OBJECTIVES:
The prevalence of insomnia is very high in our society. Although pharmacological treatment of insomnia is available, most hypnotics have been shown to alter sleep architecture and have many adverse effects. Gabapentin was originally designed for antiepileptic therapy; however, some studies reported that its use increases slow-wave sleep in healthy volunteers or patients. Our goal was to evaluate the benefits of gabapentin in the treatment of primary insomnia in patients.
METHODS:
Eighteen patients with primary insomnia participated in the study. They received gabapentin treatment for at least 4 weeks. All patients received polysomnography, a biochemical blood test, and neuropsychological tests before and after the treatment period. All measures were analyzed with Student t test to examine the treatment effects of gabapentin, except that the measures of heart rate variability were analyzed with analysis of variance.
RESULTS:
Polysomnographic study revealed increased sleep efficiency and slow-wave sleep, decreased wake after sleep onset, and spontaneous arousal index after gabapentin treatment. The biochemical blood test revealed decreased prolactin levels in the morning after treatment. Electroencephalographic power spectral analysis showed increased delta-2 and theta power in sleep stage 1 and decreased sigma activity power in sleep stages N2 and N3 after gabapentin treatment. Heart rate variability analyses also showed a significant increase in normalized high frequency percentage in sleep stages N2 and N3 and low frequency-high frequency ratio in sleep stage N2 after treatment. In addition, neuropsychological tests revealed the elevation of visual motor processing speed after gabapentin treatment.
CONCLUSIONS:
Gabapentin enhances slow-wave sleep in patients with primary insomnia. It also improves sleep quality by elevating sleep efficiency and decreasing spontaneous arousal. The results suggest that gabapentin may be beneficial in the treatment of primary insomnia.
From: https://pubmed.ncbi.nlm.nih.gov/20124884/
Can Gabapentin be Used to Treat Primary Insomnia ?
Gabapentin is a prescription medication that may help you sleep. That may be why it has been prescribed for people with insomnia, even though it is not approved for that use. However, gabapentin enacarbil (Horizant) has been approved by the Food and Drug Administration (FDA) to treat a sleep disorder called restless legs syndrome (RLS).
- One of the most common side effects of gabapentin is drowsiness.
- In people taking gabapentin for its approved conditions (certain epileptic seizures and postherpetic neuralgia), 19% of patients older than 12 years of age with epilepsy and 21% of patients with postherpetic neuralgia reported drowsiness as a side effect.
Gabapentin and sleep
Most studies show that gabapentin improves slow wave sleep (“deep sleep”) and total sleep time.
- Two small studies showed that gabapentin may help people with primary insomnia and occasional sleep disturbance improve total sleep time and wakefulness in the morning.
- In other studies, it appears that gabapentin may improve sleep in people with other medical conditions that make it more difficult to sleep, such as alcohol dependence, hot flashes and bipolar disorder.
In a large review of 26 studies on gabapentin and sleep in patients with other medical conditions, the average dose taken daily was about 1,800 mg. Although positive sleep outcomes were reported, the researchers noted that gabapentin was not tolerated as well as placebo and some patients stopped taking it. Misuse and abuse of the drug has also been reported.
It takes about 2 to 3 hours for immediate-release gabapentin to reach its fullest effect, and it’s typically taken 3 times per day.
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.