Does quetiapine help you sleep?

What is quetiapine? | How quetiapine works for sleep | Efficacy | Dosage | Side effects | Costs | Alternatives

Getting the proper amount of sleep at night is important for your physical and mental health. The Centers for Disease Control and Prevention (CDC) recommend that the average adult sleep for seven to nine hours per day. The average person gets less. In the U.S., there are 50 to 70 million adults that are affected by a sleep disorder.

If you’re consistently lying awake at night, it’s likely you’ll try just about anything to get some shut-eye—even prescription drugs. You may have heard about the drug Seroquel (quetiapine) and wondered if it is a safe option to help you sleep. Here’s what you need to know.

What is Seroquel (quetiapine)?

Seroquel (quetiapine) is not a sleep aid, but rather a mental health medication. It’s approved by the U.S. Food and Drug Administration (FDA) to treat psychiatric conditions, including schizophrenia, bipolar disorder, and major depressive disorder.

This medication is classified as an atypical antipsychotic, or second-generation, antipsychotic. That means this type of drug is less likely to cause akathisia, or involuntary movements, compared to typical, or first-generation, antipsychotic drugs. In other words, quetiapine can even out mood disorder symptoms with less severe adverse effects than earlier treatments. However, one of its side effects is drowsiness, which is why it’s sometimes prescribed off-label for sleeping problems.

RELATED: List of atypical antipsychotics

Does quetiapine work for insomnia?

“Quetiapine in low doses blocks histamine, serotonin, and dopamine receptors in the brain, causing drowsiness. Its sleep-inducing properties are high,” says Sean Ormond, MD, an anesthesiologist and pain management specialist at Atlas Pain Specialists in Phoenix, Arizona. This sedating effect is why low doses of quetiapine are sometimes used to help with sleep.

A Cleveland Clinic Journal of Medicine study found that use of quetiapine to treat insomnia has increased. It’s used as a replacement for more addictive sleep aids. For example, “benzodiazepines were prescribed for insomnia but caused dependence when used regularly so quetiapine came into the picture,” Dr. Ormond says. 

However, many providers recommend against using Seroquel for sleep issues. “The drug quetiapine is not FDA approved for sleep, and sleep organizations have advocated for the drug to not be prescribed for insomnia,” says Christopher Winter, MD, neurologist and sleep specialist ​at Charlottesville Neurology and Sleep Medicine, author of The Rested Child. “Quetiapine does not ‘help sleep,’ rather, the medication sedates you. Sedation and sleep are two different things.”

How effective is quetiapine for sleep?

The available research shows that quetiapine may be effective for secondary insomnia (sleep problems that occur along with another condition), especially when that condition is related to mental health. However, there are not high quality clinical trials showing it works well enough for primary insomnia (when sleep problems occur on their own) to counterbalance the potential side effects.

The American Journal of Health-System Pharmacy published a systematic review of the literature about using quetiapine to treat insomnia. The findings indicate that, “quetiapine’s benefit in the treatment of insomnia has not been proven to outweigh potential risks, even in patients with a comorbid labeled indication for quetiapine.” Most of the studies on the use of quetiapine treatment of insomnia were conducted on people who also experienced psychotic symptoms and therefore needed medication to treat their psychosis. 

The journal Psychopharmacology published a small placebo-controlled trial on the use of quetiapine to promote sleep in fourteen healthy male subjects who did not use the medication to treat psychosis. The study found that quetiapine did improve sleep, but because it is a small sample size, this data is not statistically significant. In 2016, researchers reviewed studies about quetiapine use for insomnia and found that there is not any scientific evidence that supports using quetiapine off-label to treat sleep issues.

Quetiapine dosage for sleep

FDA prescribing guidelines for quetiapine dosages are dependent on the reason for the use and the age of the person taking the medication. The dose can range from 25 mg to 800 mg per day, based on the indication for use. When used to treat insomnia, it’s usually low-dose quetiapine, between 25 mg and 100 mg taken at bedtime. Quetiapine causes sedation quickly after taking it, so it’s recommended to take it close to bedtime.

If you miss a dose of quetiapine, then you should take it as soon as you realize it. But if it is close to the next time you are scheduled to take the medication, then you should skip the missed dose. Never double up on a dose. Research shows that it’s possible to take too much quetiapine. “Overdose is possible when taking quetiapine,” Dr. Ormond explains. “There are many side effects such as cardiac problems, coma, or death.”

Quetiapine side effects and interactions

“Quetiapine is not well-supported by any science for use in sleep and it has significant side effects,” says Lulu Guo, MD, a family medicine physician at Valley Sleep Center in Arizona. It makes you drowsy, but there are many known adverse effects of quetiapine, including:

• Anxiety
• Confusion
• Constipation
• Decreased blood pressure, or hypotension
• Daytime drowsiness
• Depression
• Dizziness 
• Dry mouth
• Gastrointestinal distress
• Headache
• High cholesterol and triglyceride levels
• Increased heart rate
• Involuntary leg movements or restless leg syndrome
• High blood sugar
• Muscle tremors or rigidity
• Restlessness 
• Stroke 
• Suicidal thoughts or actions
• Tardive dyskinesia–repetitive and involuntary facial movements
• Weight gain and other metabolic changes

It is not recommended to take quetiapine when you are pregnant. You should avoid taking the following medications when taking quetiapine:

• Antiarrhythmic drugs such as quinidine, procainamide, amiodarone, or sotalol
• Antipsychotic drugs such as ziprasidone, chlorpromazine, or thioridazine
• Certain antibiotics such as azithromycin, clarithromycin, or levofloxacin 

Seroquel is not approved for children younger than 10 years old. It is approved to treat bipolar I disorder in adolescents who are 10 to 17 years old, or for the treatment of schizophrenia in adolescents who are 13 to 17 years old. There is an increased risk of suicidal thoughts and suicides in young adults taking Seroquel, so it is important to weigh the risks and benefits before taking Seroquel. Patients of any age should be monitored closely for changes in mood and behavior while taking Seroquel.

How much does quetiapine cost?

The price of quetiapine can vary depending on the dose but the average cash price of quetiapine without insurance is $100 for 30, 25 mg tablets.

Using our drug pricing tool, you can search for up-to-date prices of the medication in your area. Typically quetiapine is covered by insurance when needed to treat symptoms found in the mental health disorders of schizophrenia, bipolar disorder, and major depressive disorder. When prescribed off-label, insurance may not cover it. SingleCare can reduce the cost of generic quetiapine to less than $5 for 30, 25 mg tablets.

Quetiapine coupons

Alternatives to quetiapine for sleep

If you’ve tried quetiapine, and you’re still counting sheep all night, there are options—from other prescriptions to therapies. 

Sleep clinics

Providers at a sleep clinic can diagnose and treat sleep disorders. There are many different sleep disturbances that they can evaluate, such as: 

• Bruxism (teeth grinding)
• Night terrors
• Sleep apnea
• Sleepwalking

If you are having chronic insomnia or signs of another sleep disorder, consult your healthcare provider and ask for a recommendation for a nearby sleep clinic to get an evaluation.

Prescription sleep medications

The following prescription sleeping pills are effective, but some are only for short-time use:

• Silenor (doxepin) 
• Rozerem (ramelteon) 
• Halcion (triazolam) 
• Sonata (zaleplon) 
• Ambien (zolpidem)
• Lunesta (eszopiclone)

However, some of these (Halcion, Sonata, Ambien, Lunesta) are controlled substances with the potential for abuse and dependence.

Over-the-counter sleep medications

There are also over-the-counter medications like antihistamines that can help you drift off to sleep:

• Benadryl, Tylenol PM, ZZZquil, Advil PM (these contain diphenhydramine, or diphenhydramine in combination with Tylenol or Advil)
• Unisom sleep tabs (doxylamine)

Physicians also sometimes prescribe certain antidepressants off-label to treat sleep issues, such as Desyrel (trazodone).

RELATED: Trazodone for sleep

Natural supplements

According to SingleCare’s sleep survey, 44% of respondents reported using sleep aids. Natural vitamins and supplements were the most popular type of sleep aid reported in the survey. Some people use natural supplements such as melatonin, valerian root, magnesium, and/or lavender to help them relax and fall asleep. Just be sure to talk to your provider about how they could interact with any other medications you’re taking before starting a new supplement.

RELATED: Melatonin dosage guide

Relaxation techniques

One reason you might have a hard time falling asleep is because you are experiencing anxiety or you are unable to relax. If you incorporate relaxation techniques into your life on a daily basis, they can improve sleep latency, or the time it takes for you to fall asleep. It does take regular practice to learn these skills but once you do, you will find it easier to relax. Some popular types of relaxation techniques include:

• Aromatherapy
• Biofeedback
• Deep breathing
• Massage
• Meditation
• Progressive muscle relaxation
• Tai chi
• Yoga

Sleep hygiene

If you have habits like keeping the same bedtime and wake time every day, then your body will be ready for sleep. You can also have bedtime routines such as reading a book or taking a warm bath that will signal to your brain that it is time to shift into sleep mode. You should also try to not nap during the day and limit the amount you eat or drink before bedtime. Your bedroom should be reserved for sleep and sex only. It’s considered bad sleep efficiency to spend a lot of time in bed, but only a small amount of sleeping.

Cognitive behavioral therapy

“Cognitive behavioral therapy [talk therapy or psychotherapy] is the best way to create meaningful change when it comes to those suffering from insomnia,” says Dr. Winter. This type of program helps you develop strategies to improve sleep quality.