Concerns Over Sleep Aid Quetiapine

It’s estimated that about 1 in 5 adults in the U.S. face issues with sleep health, leading many to seek medication for relief.

However, recent research has highlighted potential side effects tied to a frequently prescribed sleep aid.

Quetiapine, known as Seroquel, is an antipsychotic approved for conditions like schizophrenia and bipolar disorder. Studies suggest it may help improve sleep quality, which is why it’s often prescribed off-label for insomnia, typically at lower doses.

“There’s a rising sentiment that using low-dose quetiapine is a relatively safe method to aid sleep,” noted Cricket Fauska, the lead author and sleep scientist at Flinders University in Australia.

“But our findings reveal it’s a bit more complicated than that.”

Fauska and her team conducted a small clinical trial focusing on its effects on individuals with obstructive sleep apnea, the most prevalent kind of sleep disorder.

This condition occurs when the upper airway becomes blocked during sleep, leading to symptoms like headaches, snoring, and increased fatigue the following day.

It’s estimated that nearly a billion people are affected by obstructive sleep apnea.

The experiments involved 15 participants suffering from this condition and difficulties staying asleep. While quetiapine did extend their sleep duration and reduced nighttime awakenings, there were alarming effects on their alertness the next day.

“Participants reported longer sleep and fewer awakenings, yet their reaction times were slower, and performance in simulated driving tasks was significantly poorer the next morning,” Fauska explained.

The differences were remarkable. In a 10-minute psychomotor vigilance test, reaction times were noticeably slower after quetiapine compared to a placebo. Attention lapses shot up from a median of 2 after a placebo to 10 after the medication.

In a driving simulation, participants strayed an average of 33 percent further from the lane’s center after taking quetiapine versus placebo.

The rate of actual crashes in the simulator nearly doubled with quetiapine, although the limited sample size means the statistical significance is questionable—it might just be chance.

“What’s particularly worrisome is that some individuals didn’t feel especially drowsy the next day even while performing worse on objective assessments,” Fauska said.

“This disconnect between how participants feel and their actual functioning can pose serious risks, particularly for activities like driving.”

The study does not categorically label quetiapine as unsafe, as doctors often prescribe medications off-label when the benefits might outweigh the risks. Indeed, quetiapine has shown some potential benefits for sleep.

Researchers, however, advocate for stricter regulations regarding its prescription.

Obstructive sleep apnea and insomnia frequently co-occur, yet around 80 percent of those with sleep apnea are believed to remain undiagnosed.

Individuals with sleep apnea might often wake up or have trouble staying asleep, complicating the differentiation of symptoms from insomnia.

This suggests many people could be taking a medication that initially seems effective in enhancing sleep quality but may seriously compromise attention and reaction times the next day—even if the individuals do not perceive any changes in their state.

“Our results indicate that quetiapine shouldn’t be used routinely as a sleep aid in individuals with known or suspected sleep apnea, especially when alertness the following day is crucial,” said Danny Eckert, another sleep scientist at Flinders University.

The researchers also point to growing evidence illustrating that a one-size-fits-all approach doesn’t work for managing obstructive sleep apnea.

The next step involves testing quetiapine on larger cohorts, with varying dosages and over extended periods. This study only involved one night of quetiapine and one night of placebo, so it cannot determine outcomes of extended use.

“Sleep apnea is a multifaceted condition with various underlying causes in different individuals,” Eckert remarked.

“What we’re learning is that treatment should be customized—utilizing the appropriate approach or combination of approaches for each individual, rather than automatically resorting to sedative medications.”

The findings were published in Annals of the American Thoracic Society.