Eszopiclone (Lunesta) for Insomnia: Everything You Need to Know
To help manage these difficulties, doctors often turn to medications like Lunesta – one of the most commonly prescribed drugs approved by the U.S. Food and Drug Administration (FDA) for the treatment of insomnia.
But what exactly is Lunesta, and how does it work? Plus, is it safe for long-term use, and what are the side effects you should watch out for? And is it your only option? Are there natural, evidence-based alternatives that can help you sleep better?
On this page, you’ll find answers to all of these questions about Lunesta and more.
What Is Lunesta Used For?
This medication isn’t for the occasional “I had too much coffee” kind of night. Rather, Lunesta works against sleep difficulty that sticks around night after night, often with no obvious trigger, to the point it affects your ability to function during the day. Lunesta is used for both:
Sleep-onset insomnia (difficulty falling asleep)- Sleep-maintenance insomnia (trouble staying asleep, frequent wake-ups, or early morning awakenings)
It belongs to the non-benzodiazepine hypnotics class of drugs, also referred to as “Z-drugs,” which are engineered to act on sleep receptors in the brain without having sedative effects. Lunesta is one of the few sleep medications that’s FDA-approved for long-term use – you can take it for up to six months.2
How Does Lunesta Work for Insomnia?
When GABA is active, your brain slows down, your muscles relax, your thoughts quiet, and your body transitions into a rest-and-recovery mode. These are exactly what you need to fall asleep.
In people with insomnia, the GABA system doesn’t work as well as it should. Lunesta helps by attaching to a part of the brain’s GABA-A receptor, which boosts GABA’s natural calming effects.3 When Lunesta is active, it helps brain cells take in signals that make them less excitable, so they’re more likely to stay “quiet” – making it easier for your body and mind to relax and fall asleep.
In this way, Lunesta reduces the brain activity that keeps you awake, and therefore, leads to:
Faster sleep onset (you fall asleep quicker)- Improved sleep maintenance (you stay asleep longer)
- Fewer middle-of-the-night awakenings
How Fast Does Lunesta Work?
Its fast-acting nature is precisely why doctors strongly advise people to take it just before going to bed, as staying up for hours after taking it could counteract the usefulness of the drug.
Lunesta reduces sleep latency, the time it takes to fall asleep, by 12 minutes and increases total sleep time by approximately half an hour, according to evidence from clinical studies.4
How Long Does Lunesta Last?
If, for example, you take Lunesta at 11:00 PM, it will:
Start helping you fall asleep by 11:30 PM- Keep working steadily until around 5:00 – 7:00 AM, depending on how your body metabolizes it
Lunesta Dosage Guide for Insomnia
The usual starting dose of Lunesta is 1 mg. It’s advised that this is taken immediately before going to bed and only when you can get a full night’s sleep of at least 7 – 8 hours. 1 mg (not a higher dose) must be used as the starting dose for:
Adults over 65- People with diseased livers
- Those taking medications that inhibit the enzyme CYP3A4, such as ketoconazole, ritonavir, or clarithromycin
As this is the safest dose, to begin with. Quite naturally, a lower 1 mg dosage causes fewer next-day effects than higher doses, particularly in the elderly with risks of cognitive impairment and balance issues.
If you’re younger than 65, have no major medical conditions, and a 1 mg dose isn’t working for you, your doctor will bump you up to 2 mg. At this dose, the FDA cautions against driving or engaging in activities that require full alertness the next morning unless you’re sure you’re not experiencing any residual effects. 2
3 mg is the maximum FDA-approved dose of Lunesta, and this is reserved for people who’ve tried lower doses and still can’t get a full night’s sleep. It is generally not recommended for older adults or people with liver issues, due to it having a high risk of next-day drowsiness. In fact, in 2014, the FDA updated its safety guidelines for Lunesta due to many people reporting strong sedative effects, even in the morning after taking it. This included:
Drowsiness- Slower thinking or movement
As a result, the FDA lowered the recommended starting dose from 3 mg to 1 mg and required stronger warning labels for the drug.6
Side Effects of Lunesta
The most commonly reported Lunesta side effects, seen in 2% or more of people during clinical trials, include:
- Unpleasant taste (metallic or bitter, especially with the 3 mg dose)
- Headache
- Drowsiness (or what doctors call “somnolence”)
- Dizziness
- Dry mouth
- Rash
- Upper respiratory infections, like a mild cold or sinus infection
- Viral infections
- Anxiety
Remember, Lunesta is a brain depressant, meaning it slows down brain activity. This decreased activity of the brain may cause next-morning drowsiness (as previously mentioned), reduced alertness, and impaired coordination.
The FDA and the manufacturer both caution users not to drive or operate machinery the morning after taking Lunesta, especially those on the higher dose. Even if you feel awake, your reaction time and judgment may be negatively affected.
Though rare, some people have also experienced complex sleep-related behaviors due to Lunesta, like:
- Sleepwalking
- Sleep-driving
- Eating in your sleep
- Having conversations or performing activities while not fully awake, with no memory afterward
These effects are more likely in people who are particularly sensitive to the drug’s effects or when Lunesta is combined with other sedating substances.
Who Should Not Take Lunesta?
It’s important that Lunesta is not used by anyone with a known hypersensitivity to eszopiclone. That includes previous allergic reactions to the drug, such as a rash, redness, swelling, itching, or difficulty breathing after taking it.
It’s also important to avoid it if:
- You have a history of mental health issues
- You have a history of suicidal behavior
- You suffer from long-term liver disease, since the drug is processed by the liver
- You are pregnant or breastfeeding
How Should You Store Lunesta?
Lunesta must be stored at a controlled room temperature of 25°C (77°F). Temperatures between 15°C and 30°C (59°F to 86°F) are also fine. Avoid storing it anywhere with excess heat (like near radiators or in a car), high humidity, or direct sunlight.
In addition, like all prescription drugs, Lunesta has a shelf life. Don’t take it past the expiration date printed on the bottle.
Also, because Lunesta is a Schedule IV controlled substance, you want to keep it in a secure, locked location out of the reach of children, teenagers, pets, or anyone for whom it wasn’t prescribed.
Which Is Better, Lunesta or Ambien?
Both Lunesta and Ambien are non-benzodiazepine hypnotics that work by boosting GABA, the calming brain chemical. However, they attach to the brain’s GABA receptors in slightly different ways.
Ambien mainly targets a part of the receptor linked to sedation, helping you fall asleep quickly. Lunesta, on the other hand, connects to more areas of the receptor, which helps you fall asleep and stay asleep through the night.
Ambien wears off faster – its effects last about 2.5 hours – so it’s less likely to cause grogginess the next morning. In contrast, Lunesta lasts around six hours, which can be helpful if you have severe difficulty with falling asleep, but may cause more next-day drowsiness.
Both drugs share several side effects, such as drowsiness, dizziness, and headache, but Lunesta is known for leaving a bitter or metallic after taste in the mouth. Ambien is more likely to cause unusual sleep behaviors, like sleepwalking or even sleep-driving.
Natural Sleep Alternatives to Lunesta
Cognitive behavioral therapy for insomnia (CBT-I) is the most clinically validated, first-line treatment for chronic insomnia, even above medication like Lunesta or Ambien. It targets the root causes of insomnia, like racing thoughts, poor sleep habits, anxiety about sleep, and inconsistent routines.
The components of CBT-I include:
Stimulus control therapy- Sleep restriction therapy
- Cognitive restructuring to reduce nighttime anxiety
- Relaxation techniques, such as mindfulness, diaphragmatic breathing, and progressive muscle relaxation
There are also other tools you can combine with CBT-I for added benefit. Melatonin, for example, acts as a body clock signal and is very useful if your circadian rhythm is off (e.g., jet lag; shift work) and you’re trying to reset your sleep schedule.
Then there’s valerian root, a commonly used herbal supplement for which the clinical evidence is mixed. Still, some people appear to find it helpful in calming nighttime anxiety. Chamomile, lavender, and passionflower teas may also promote relaxation and help you fall asleep faster.
Too often overlooked, some lifestyle changes can also drastically improve sleep quality. If you go to bed and wake up at the same time every day, including the weekends, you train your circadian rhythm to stabilize. Getting bright light in the morning and avoiding blue light from screens 1-2 hours before bed also reinforces a healthy sleep-wake cycle.
Last but not least, caffeine has a half-life of 4-6 hours, meaning that your afternoon latte may still be active at 10 PM. So, avoiding caffeine after 2 PM helps you sleep better.7
Find Compassionate and Comprehensive Insomnia Treatment Near You
Lunesta is an effective short-term solution for insomnia, but it does not address the deeper, long-term causes of sleep disruption. Over time, medications like Lunesta can lose their effectiveness or bring unwanted side effects. However, in the short term, they can help give you the space to understand your insomnia and get your sleep back on track.
If you’re looking for long-term solutions, as well as a strategy that addresses the root cause of your sleep issues, it’s worth considering getting cognitive behavioral therapy at Mission Connection.
Our multidisciplinary team delivers a comprehensive program that includes daily group therapy with licensed therapists, individual treatment plans, and access to evidence-based modalities like CBT, mindfulness, and more. We also offer medication management when needed.
References
- Morin, C. M., & Jarrin, D. C. (2022). Epidemiology of Insomnia. Sleep Medicine Clinics, 17(2). https://doi.org/10.1016/j.jsmc.2022.03.003
- U.S. Food and Drug Administration. (n.d.). Highlights of prescribing information: Lunesta (eszopiclone). https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/021476s030lbl.pdf
- Monti, J. M., & SR Pandi-Perumal. (2007). Eszopiclone: its use in the treatment of insomnia. Neuropsychiatric Disease and Treatment, 3(4), 441. https://pmc.ncbi.nlm.nih.gov/articles/PMC2655082/
- Rösner, S., Englbrecht, C., Wehrle, R., Hajak, G., & Soyka, M. (2018). Eszopiclone for insomnia. Cochrane Database of Systematic Reviews, 10(10). https://doi.org/10.1002/14651858.cd010703.pub2
- Najib, J. (2006). Eszopiclone, a Nonbenzodiazepine Sedative-Hypnotic Agent for the Treatment of Transient and Chronic Insomnia. Clinical Therapeutics, 28(4), 491–516. https://doi.org/10.1016/j.clinthera.2006.04.014
- U.S. Food and Drug Administration. (2019). FDA drug safety communication: FDA warns of next-day impairment with sleep aid Lunesta (eszopiclone) and lowers recommended dose. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-next-day-impairment-sleep-aid-lunesta-eszopiclone-and-lowers
- Sajadi-Ernazarova, K. R., & Hamilton, R. J. (2023, August 8). Caffeine Withdrawal. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430790/
