When people cannot sleep well, they often look for quick solutions. Sleep medications are commonly prescribed, and one drug that has gained popularity in recent years is quetiapine.
Although the medication was originally approved for schizophrenia and bipolar disorder, many doctors prescribe it in low doses to help patients with insomnia because of its strong sedative effects.
A new study from Flinders University suggests that the benefits of this approach may come with important trade-offs.
The research, published in the Annals of the American Thoracic Society, found that low-dose quetiapine improved sleep quality but also reduced next-day alertness and impaired driving-related skills.
Insomnia and sleep apnea are both common conditions. Insomnia involves difficulty falling asleep or staying asleep, while obstructive sleep apnea occurs when breathing repeatedly stops and starts during sleep.
Some people experience both conditions at the same time, creating a particularly difficult situation that can leave them exhausted during the day.
To investigate how quetiapine affects this group, researchers recruited 15 adults with both insomnia and obstructive sleep apnea. Participants spent two nights in a sleep laboratory where scientists could carefully monitor their sleep.
On one occasion, participants received a low dose of quetiapine. On another occasion, they received a placebo that contained no active medication. Researchers then compared sleep quality, breathing patterns, daytime alertness, and simulated driving performance.
The study found that quetiapine produced some positive effects during sleep. Participants slept more efficiently, woke less often, and experienced fewer breathing interruptions. Importantly, oxygen levels did not worsen, suggesting that the medication did not aggravate the breathing problems associated with sleep apnea.
However, the story changed the next morning. Participants reacted more slowly, had greater difficulty maintaining attention, and performed worse on a driving simulator.
Their steering control deteriorated, and they experienced more lapses in concentration. These findings are important because similar impairments have been linked to increased crash risk on real roads.
One surprising finding was that some participants did not recognize their own impairment. Although objective tests clearly showed poorer performance, they did not necessarily feel much sleepier. This disconnect between perception and actual functioning may be especially dangerous because individuals could mistakenly believe they are fit to drive.
Researchers also documented several side effects. More than 75 percent of participants reported problems such as dizziness, grogginess, or low blood pressure. One participant suffered a fall that required medical evaluation.
The findings arrive at a time when concerns are growing about the widespread off-label use of sedative medications. Off-label prescribing occurs when a drug is used for a purpose that regulators have not officially approved. While this practice is legal and sometimes appropriate, it can expose patients to risks that have not been fully studied.
The study’s authors point out that many people with sleep apnea remain undiagnosed. Symptoms such as difficulty staying asleep may lead doctors to prescribe sleeping pills when the underlying problem is actually a breathing disorder. Without proper assessment, patients may receive treatment that addresses symptoms without solving the root cause.
Experts increasingly recommend alternatives that target the causes of sleep difficulties rather than simply producing sedation.
One example is cognitive behavioral therapy for insomnia, which has been shown to improve sleep without the risks associated with many medications. Better screening for sleep apnea may also help identify patients who would benefit from specialized treatment.
Analysis of the findings suggests that the study offers an important warning about relying on quetiapine as a routine sleep aid. Its strengths include the use of objective sleep studies, attention testing, and driving simulations.
However, the small sample size means the results should be interpreted cautiously until larger studies are completed. Nevertheless, the findings highlight a significant issue: a medication that appears to improve sleep may simultaneously impair daytime functioning.
For patients whose jobs or daily responsibilities require alertness, this trade-off could have serious consequences. The research supports calls for more careful prescribing practices and greater use of evidence-based treatments for sleep disorders.
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