So while you may fall asleep quicker, your body and brain may not be able to function at their highest levels and you may be left feeling tired, sore, or ultimately become sick as a result of a weakened immune system—although not everyone who takes amitriptyline will experience these side effects. 

If you do choose to use amitriptyline for sleep, it’s recommended that you take it shortly before bedtime. However, you can move this up an hour or two if you find that you are waking feeling groggy in the morning. 

Amitriptyline dosage for sleep

Amitriptyline is most commonly prescribed in tablet form, with tablet strengths ranging from 10 mg to 150 mg. However, the amitriptyline dosage for sleep generally starts at 10 mg. 

“The amitriptyline dose should start at the lower doses of 10 mg to 25 mg for sleep,” says Dr. Aggarwal. “If the initial low dose doesn’t help, your prescribing healthcare provider can slowly increase the dose until you find one that works well to help with your insomnia.”

“The prescribed dose of amitriptyline can also depend on factors like age, medical history, and other medical conditions,” adds Sean Ormond, MD, a dual-board certified anesthesiologist and interventional pain physician at Atlas Pain Specialists in Phoenix, Arizona.

Amitriptyline side effects 

Like any medication, there is a risk of side effects for individuals who take amitriptyline. While some side effects are common and may not be cause for concern, others can be serious and require medical attention. 

Common side effects of amitriptyline include:

• Constipation
• Headache
• Dizziness
• Dry mouth
• Drowsiness
• Weight gain

Other side effects of amitriptyline may include:

• Nausea or vomiting
• Blurred vision
• Fever
• Urinary retention
• Sexual problems, such as decreased sex drive or impotence
• Confusion

In some cases, these side effects can improve with continued use. However, if you experience prolonged or bothersome side effects and would like to discontinue use of the amitriptyline, you should consult your healthcare provider first. Depending on your dose, they will likely advise you to wean off the drug slowly to avoid additional side effects. 

In rare cases, serious side effects can occur. Serious side effects of amitriptyline include:

• Fast or irregular heartbeat
• High blood pressure
• Chest pain or difficulty breathing
• Seizures
• Thoughts of harming yourself or others
• Itching or hives
• Swelling of your hands, face, mouth, or throat 
• Increased risk of bone fractures
• Severe dizziness or feeling lightheaded

If you experience any of these serious side effects, contact a healthcare professional immediately for medical advice. 

Alternative to amitriptyline for sleep

It’s important to tell your healthcare provider every medication you are taking prior to starting amitriptyline, as certain drug interactions can occur. Amitriptyline also may not be an option for everyone, including individuals with:

• Heart problems, such as heart rhythm abnormalities or increased heart rate
• Opioid or benzodiazepine addiction
• Pregnant or breastfeeding
• Glaucoma
• Bipolar disorder
• History of epilepsy or seizures
• Liver or kidney disease

In addition, while amitriptyline is commonly prescribed by healthcare providers for the treatment of insomnia, there isn’t a lot of research to support the effectiveness of amitriptyline for sleep.

“There is actually not much proof that amitriptyline has any beneficial effect on sleep or insomnia,” explains Dr. Ormond. He adds that there are alternatives to amitriptyline that are more effective for treating insomnia. 

Dr. Aggarwal shares that common alternatives to amitriptyline for sleep-related concerns include: 

• Melatonin: This over-the-counter, natural supplement can help you fall asleep, but you may develop a tolerance and need higher doses over time. Possible side effects include headaches and dizziness.
• Zolpidem tartrate (Ambien): This medication acts on benzodiazepine receptors. It can cause significant side effects, including daytime grogginess, nightmares, and confusion. This medication does have the potential to be abused. 
• Trazodone HCL: This is an antidepressant that is commonly prescribed off-label for insomnia. Common side effects include daytime sleepiness, dry mouth, and dizziness. With continued use, a tolerance to the medication can be built up.
• Eszopiclone (Lunesta): This medication acts on the same brain receptors as the benzodiazepines to promote sleep. It’s advised to avoid high-fat meals with this medication, as the effectiveness can decrease. You should also ensure you have at least seven to eight hours to sleep after taking the medication to reduce the risk of daytime drowsiness the next day. 
• Antihistamines (Diphenhydramine, Hydroxyzine): These medications can be used for short-term insomnia, but can cause dry mouth, dry eyes, and daytime sleepiness.
• Benzodiazepines (Lorazepam, Clonazepam, Valium): This class of medications can cause sedation and decrease anxiety for better sleep. However, they are not ideal for long-term treatment of insomnia. Unfortunately, there is a risk of addiction and withdrawal symptoms associated with benzodiazepines.

If you are experiencing side effects from taking amitriptyline, or just want to try another medication, talk to your healthcare provider about other treatment options. They will help identify which drugs may be an option to help with your sleepless nights. It’s important to find the medication that works best for you, as it can vary by person and may require that you try several options. 

Regardless of the medication you and your healthcare provider decide is the right fit for you, SingleCare’s prescription drug savings card can help you save up to 80% off your next prescription medication. You can use the free search tool to compare prices at pharmacies nearby to be sure you’re getting the best price. Simply enter the name of your medication and your location to get started.