Hydroxyzine for sleep: What you need to know

How does an allergy medication help control insomnia?


Medically reviewed by

July 30, 2021

The American Sleep Association reported that 50-70 million Americans suffer from sleep disorders, with insomnia being the most common. Insomnia can make it hard to fall asleep, stay asleep or go back to sleep after waking up too early. It can be both chronic (insomnia that lasts for more than a month) or acute. The good news, according to the University of Pennsylvania School of Medicine, is that while 1 in 4 Americans develops insomnia each year, 75 percent recover. 

Doctors and nurse practitioners may prescribe hydroxyzine for the treatment of insomnia. It can help improve sleep as well as reduce anxiety. Before taking hydroxyzine for anxiety as a sleep medication, you should get answers to common questions you might have about using it.

Keep reading to learn more about taking hydroxyzine for sleep, including:

  • What is hydroxyzine and what does it do?
  • Does hydroxyzine make you sleepy?
  • How hydroxyzine works to treat sleep disorders and anxiety
  • The recommended dosage of hydroxyzine for sleep
  • How long does it take hydroxyzine to work?
  • Some side effects that might occur as a result of taking hydroxyzine
  • What cautions to be aware of before, during, and after using hydroxyzine for sleep

Disclaimer: This article is intended for medical informational purposes only. Please consult with your doctor or prescribing nurse to determine if using hydroxyzine for sleep is right for you. 

What is Hydroxyzine?

Hydroxyzine is an antihistamine drug that has drying (anticholinergic) effects and sedative properties. Like all antihistamines, hydroxyzine helps reduce the body’s reaction to its own histamine, a chemical substance responsible for causing allergic reactions like itching eyes, hives, rashes, and runny noses. 

Unlike many over-the-counter drugs commonly used to treat allergies, hydroxyzine is a prescription medication. You may see it listed as hydroxyzine hydrochloride or hydroxyzine pamoate (Vistaril).


Hydroxyzine for sleep

So how does an allergy medication help control chronic insomnia? Think of it this way: When you take antihistamines like Zyrtec® and Benadryl®, you may start to feel drowsy because of their sedative properties, mentioned above. Taking hydroxyzine for sleep works the same way.

Hydroxyzine also, however, has a distinct effect on serotonin, a neurotransmitter thought to regulate mood and sleep. This is why doctor's sometimes prescribe hydroxyzine for anxiety disorders—including Generalized Anxiety Disorder (GAD)—especially when they are associated with insomnia.

What is hydroxyzine

Unlike using controlled substances like Klonopin for sleep, taking hydroxyzine for insomnia is not habit-forming.


Recommended hydroxyzine dosage for sleep 

The long-term use of hydroxyzine for sleep and anxiety disorders has not been clinically assessed; it is, instead, primarily prescribed as a short-term medication. The recommended dose for hydroxyzine for sleep varies, depending on age and reaction to the medication.

For adults, however, the typical hydroxyzine dosage for sleep range is 25 mg to 100 mg, taken before bed, either with or without food.

If you use hydroxyzine for sleep, take it as your doctor has prescribed. Always consult your doctor (or a member of our Care Team if you are a Minded consumer) before increasing or decreasing your dose. 

How long does hydroxyzine take to work?

One of the benefits of taking hydroxyzine for sleep is how quickly it works. Sleep-inducing effects can be felt in as few as 15-30 minutes, and the maximum clinical effect happens 2 hours after taking it.

How long does hydroxyzine last?

The duration of hydroxyzine's action is 3-4 hours.

Hydroxyzine side effects

For some people, hydroxyzine side effects, which vary from mild to severe, can be unwelcome. When using hydroxyzine for sleep, common side effects include drowsiness, fatigue, nausea, dry mouth, and headache.

Sometimes hydroxyzine makes people feel groggy, and they experience daytime sleepiness from its persistent effects after sleep. Although this sedating effect is usually transient with regular or reduced usage, some people have reported that hydroxyzine leaves them feeling perpetually fatigued. Using hydroxyzine for sleep also can make you feel nauseous. Side effects like dry mouth and headaches are typically mild and short-lived, disappearing after a few days.

More severe hydroxyzine side effects include chest pain, severe headache, hallucinations and trauma nightmares, severe grogginess, respiratory depression, over-sedation and confusion in the elderly, and fainting. In the case of a hydroxyzine overdose, seizures may result. 

To avoid complications or serious side effects, do not take additional sleep-inducing substances when using hydroxyzine for sleep. Always pay attention to how your body reacts the first few times you take any prescription medication, including hydroxyzine. If you experience any persistent, mild side effects or any severe side effects, consult your doctor for medical advice. Minded consumers also can reach out to our Care Team with any questions or concerns regarding the side effects of using hydroxyzine for sleep.

Cautions for hydroxyzine use

There are certain things to pay attention to before, during, and after taking hydroxyzine for sleep.

Before you use hydroxyzine for sleep, make sure you’re not allergic to any of the ingredients mentioned on the drug information sheet attached to the prescription. Talk to your prescriber about starting with a low dose, especially if you are hypersensitive to medications. Don’t leave hydroxyzine within reach of children or pets. Inform your doctor of any medical conditions you have, including a respiratory disease or prostatic hyperplasia.

When you are taking hydroxyzine, avoid driving or doing hard, risky work, especially if you feel dizzy. Only consume the prescribed amount of hydroxyzine for sleep. Ask your doctor about drug interactions with hydroxyzine, especially if you are taking benzodiazepines like Klonopin or Ativan or sleeping pills like Lunesta. And, always consult your doctor before using hydroxyzine during pregnancy and while breastfeeding.

After you’ve taken hydroxyzine, monitor your reactions. If you experience any persistent, mild side effects or any severe side effects after using hydroxyzine for sleep, tell your healthcare provider. They may adjust the prescribed dosage and can tell you if your symptoms are cause for concern. In the case of an accidental hydroxyzine overdose, contact your doctor or 911 immediately.

Hydroxyzine’s interaction with other drugs and substances

When hydroxyzine interacts with other drugs, its effectiveness can be decreased and side effects may be increased. If you experience any negative effects from combining hydroxyzine for sleep with other medications, consult a healthcare professional for advice, which might include changing your dosage of hydroxyzine or stopping the medication altogether. 

Avoid using other substances that may have a sedative effect, including cannabis, alcohol, muscle relaxants (like cyclobenzaprine, Flexiril®), and opioid pain relievers (like hydrocodone and codeine). Do not use additional sleep or anxiety drugs like lorazepam and alprazolam, or antihistamines like cetirizine, diphenhydramine, and levocetirizine.

Final thoughts on using hydroxyzine for sleep

If you’re one of the many people looking for an improvement in sleep, hydroxyzine might be an appropriate form of medical treatment to induce and maintain sleep. Hydroxyzine’s unique effect on serotonin may also help regulate mood and alleviate symptoms of anxiety.

Hydroxyzine can be an effective treatment for primary insomnia, meaning insomnia that is not directly related to an underlying cause. Before taking hydroxyzine, you should tell your doctor if you suffer from other psychopharmacological sleep disorders such as obstructive sleep apnea, narcolepsy, or restless legs syndrome. Hydroxyzine can have mild to severe side effects, which you should know before using it as a sleep aid. If you experience any persistent mild or severe side effects while taking hydroxyzine, discuss these with your doctor immediately, or consult with Minded’s Care Team if you are a consumer.

To find out if hydroxyzine might work as a prescription sleep medication for you, sign up to become a Minded member now. Minded offers online appointments within 24 hours with board-certified psychiatrists and nurse practitioners. If you already have a prescription for hydroxyzine, Minded can help you refill or renew it online. Our team of professionals can also help in adjusting your dosage or advising on other medications that might be a fit for you.



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