Medical Review by Jennie Stanford, MD, FAAFP
Summary:
- Amitriptyline is sometimes prescribed off-label for sleep, but it is not FDA-approved for this use.
- It may help with sleep maintenance due to its antihistamine effects, but research on its effectiveness is limited.
- Common side effects include weight gain, dry mouth, dizziness, and constipation, while severe risks can include suicidal thoughts and changes to your heart rate.
- Other medications like hydroxyzine (Vistaril) and trazodone (Desyrel) may be safer and more effective options for treating insomnia.
- Consulting a healthcare provider is essential to determine the best approach to improving sleep and minimizing risks.
Amitriptyline may be prescribed off-label for sleep issues—but is this safe & effective?
Amitriptyline is a tricyclic antidepressant (TCA) commonly used to treat depression. However, it has also been prescribed off-label for conditions such as chronic pain, migraines, and sleep disturbances.
If you’re struggling with sleep and looking for insomnia treatment, you may have heard that amitriptyline can help. But, before considering this medication for sleep issues, it’s important to understand how it works, its potential benefits, and the risks involved.
Below, our team at Lemonaid Health walks you through how this medication works, along with its suitability as a sleeping aid. Keep reading and learn how to talk to your doctor about finding appropriate ways to rest easier at night.
How amitriptyline works
Amitriptyline works by increasing levels of neurotransmitters like serotonin and norepinephrine in the brain. These chemical messengers play a role in mood regulation and pain perception, but they can also influence sleep.
Unlike medications specifically developed for sleep—such as melatonin receptor agonists —amitriptyline’s sedative effects are largely due to its ability to block histamine (H1) receptors. This antihistamine-like effect can cause drowsiness, making it potentially useful for people who have trouble falling or staying asleep.
Typical dosages for sleep aid
When used to treat depression, the typical maintenance dose for amitriptyline is 50 mg to 150 mg per day. However, when prescribed for sleep, much lower doses are often used.
There is no “standard” dosage to use amitriptyline as a sleep aid since it has not been FDA-approved for this purpose. However, one study on people taking amitriptyline off-label to help with sleep disorders provided participants with a dosage of 10mg to 20mg per day, although nearly half of the patients involved reported double-dosing. After about 6 weeks, 74% of study participants reported improvements in their sleep, while less than 5% stopped taking the medication.
Potential benefits of amitriptyline for sleep
Although there is limited research available on amitriptyline as a sleep aid, what we do know suggests that it may be able to provide several benefits. The most common one appears to be improving sleep maintenance, although some people have also reported that amitriptyline can make it easier to fall asleep and reduce daytime sleepiness. However, not everyone seems to experience these benefits—and many people who take amitriptyline experience side effects, even at relatively low doses.
Risks & side effects
While amitriptyline may have the potential to be useful for sleep, it also comes with a considerable side effect profile. For this reason, amitriptyline is no longer used as a first-line treatment for depression.
Common side effects
The most common side effects of amitryptiline include:
- Weight gain
- Constipation
- Dry mouth
- Dizziness
- Headache
- A strong desire to fall asleep
Severe side effects
Amitriptyline has also been linked to more severe adverse effects, which include:
- Suicidal thoughts or behavior, especially in people under 24 years old
- Changes to your heartbeat
- Confusion or delirium
- Glaucoma
- An increased risk of seizures
- Increased risk of bone fracture and bone marrow suppression
It can also change the way your liver functions, although these changes are typically mild and go away once you stop taking the drug. People with certain psychiatric conditions including bipolar disorder may also be advised to avoid this medication, as it can cause mania in rare cases.
Consulting a Healthcare Provider
If you are considering taking amitriptyline for sleep, it’s important to discuss your options with a healthcare provider beforehand. They can help determine whether it’s the right option based on your medical history and overall health.
It’s also important to remember that amitryptiline is not the only sleep medication that may be able to help you, and that alternative options may be more effective depending on your individual circumstances. Other H1-blockers such as hydroxyzine have demonstrated some effectiveness for adults with insomnia who have not experienced success with other treatment methods.
Low doses of trazodone, another H1-blocking medication, have also been shown to be effective and generally safe for treating insomnia. Trazodone may be particularly effective as an insomnia treatment for people who are also suffering from depression, and it comes with little to no risk for most people who take it, although there is a low risk that it can be habit-forming.
Speaking with a healthcare professional is the best way to ensure that you are prescribed appropriate medication for your unique case and that you know how to take it responsibly. At Lemonaid Health, our team of US-based medical experts can prescribe both hydroxyzine (under the brand name Vistaril®) and trazodone (under the brand name Desyrel®) for insomnia in clinically indicated cases.
Learn more about treating insomnia with Lemonaid Health
Amitriptyline may be a useful sleep aid for some people, but it’s important to recognize the risks that come with this medication. Always talk to your healthcare provider before taking any new drug to help you sleep—they’ll be able to help you weigh the potential side effects and benefits, and they may also be able to help you find more effective alternatives depending on your individual needs.
Lemonaid Health can help you connect with a network of qualified care providers based in the United States, who can answer your questions about amitriptyline and other sleep medications in detail. They can also help you create a personalized plan to safely improve your sleep quality, which may include appropriate medication if clinically indicated. Get started today—and enjoy healthier, more restful sleep tomorrow.
Vistaril® is a registered trademark of Pfizer Inc. Desyrel® is a registered trademark of Bristol-Myers Squibb Company.
