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

If you find it difficult to fall asleep or stay asleep throughout the night, you’re likely familiar with how this lack of sleep can start affecting your quality of life. And when a medication-free approach isn’t providing you with insomnia relief, it’s good to know your options.

There are many different sleep medications available. One that you may come across is Seroquel (quetiapine). Seroquel isn’t approved for insomnia. But it can make you feel drowsy, similar to how antihistamines such as Benadryl do. And it doesn’t have the same dependency risk as several other common sleeping pills, making it an appealing option for some people. 

So, does Seroquel actually work for sleep? And what are the risks?

Promotion disclosure

Seroquel (Quetiapine)

Avg retail price

$59.67(Save 84.95%)

GoodRx discount

$8.98

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

What is Seroquel?

Seroquel (quetiapine) is an atypical antipsychotic medication. It’s approved for bipolar disorder and schizophrenia. Seroquel comes in immediate-release (IR) and extended-release (ER or XR) tablets. Seroquel XR is also approved to treat depression in combination with an antidepressant.

Dopamine and serotonin are chemicals in your brain that are thought to regulate mood, thoughts, and behaviors. Seroquel is thought to work for mental health conditions by balancing these chemicals to improve symptoms. But, it also acts on histamine receptors (binding sites), which can make you feel sleepy. 

Can Seroquel be used for sleep?

It depends. Seroquel causes drowsiness, so it may be helpful if your sleep problems are related to symptoms of schizophrenia or bipolar disorder. It may also help reduce the feelings of anxiety and depression, which can interfere with sleep.

But Seroquel is also sometimes prescribed in low doses for sleep in people without mental health conditions, and rather they are dealing with a condition called primary insomnia. Taking Seroquel for this is considered an off-label use, which means the FDA hasn’t determined that Seroquel is safe and effective specifically for sleep.

So, does Seroquel actually work for primary insomnia? The short answer: It’s not clear. There isn’t strong evidence showing that Seroquel is effective for this use. What’s more, Seroquel can cause risky side effects. Because of this, experts advise against taking Seroquel off-label for primary insomnia.

What are the potential dangers of taking Seroquel for sleep?

Even at low doses used for sleep — which usually range from 25 mg to 100 mg — Seroquel may cause weight gain and increase blood glucose (sugar) and cholesterol levels. This group of conditions makes up metabolic syndrome, which can increase the risk of diabetes and heart disease.

One study found a higher risk of major cardiovascular events, such as heart attack and stroke, in people taking low-dose Seroquel. This was compared to people taking Z-drug sleep medications, such as zolpidem (Ambien). In the Seroquel group, cardiovascular risks appeared to be higher in women and people aged 65 and older.

Seroquel can also have a few other concerning effects in older adults. For example, it can cause orthostatic hypotension — a sudden blood pressure drop when changing positions. This can increase the risk of falls. Seroquel also has a boxed warning (the strictest medication warning) due to an increased risk of death in older adults with dementia-related psychosis.

Lastly, you may still feel drowsy the next day after taking Seroquel for sleep, which can impair your ability to perform tasks that require alertness, such as driving. While this isn’t unique to Seroquel and can happen with other sleep medications, it’s good to keep in mind.

Precautions to consider before taking Seroquel

Your healthcare provider may recommend Seroquel for sleep if the potential benefits outweigh the risks for you. In this case, here are some precautions to keep in mind. 

Drug interactions: Many common medications and supplements can interact with Seroquel. For example, antiepileptic medications, such as carbamazepine and phenytoin, change the way Seroquel is cleared from your body. Some blood pressure medications and alcohol are among other interactions to watch out for.

Side effects: As mentioned above, changes in weight, blood glucose, and cholesterol are all possible with Seroquel. You may also feel drowsy the next day after taking it. Other side effects, such as restless legs syndrome and feeling unable to sit still, have also been reported by some people taking Seroquel for sleep.

Age: Older adults may be more sensitive to Seroquel’s effects. So it’s good to take note of how the medication affects you and make adjustments as necessary. For example, be sure to change positions more slowly to avoid passing out or falling down, especially if you’re feeling dizzy. And avoid driving a car if you’re feeling drowsy or less alert the next day.

Alternative sleep aids to Seroquel

Non-medication options, such as cognitive behavioral therapy for insomnia (CBT-I), are usually recommended first for insomnia treatment. But some people may still require medication to help with sleep. Think of medication as a short-term option. All sleep medications have side effects and risks, and they generally aren’t intended for long-term use.

While there’s no clear first choice when it comes to which medication is best for sleep, below are a few available options.

Over-the-counter (OTC) sleep aids

Antihistamines and melatonin are two popular examples of over-the-counter (OTC) sleep aids. Experts generally don’t recommend them for chronic insomnia. But if you don’t want to take prescription medication, they can be a convenient alternative.

• Antihistamines: Diphenhydramine (Benadryl) and doxylamine (Unisom) are antihistamines commonly taken for sleep. Some people may find them helpful for short-term sleep problems. But older adults should avoid them due to side effects.

• Melatonin: Melatonin is a hormone that helps us fall asleep at night. Melatonin supplements have mixed reviews, especially when taken for chronic insomnia. Short-term use appears to be safe for most people, but there isn’t much information on the safety of taking melatonin long term.

Good to know: Since it’s a supplement, melatonin isn’t regulated in the same way as prescription medications. Look for a good manufacturing approval to ensure it has gone through proper quality checks.

Prescription medications

There are several different types of prescription sleep medications available. Examples of these include:

• Z-drugs and benzodiazepines (BZDs): These medications can be taken as needed, or nightly for short periods of time. But they have a risk of dependence, which limits their use. Eszopiclone (Lunesta) and temazepam (Restoril) are two examples.

• Antidepressants: Trazodone and doxepin (Silenor) are antidepressants taken at lower doses for sleep. They aren’t considered habit-forming. Low-dose doxepin is approved for sleep, while trazodone is sometimes taken off-label for sleep.

• Melatonin receptor agonists: Ramelteon (Rozerem) works similarly to melatonin to help you fall asleep. It tends to have few side effects and risks, making it a potentially safer option for older adults.

• Orexin receptor antagonists (ORAs): ORAs are the newest class of sleep medications. During initial clinical studies, they were not shown to cause dependence. But they’re only available as brand-name medications, so they may cost more than other options. Suvorexant (Belsomra) and lemborexant (Dayvigo) are two examples.

Why trust our experts?

Written by:

Julie Adkison, PharmD, BCACP, CDCES

Julie Adkison, PharmD, BCACP, CDCES, is a clinical pharmacist specializing in ambulatory care practice and diabetes care and education. She has worked in a faculty position in family medicine for many years.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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.

Our editorial standards

Meet our experts