Millions of people have trouble getting a good night’s sleep. So, when tossing and turning turns into a nightly issue, they often reach for sleep meds.
Quetiapine is one such drug – it was made for serious mental health issues but is now sometimes prescribed in lower doses just to help with sleep.
However, a recent study shows that while it might keep people asleep longer, it comes with its own series of problems.
Using the med can make people less alert the next day, even if they feel like they’re functioning fine.
Better sleep, but at what cost?
The study looked at people dealing with both obstructive sleep apnea and insomnia at once. This combination is more common than people think.
Sleep apnea interrupts breathing while you’re asleep, and insomnia makes falling or staying asleep super tough.
But researchers found that a small dose of quetiapine helped a lot. People slept more efficiently, were woken up less during the night, and had fewer breathing issues too.
“There’s a growing belief that low-dose quetiapine is a relatively harmless way to help people sleep,” said study lead author Cricket Fauska at Flinders University.
“Our results show it’s not that simple. Although participants slept longer and woke less overnight, their reaction times were slower, and their simulated driving performance was noticeably worse the next morning.”
A closer look inside the study
The trial used one of the most reliable approaches available in medical research. In the randomized, double-blind, placebo-controlled study, 15 adults spent two separate nights in a sleep laboratory.
On one night, they received 50 milligrams of quetiapine. On the other, they received a placebo.
Researchers monitored their sleep throughout the night using full sleep studies. The next morning, participants completed tests designed to measure attention, alertness, and driving ability.
The results revealed a concerning tradeoff. Compared with the placebo, quetiapine improved sleep quality and reduced sleep apnea severity without lowering oxygen levels.
At the same time, participants showed slower reaction times, more attention lapses, and poorer steering control during a driving simulation.
These are all warning signs associated with an increased risk of vehicle crashes in the real world.
People feel fine when they’re not
One of the most surprising findings involved the gap between perception and performance.
Some participants did not report feeling especially tired after taking the medication. Yet objective testing showed that their alertness and driving performance had declined.
“What was particularly concerning is that some people didn’t feel especially sleepy the next day, despite performing worse on objective tests,” said Fauska.
“That mismatch between how people feel and how they actually function poses a serious safety risk, especially when it comes to driving.”
This finding matters because many people judge their ability to drive, work, or make decisions based on how they feel rather than how they actually perform.
A widespread issue hiding in plain sight
Quetiapine is approved for schizophrenia and bipolar disorder, but doctors now often prescribe it at lower doses for insomnia and anxiety due to its sedating effects.
According to Professor Danny Eckert, who directs FHMRI Sleep Health and co-authored the study, this practice raises significant questions about current prescribing habits.
“Around 80 percent of people with OSA are undiagnosed and unaware they have the condition, and to add to this, a key symptom is finding it difficult to stay asleep,” said Professor Eckert.
“Sleep complaints like this are common in general practice, and in Australia around 90 per cent of people who present with insomnia symptoms will leave with a sleeping pill rather than a sleep assessment.”
Because sleep apnea often goes undetected, many people seeking help for insomnia may actually have an underlying breathing disorder affecting their sleep.
Side effects appeared quickly
The study also found that more than three-quarters of participants experienced side effects after only one dose of quetiapine.
Reported problems included grogginess, dizziness, and drops in blood pressure. One participant required medical review after suffering a fall.
Although no serious long-term harm occurred during the trial, the researchers say these results highlight the need for caution when prescribing sedating medications for sleep problems.
“Our study shows that while quetiapine can make sleep look better on the surface, it may actually make people less safe the next day,” said Eckert.
A shift in sleep disorder treatments
Sleep specialists have increasingly moved toward treatments that target the root causes of sleep problems instead of simply making people drowsy.
For chronic insomnia, cognitive behavioral therapy for insomnia, often called CBTi, has become one of the most effective evidence-based treatments.
It helps people change habits and thought patterns that interfere with sleep without relying on medication.
“Sleep apnea is a complex condition with different underlying drivers in different people,” said Professor Eckert.
“What we’re learning is that treatment needs to be tailored – using the right approach, or combination of approaches, for the individual rather than defaulting to sedating medications.”
The researchers recommend better screening for sleep apnea, greater access to CBTi, and clearer warnings about possible next-day impairment.
“Our findings suggest quetiapine should not be used as a routine sleep medication in people with known or possible sleep apnea, particularly when next-day alertness is critical,” Professor Eckert concluded.
The full study was published in the journal Annals of the American Thoracic Society.
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