Low doses of Seroquel, which causes drowsiness and somnolence as a side effect, are increasingly being prescribed off-label as a treatment for insomnia. Many experts do not recommend this use in the general population because there are safer alternatives.

• You should not use Seroquel to help with sleep unless your doctor has specifically prescribed it for this use.
• Your healthcare provider will need to monitor you for effectiveness and side effects if prescribed.
• When Seroquel is used for insomnia, it is usually given at the lowest effective dose (typically 25 mg to 100 mg at bedtime).

What is Seroquel?

Seroquel (quetiapine) is an atypical antipsychotic which causes drowsiness and sedation as a side effect. It is approved to treat schizophrenia and bipolar disorder, but is NOT approved by the FDA to treat insomnia (trouble getting to or staying asleep).

The long-acting form Seroquel XR is also used with antidepressant medications to treat major depressive disorder in adults.

Seroquel is specifically approved for the treatment of:

• Schizophrenia in people 13 years of age or older
• Bipolar disorder in adults, including: depressive episodes associated with bipolar disorder; manic episodes associated with bipolar I disorder, given alone or with lithium or divalproex; and for long-term treatment of bipolar I disorder with lithium or divalproex.
• Manic episodes associated with bipolar I disorder in children ages 10 to 17 years old, as monotherapy (single) treatment.

Seroquel use is considered “off-label” when used as a treatment for insomnia (trouble with sleeping). Off-label uses are those that have not been approved by the FDA and are not found in the package labeling. Doctors may choose to prescribe drugs “off-label” if they feel confident in the effectiveness and safety of the medicine for that use.

You should not use Seroquel for sleep unless prescribed by your doctor specifically for this use. In people being treated for the approved mental health disorders such as schizophrenia or bipolar disorder, it can cause drowsiness, which may help with sleep.

Your doctor will need to monitor you for Seroquel effectiveness and side effects, some of which may be severe. Your doctor may suggest safer options to help you with trouble sleeping.

Related: Alternatives to Seroquel for Sleep

How does Seroquel help with sleep?

When used at lower doses for insomnia (25 mg to 100 mg before bedtime), Seroquel has antihistamine activity at the histamine 1 and antiadrenergic effects at the alpha 1 and 2 adrenergic receptors. These receptor effects in the brain can lead to drowsiness, sleepiness and sedation.

In Seroquel studies, somnolence (a state of drowsiness or strong desire to fall asleep) was reported in 18% to 57% of patients.

Higher doses also have actions at serotonin and dopamine receptors, lending action to its approved uses as an antidepressant and antipsychotic medicine.

Clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel) are the most sedating atypical antipsychotics.

What is the dosage of Seroquel for sleep?

Lower doses of Seroquel, typically ranging from 25 mg to 100 mg before bedtime, have been used in studies to treat insomnia in people without mental health disorders.

If Seroquel is prescribed for sleep by your doctor, they should prescribe the lowest effective dose and follow up with you on a regular basis for side effects and continued need for treatment.

Use in the elderly should be approached with caution. Atypical antipsychotics carry a Boxed Warning for increased risk of cardiovascular events, stroke and death when used in elderly patients with dementia-related psychosis.

In addition, Seroquel can cause orthostatic hypotension (dizziness or lightheadedness when standing up with a drop in blood pressure). This can lead to falls and the possibility of bone fractures or other trauma.

Clearance of Seroquel is reduced by up to 50% in elderly patients 65 years and older compared to younger patients. When used in older patients, doctors should consider a lower starting dose, slowly increasing the dose, and monitoring patients carefully for side effects.

Dose adjustments of Seroquel may be needed if you have liver disease or take certain medications that interact with Seroquel.

Studies of Seroquel for sleep

Seroquel has been used to help with insomnia (trouble sleeping) in people without mental health disorders, but many clinicians and professional medical organizations do not recommend this use because of safety reasons and uncertain effectiveness. Some studies evaluating quetiapine for sleep have been inconclusive with regards to effectiveness and long-term safety.

People with mental health disorders like schizophrenia often have trouble with sleep. Treatment with antipsychotics may improve the mental health outlook for the patient and also improve their overall sleep patterns.

Side effects like weight gain, metabolic changes and daytime drowsiness can occur.

Primary insomnia

In one small sleep study in 14 healthy men, participants received Seroquel (quetiapine) at a dose of 25 mg or 100 mg orally one hour before sleep or a placebo (a pill with no medicine). Compared to the placebo, Seroquel significantly improved how quickly participants fell asleep, sleep quality and length of sleep. An increase in stage 2 sleep and periodic leg movements were seen with higher doses of Seroquel. (Lowe study)

In a review from the Agency for Healthcare Research and Quality (AHRQ), authors were inconclusive about the use of Seroquel for sleep. In one small study from Thailand that met criteria for review, participants received either quetiapine 25 mg or placebo each for 14 nights. Results were not significant but did show a trend toward falling asleep faster and a longer sleep time.

A review of studies from Anderson and Vande Griend found that quetiapine effectiveness and safety for use in insomnia was inconclusive, as data was lacking. The authors concluded that this medicine should not be used to treat insomnia due to potential for side effects and lack of effectiveness.

Another comparative review study from Atkin found that there was little evidence to support the use of quetiapine for insomnia in the general population. They did note that it may be useful in groups with certain psychotic or mood mental health disorders and has a low risk of addiction.

Insomnia related to substance use disorders

Seroquel has also been used as an option to help people with depression, agitation and trouble sleeping while undergoing substance abuse withdrawal and treatment. However, studies have not shown long-term effectiveness or safety for this use.

In one 8-week pilot study in 20 people undergoing withdrawal from alcohol use, doses of quetiapine XR (Seroquel XR) ranged from 40 mg to 400 mg per night. Seroquel improved trouble sleeping over the first 3 weeks of treatment when compared to a placebo (a pill with no medicine), but the effect did not last at 8 weeks time.

In another study with 224 alcohol-dependent people, doses of quetiapine (Seroquel) 400 mg per day was compared to a placebo to assess changes in sleep quality over 12 weeks. Sleep quality ratings only showed small improvements and had no positive effect on alcohol dependence.

Post-traumatic stress disorder (PTSD)

Data from some studies also support the use of Seroquel in people with post-traumatic stress disorder (PTSD) and may help with improvements in sleep quality and duration, and occurrence of night terrors or nightmares.

Does Seroquel cause rebound insomnia? Is it addictive for sleep?

Seroquel is not addictive and does not cause euphoria or a pleasurable effect associated with drugs of abuse when used alone.

Seroquel can cause rebound insomnia (a temporary return to trouble with sleeping) for about a week if you suddenly stop taking it. Abruptly stopping Seroquel can also lead to other side effects, like nausea or vomiting, dizziness, restlessness, headache, diarrhea, and irritability. Seroquel treatment should be gradually stopped.

Some people who use marijuana or illicit drugs may abuse Seroquel to enhance the pleasurable effects of these drugs or counteract the stimulating effects.

• Studies have shown that Seroquel has a potential for abuse in people already using substances such as marijuana, cocaine, and heroin. There are also reports of crushing the tablets for intravenous (IV) injection or snorting the powder intranasally.
• It can enhance or counter the stimulating effects of these illegal drugs, a practice known as “seroquelling”.
• Those who abuse Seroquel may use higher doses than normal which can lead to fatal overdoses.

Seroquel is not a controlled substance, which may contribute to its use as a sleep medicine. Some doctors may prefer to prescribe a non-controlled substance like Seroquel to help with sleep in people at risk for abuse, instead of controlled substances like the benzodiazepines or the Z-drugs like Ambien, Sonata or Lunesta. However, in general, there are usually safer alternatives that can be used, especially in people with substance abuse disorders.

Side effects or dangers of Seroquel for sleep

In studies when Seroquel was used for sleep, side effects have included:

• weight gain
• akathisia (restlessness)
• increased blood sugar (glucose) or other metabolic changes
• daytime drowsiness
• dizziness
• dry mouth
• heartburn / stomach pain
• increased appetite
• elevated cholesterol and triglycerides
• sedation and somnolence

If Seroquel is used for sleep, the lowest effective dose should be prescribed by your doctor. However, even low doses of Seroquel used for insomnia have led to weight gain up to 5 kg (11 lb). Longer-term use may increase the risk for metabolic syndrome, and related heart disease.

Other potential risks, especially at higher doses, can include movement disorders, heart rhythm disorders (QTc prolongation), and orthostatic hypotension and fainting (which may lead to fall and bone fracture).

You should avoid or limit alcohol use when taking sedating drugs while taking Seroquel. Do not drive, operate hazardous machinery or perform other dangerous activities if you are drowsy or until you know how you will respond to this medicine.

A Boxed Warning is the most stringent prescription safety warning from the FDA. Atypical antipsychotics like Seroquel (quetiapine) also carry a Boxed Warning on their label for increased risk of death when used in elderly patients with dementia-related psychosis. Seroquel is not approved for the treatment of patients with dementia-related psychosis.

Seroquel also has a Boxed Warning for increased risk of suicidal thoughts and behaviors.

What are alternatives for sleep beside Seroquel?