Gabapentin For Insomnia: Does It Help? (Research-Backed)

Gabapentin is one of the most prescribed medications in North America.

Don’t confuse it with Gamma-Aminobutyric Acid, which is sold in “GABA” supplements over the counter.

Gabapentin is an anticonvulsant medication that also affects sleep, and requires a prescription.

I’m going to summarize the research on how gabapentin affects insomnia in this short post.

The Effect of Gabapentin on Insomnia

While it might not be the main purpose of the drug, gabapentin has a reliably positive effect on sleep quality.

In one study, patients took gabapentin for 4 weeks with promising results (1):

Gabapentin enhances slow-wave sleep in patients with primary insomnia. It also improves sleep quality by elevating sleep efficiency and decreasing spontaneous arousal.

Another randomized double-blind controlled study also found that gabapentin increased sleep duration and quality. It resulted in fewer disturbances during the night, and overall shorter wake after sleep onset (WASO) time (2).

Subjects either had a placebo or different gabapentin dosage (250 mg or 500 mg) 30 minutes before bedtime.

The graph above shows that the placebo group (no medication) were awake for an average of just under 150 minutes per night after initially falling asleep.

However, the group who took 250 mg of gabapentin 30 minutes before bed only had a WASO of about 100 minutes, and the group who took 500 mg of gabapentin were only awake for about 75 minutes.

Overall, gabapentin reduced sleep disturbances by roughly half in the 500 mg group.

A total of 16 out of 377 subjects had at least 1 adverse events. Most were mild in the form of headaches and nausea.

SummaryMultiple studies have shown that gabapentin is effective for most people with insomnia at improving multiple aspects of sleep quality.

Gabapentin vs. Other Sleep Medication

Another study looked at the effect of gabapentin vs trazodone.

Trazodone is an antidepressant that is sometimes prescribed for sleep issues (although antidepressants can also worsen sleep in some cases).

The researchers assessed subjects after 4-6 weeks of being on medication using the Sleep Problems Questionnaire (SPQ) (3).

Both groups did see improvements in sleep, but gabapentin had a slightly better effect.

That graph might be a bit confusing at first.

The solid black bar for each group is the SPQ score (where a higher score represents worse sleep quality).

The middle bar for each group is the SPQ score at the follow-up time, while the final striped bar is the change or improvement in score for each group.

While both trazodone and gabapentin caused an improvement in sleep quality, gabapentin caused a larger decrease in SPQ score, which is a desired result.

Does Gabapentin Work In Children With Poor Sleep Quality?

The majority of gabapentin research focuses on adults.

However, there’s one study that shows that it might be appropriate for children as well (more research will be needed). The study had children with neuro-disorders and insomnia take gabapentin before sleep (4). Improved sleep was seen in 78% of children.

There were adverse effects in 6 children, and other research shows that gabapentin can exacerbate behavioral problems in children (5).

SummaryGabapentin can improve sleep in children, but there are questions over how safe it is and in what specific populations it should be prescribed for.

How Safe is Gabapentin?

As noted before, serious adverse events aren’t too common with gabapentin and any side effects are mostly mild.

However, gabapentin misuse can lead to toxicity and even death. Research has shown that people misuse it mainly to get high, but that’s mainly in the context of opioid withdrawal (6).

Finally, gabapentin can interact with other medications, but also common substances like caffeine and magnesium oxide. It’s important for prescribing doctors to be aware of a patient's diet and any other medication they are taking.

SummaryGabapentin is one of the safer medications prescribed for insomnia, but does cause significant side effects that may not be tolerated well in all patients.

Which Parts of Sleep Does Gabapentin Improve?

Sleep quality is a very general term that includes many aspects of sleep.

Some substances or techniques improve sleep by reducing sleep latency (i.e. fall asleep faster), reducing sleep disturbance, or changing sleep architecture itself.

One study looked at the impact of gabapentin on sleep structure and found that gabapentin can enhance slow wave sleep (i.e. deep sleep) (7).

It was a relatively small study with only 10 adult participants who took 1,800 mg of gabapentin per day, but still provides some interesting insights.

They found that:

• Slow wave sleep increased by approximately 75%
• A small reduction in arousals and awakenings was also observed
• No other statistically significant change in sleep architecture was seen

Therefore, gabapentin is most useful in situations where someone can't stay asleep, rather than someone having trouble falling asleep in the first place.

When is Gabapentin Prescribed?

As mentioned before, gabapentin is primarily a prescription medication that's used as an anticonvulsant medication.

It is prescribed for neuropathic pain (i.e. nerve pain) and to treat seizures, mainly from conditions like restless legs syndrome and shingles (8).

If someone has both restless leg syndrome and insomnia, gabapentin can be a useful medication.

However, gabapentin is often useful in other situations as well. Some research has also shown that gabapentin is effective at reducing withdrawal symptoms in those with alcohol dependence and even at managing hot flashes (9).

With that being said, gabapentin is not approved for sleep disorders like insomnia, even if it is sometimes prescribed for sleep issues.

Alternatives to Gabapentin for Insomnia

In most cases, other treatments will be tried before gabapentin for insomnia.

Other sleep medicine that doctors prescribe for insomnia include:

• Antidepressants
• Antihistamines
• Benzodiazepines

In addition to prescription medications, there are also non-pharmacological insomnia treatment methods depending on the specific case. These typically revolve around cognitive behavioral therapy, but can also include relaxation therapies like meditation or yoga.

Summary: Gabapentin and Insomnia

In summary, gabapentin is an effective medication at reducing insomnia symptoms in most cases of primary insomnia.

However, it can cause adverse effects, which should be monitored closely by the prescribing physician.

It's also mainly prescribed for things other than a sleep disorder, but there are some specific cases where a physician may feel it's the best choice.

References

1. Treatment Effects of Gabapentin for Primary Insomnia
2. A Randomized, Double-Blind, Single-Dose, Placebo-Controlled, Multicenter, Polysomnographic Study of Gabapentin in Transient Insomnia Induced by Sleep Phase Advance
3. Open pilot study of gabapentin versus trazodone to treat insomnia in alcoholic outpatients
4. Gabapentin Shows Promise in Treating Refractory Insomnia in Children
5. Behavioral Side Effects of Gabapentin in Children
6. Review about gabapentin misuse, interactions, contraindications and side effects
7. Gabapentin Increases Slow-wave Sleep in Normal Adults
8. Treatment of restless legs syndrome with gabapentin
9. Gabapentin Treatment for Alcohol Dependence