Controversies in the use of second generation antipsychotics as sleep agent

Pharmacol Res. 2014 Jan;79:1-8. doi: 10.1016/j.phrs.2013.10.005. Epub 2013 Nov 1.


A growing number of patients present in clinics with complaints of insomnia. Over the past century, great advances have been made in our knowledge of mechanisms of sleep and wakefulness. Understanding sleep neurochemistry has led to better management of different types of insomnias with a variety of non-pharmacological and pharmacological treatments. Unfortunately, the increasing development and availability of second generation antipsychotics (SGA) have prompted their frequent use exclusively for insomnia. However, to date, no large randomized-controlled or placebo-controlled studies have shown the utility of SGAs in the realm of treating insomnia. Many clinicians use SGAs as "off-label" for sleep induction and maintenance, but this practice needs to be readdressed given their potential risks and the current lack of evidence base. This review will highlight the neurochemistry related to sleep, the mechanisms of action by which SGA may have some benefit in treating insomnia, and the risks associated with their utilization.

Keywords: Pharmacology; Second generation antipsychotics; Sleep.

Publication types

  • Review

MeSH terms

  • Animals
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / therapeutic use*
  • Humans
  • Hypnotics and Sedatives / therapeutic use
  • Off-Label Use
  • Sleep / physiology
  • Sleep Wake Disorders / drug therapy*
  • Sleep Wake Disorders / physiopathology
  • Sleep Wake Disorders / therapy


  • Antipsychotic Agents
  • Hypnotics and Sedatives