Gabapentin for Sleep: Does It Work, and What Are the Risks?

You toss, you turn. It’s nearly time to wake up, and you feel like you’ve barely slept. But you’re not alone. In fact, 1 in 7 adults regularly struggle to fall asleep. 

In a perfect world, everyone would have good “sleep hygiene” — daily habits that help promote sleep. But in reality, it can be difficult to practice these habits all the time. And sometimes, you may still have trouble sleeping even when you do everything right. 

Gabapentin (Neurontin) is a prescription medication that’s FDA approved to treat a certain type of seizure and nerve pain from shingles. But gabapentin has many off-label uses, too, including for sleep. Does it work for sleep? And is it safe? 

What is gabapentin?

Gabapentin is FDA approved for a specific type of seizure and nerve pain from shingles. It’s widely used. But this is mainly due to its off-label uses. For example, anxiety and nerve pain from diabetes are just a few other conditions that gabapentin may be used to treat. 

Gabapentin works by blocking the release of “excitatory” chemicals in the brain. In large amounts, these chemicals can cause you to feel restless and anxious. By decreasing their levels, gabapentin has a calming effect. Gabapentin may also work by raising serotonin levels in the brain.

Gabapentin comes in pill forms as well as a liquid solution. It’s also available in long-acting forms called Gralise and Horizant. These are approved for nerve pain from shingles. Horizant is also approved for restless leg syndrome.

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What does the research say about using gabapentin for sleep?

Drowsiness is one of the most commonly reported gabapentin side effects. So it’s not surprising gabapentin is sometimes prescribed to help people sleep. It’s been studied in people with primary insomnia and in people with insomnia from other health conditions.

Primary insomnia

Studies of gabapentin in people with primary insomnia are limited. Primary insomnia is trouble sleeping that isn’t linked to another health condition. 

Available research suggests that gabapentin may be helpful for primary insomnia. But we need more studies before we can determine if the benefit outweighs the risk.

• A study of over 250 people with occasional insomnia found that taking 250 mg of gabapentin before bedtime increased the length of time people slept.

• A study of over 350 people with occasional insomnia found that taking gabapentin 250 mg and 500 mg doses increased the amount of time people slept. The 500 mg dosage helped people sleep for longer than the 250 mg dosage. But neither dosage shortened the amount of time it took to fall asleep.

Insomnia from other health conditions

Most studies on gabapentin for sleep are in people who have sleep troubles due to other health conditions, like alcohol use disorder, restless leg syndrome, and fibromyalgia. One large meta-analysis of 26 studies and over 4,500 people found that gabapentin improved sleep in people with these conditions. The average gabapentin dosage in these studies was 1800 mg/day. 

Additionally, a study of 50 people with cannabis use disorder found that 1200 mg of gabapentin per day helped improve sleeping problems, a symptom of cannabis withdrawal.

So, what’s the verdict?

While gabapentin may help improve sleep for some people (especially if you have another health condition that worsens sleep), it’s unlikely to be the first medication your healthcare provider recommends. Lifestyle changes and other medications may be a better option (more on these below).

Keep in mind: In their 2017 guidelines for treating primary insomnia, the American Academy of Sleep Medicine (AASM) didn’t recommend gabapentin. However, they noted that they only considered one study of 18 people. It was a poorly designed study, so AASM didn’t feel they had enough research to review gabapentin’s usefulness for sleep.

What are the risks of taking gabapentin for sleep?

Like any medication, gabapentin has possible side effects and drug interactions to consider.

Common gabapentin side effects

In addition to drowsiness, other common gabapentin side effects include:

• Dizziness

• Fluid buildup (peripheral edema)

• Blurred vision

• Dry mouth

If you’re only taking gabapentin before bedtime, dizziness is less likely to bother you. But  gabapentin is often taken multiple times a day. So it’s best to be careful when you first start taking it. Avoid doing any activities that require alertness (such as driving) until you know how gabapentin affects you. And move slowly when changing positions (like going from a seated position to standing).

Serious gabapentin risks

Gabapentin has a risk for misuse and dependence. In fact, gabapentin is classified as a controlled substance in some states. 

Other serious (but rare) gabapentin side effects include: 

• Severe allergic reactions

• Trouble breathing when taken with other medications that slow down the brain, like opioids or benzodiazepines

• Withdrawal symptoms like agitation and restlessness if you stop taking gabapentin abruptly

• Suicidal thoughts and behavior

Drug interactions

Most gabapentin drug interactions occur with medications or substances that also cause drowsiness. In fact, the FDA issued a warning  in 2019 about combining gabapentin with other medications that cause drowsiness. 

Examples of these medications and substances include:

• Alcohol

• Opioid pain medications like hydrocodone / acetaminophen

• Some over-the-counter (OTC) antihistamines like diphenhydramine (Benadryl)

• Benzodiazepines like alprazolam (Xanax)

• Sleep medications like zolpidem (Ambien)

In rare cases, these drug interactions can cause life-threatening breathing problems. Always check with your healthcare provider or pharmacist before taking other medications with gabapentin. In some cases, your provider might still prescribe gabapentin with other medications that make you sleepy if the benefit outweighs the risk.

What are alternatives to gabapentin for sleep?

If you’re having trouble sleeping, it’s best to check in with your healthcare provider. They may be able to pinpoint an underlying cause, which may solve your sleep issues. They may also recommend lifestyle changes, OTC products, or prescription medications that can help you get some Zs. We’ll cover a few of these options below.

Keep in mind: Experts generally recommend lifestyle changes to improve sleep over long-term medication use. And if sleep medications are needed, they’re typically only recommended for a short amount of time. Your healthcare provider can help you decide what’s right for you.

Good sleep habits

Besides going to bed around the same time each night and limiting screen time before bed, many other lifestyle changes may help with sleep. This includes not eating too much right before bed, and making sure the place you sleep is dark and cool. Eating certain foods for your last meal of the day might even make a difference.

Here are more sleep strategies you can try.

OTC options

American Academy of Sleep Medicine (AASM) guidelines for insomnia don’t recommend OTC sleep aids. They state that it’s unclear whether these products provide an overall benefit since they may have significant risks. But, it’s possible your healthcare provider will recommend an OTC product before trying a prescription medication. 

Two common options are:

• Benadryl (diphenhydramine): Though it’s mostly used for allergies, Benadryl is also FDA approved for short-term use for sleep problems (less than 2 weeks). Due to a higher risk of side effects — like constipation, dizziness, and falls — it’s usually not recommended for older adults.

• Melatonin: Research on how well this popular OTC sleep supplement works is mixed. Some studies show a benefit, but the effect may be small. For example, a large meta-analysis showed that people fell asleep 7 minutes faster and stayed asleep 8 minutes longer after taking melatonin. It is often used for other sleep issues like jet lag, but research is mixed here, too.

Prescription medications

The AASM recommends certain prescription medications for chronic insomnia (trouble sleeping at least 3 times a week for 3 months). Many treatment options are available, each with different benefits and risks. Some common types include:

• Z-drugs like Ambien (zolpidem) and Sonata (zaleplon) 

• Ramelteon (Rozerem)

• Orexin receptor antagonists like Belsomra (suvorexant) 

• Benzodiazepines like Restoril (temazepam)

• Silenor (Doxepin)

Who shouldn’t take gabapentin?

Gabapentin is generally safe. But some people are more likely to experience gabapentin side effects. This includes people who:

• Are over the age 65 

• Have kidney problems

• Take other medications that cause drowsiness

• Drink alcohol

• Have a history of substance misuse

Why trust our experts?

Written by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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