Eszopiclone Side Effects: What You Should Know About Lunesta

Key Points

• Eszopiclone (Lunesta) commonly causes unpleasant metallic taste, next-day drowsiness, and dizziness in many users.
• Serious risks include complex sleep behaviors like sleepwalking or sleep-driving, next-day impairment affecting driving ability, and potential mood changes.
• Long-term use can lead to tolerance, dependence, and withdrawal symptoms similar to other sleep medications.
• Combining eszopiclone with alcohol or other sedatives significantly increases dangerous side effects and should be avoided.

People who receive eszopiclone prescriptions (under the brand name Lunesta and others) usually need help with ongoing sleep problems. The medication helps patients both fall asleep and maintain sleep throughout the night but patients need to understand its side effects to use it properly.

Eszopiclone belongs to a class of sleep medications that work by affecting your brain’s chemistry to promote sleep. Like all medications, it comes with both benefits and risks. Balancing the benefits of improved sleep against potential risks, such as next-day alertness problems, unusual sleep behaviors, and other side effects, requires informed decision-making.

This guide provides an overview of what you need to know about eszopiclone side effects, including common reactions and serious risks that require immediate attention. We’ll help you understand how to use this medication safely and when to seek help.

What Is Eszopiclone (Lunesta) and How It Works

Eszopiclone is a non-benzodiazepine hypnotic medication prescribed for adult insomnia. It helps people who have difficulty falling asleep or staying asleep throughout the night. The brand-name version, Lunesta, is widely recognized, although generic eszopiclone is now available.

The medication works by acting on the GABA receptor system in your brain. GABA is a neurotransmitter (chemical messenger) that reduces nerve activity, promoting relaxation and sleep. By enhancing GABA’s effects, eszopiclone helps calm brain activity and induce sleep.

Typical starting doses range from 1 mg to 3 mg taken orally, immediately before bedtime. Your doctor will prescribe the lowest effective dose based on your individual needs, medical history, and response to the medication.

It’s important to understand that medication represents just one approach to treating insomnia. Behavioral treatments like cognitive behavioral therapy for insomnia (CBT-I, a form of talk therapy that focuses on identifying and changing unhelpful thoughts and behaviors around sleep) are often recommended as first-line treatment and may be more effective long-term without the risks associated with medication. Eszopiclone is typically appropriate when behavioral approaches haven’t provided sufficient relief or when combined with these strategies.

Common Side Effects of Eszopiclone

Most Frequently Reported Side Effects

The most common eszopiclone side effects include reactions that many users experience, particularly when first starting the medication:

Unpleasant taste is perhaps the most frequently reported side effect. Many people describe a metallic or bitter taste in their mouth after taking eszopiclone. This taste disturbance [1] can linger into the next day and may affect a significant percentage of users, with some studies suggesting up to 30% or more experience this effect.

Dry mouth occurs commonly, causing discomfort and sometimes affecting taste f+urther. Keeping water nearby can help manage this symptom.

Drowsiness and next-day grogginess affect many users [2], even after a full night’s sleep. You may feel less alert, slower to react, or generally foggy the following day.

Dizziness can occur, particularly when standing up or moving around shortly after taking the medication, or the following morning.

Headache is reported by some users, ranging from mild to moderate in intensity.

Cold-like symptoms, including a runny nose, sore throat, or general malaise (a vague feeling of discomfort that is hard to pinpoint, often accompanied by fatigue, lack of motivation, or body aches), may develop.

What to Expect in the First Night(s)

When you first take eszopiclone, you may notice an unpleasant taste almost immediately or upon waking. The sleep-promoting effects typically begin within 30 minutes to an hour. Next-day drowsiness may be more pronounced during initial use as your body adjusts to the medication.

What Your Partner May Notice

It’s worth considering that your bed partner or household members might observe effects you’re not aware of. They may notice that you seem groggier or slower in the morning, and observe unusual sleep behaviors, such as talking in your sleep, walking while asleep, or engaging in activities you don’t remember. They may also notice changes in your personality, increased irritability, or unusual behaviors that concern them.

Having open communication with those you live with about your medication use helps ensure someone can alert you to side effects you might not recognize yourself.

Potential Risks and Considerations Associated With Eszopiclone Use

Beyond common side effects, eszopiclone carries several serious risks that require careful consideration.

Next-Day Impairment & Alertness

Even after a full night’s sleep, eszopiclone can impair your abilities the following day. Your coordination, memory, and reaction times may be affected even if you subjectively feel fine. This creates particular risks when driving, operating machinery, or performing tasks requiring alertness and coordination.

The FDA has issued warnings about driving [3] after taking sleep medications like eszopiclone. You may not recognize your level of impairment, creating dangerous situations for yourself and others.

Complex Sleep Behaviors

One of the most concerning risks of eszopiclone use involves complex sleep behaviors. These include sleepwalking, sleep-driving, [4] preparing and eating food, making phone calls, or engaging in other activities while not fully awake, with no memory of these events afterward. Serious injuries and deaths have been reported related to these behaviors.

These behaviors can occur even at recommended doses and may happen after the first dose or after taking the medication for some time. They appear more likely when taking higher doses, combining eszopiclone with alcohol or other sedatives, or not allowing adequate sleep time.

Mood and Behavior Effects

Eszopiclone can affect mood and mental state. Some people experience abnormal thoughts [5], agitation, confusion, or hallucinations. More seriously, worsening depression and suicidal ideation (thoughts about ending one’s own life) have been reported. If you have a history of depression, mental health conditions, or suicidal thoughts, your doctor needs to monitor you closely while taking this medication.

Special Populations and Contraindications

Certain groups face elevated risks:

Older adults are more sensitive to eszopiclone’s effects, experience greater next-day impairment, and have a higher fall risk. Lower doses are typically recommended for adults over 65 years old, or the medication may be inappropriate for older people.

People with liver impairment process the medication more slowly, leading to higher blood levels and increased side effects. Dose adjustments are necessary.

Those with a history of substance misuse may be at higher risk for misusing or developing dependence on eszopiclone.

People with breathing problems or sleep apnea should use caution, as eszopiclone can depress respiratory function (suppress breathing).

Dependence, Tolerance, and Withdrawal

While eszopiclone has a lower dependence risk compared to benzodiazepines, it still carries potential for misuse, tolerance development, and withdrawal symptoms. With regular use, your body may become accustomed to the medication, requiring higher doses to achieve the same effect. If you stop suddenly after prolonged use, you may experience withdrawal symptoms, including rebound insomnia (worse than your original sleep problems), anxiety, shakiness, or other uncomfortable effects.

Interactions and Precautionary Behaviors

Combining eszopiclone with alcohol significantly increases risks of complex sleep behaviors, respiratory depression, dangerous impairment, and overdose. Never take eszopiclone with alcohol.

Other sedating medications, including benzodiazepines, opioids, certain antidepressants, antihistamines, or other sleep aids, create dangerous interactions when combined with eszopiclone.

Critically, you must allow 7 to 8 hours for sleep after taking eszopiclone. Taking it when you have insufficient sleep time ahead creates significant next-day impairment and increases accident risk.

Risk Considerations

Your individual risk depends on multiple factors:

Dose: Higher doses increase all risks. Always use the lowest effective dose.

Sleep hours available: Sleeping less than 7-8 hours significantly increases the risk of next-day impairment.

Additional sedatives/alcohol: Combining substances dramatically elevates all risks.

Patient factors: Age over 65, liver or kidney problems, low body weight, female sex, and certain genetic factors affect how you process the medication.

How to Make Informed Decisions When Using Eszopiclone

Discussion Checklist for Your Prescriber

Before starting eszopiclone, have a thorough conversation with your doctor covering:

• All current medications, including over-the-counter drugs and supplements
• Your alcohol use patterns, including frequency and amount
• Your typical sleep schedule and how many hours you can dedicate to sleep
• Any history of sleepwalking, unusual sleep behaviors, or parasomnias (sleep disorders involving abnormal behaviors, emotions, or sounds, like sleepwalking or nightmares)
• Mental health history, particularly depression or suicidal thoughts
• Liver or kidney problems
• History of substance use or addiction

Important Questions to Ask your Prescriber

How many hours will I need to sleep after taking this medication? The answer should be 7-8 hours. If you can’t consistently dedicate this time, eszopiclone may not be safe for you.

What dose is the least dose effective for my situation? Starting with the lowest dose and increasing it only if necessary minimizes side effects.

What side effects should I watch for, and when should I contact you? Understand which effects are expected and which require immediate attention.

What’s the plan for reviewing and potentially ending this medication? Eszopiclone is intended for short-term use. Early in treatment, establish a timeline for reassessment.

What behavioral approaches should I combine with this medication? Medication works best when combined with good sleep hygiene (practices and habits that promote healthy, restful sleep) and other strategies.

Monitoring and Warning Signs to Stop Use

Stop taking eszopiclone and contact your doctor if you experience:

• Next-day grogginess that persists beyond the first dose or worsens
• Any sleepwalking, sleep-driving, or activities you don’t remember
• Mood changes, particularly worsening depression or suicidal thoughts
• Falls, injuries, or near-accidents
• Allergic reactions, including swelling, difficulty breathing, or rash
• Memory gaps or periods you can’t account for

Lifestyle and Behavioral Adjuncts

Maximize eszopiclone’s effectiveness and minimize risks by:

• Practicing good sleep hygiene: consistent sleep schedule, cool dark bedroom, eliminating electronic screens for an hour before bed, avoiding caffeine after noon
• Considering CBT-I (cognitive behavioral therapy for insomnia) with or instead of medication
• Avoiding heavy meals within 2-3 hours of bedtime
• Abstaining from alcohol
• Being in bed and ready for sleep when you take the medication, not taking it earlier in the evening
• Not taking the medication if you don’t have 7-8 hours available for sleep

How Paramount Wellness Can Help

At Paramount Wellness, we understand that sleep problems often connect to broader mental health concerns, substance use issues, and overall wellness. Our boutique facility in Haddam, Connecticut, offers comprehensive care that addresses these interconnected needs.

If you’re struggling with dependence on sleep medications like eszopiclone, our medically supervised detox program offers safe support for discontinuation. Our team manages withdrawal symptoms and provides safety during this vulnerable period.

Our residential treatment program addresses underlying issues contributing to insomnia, including anxiety, depression, trauma, and substance use, through our dual-diagnosis approach. We offer evidence-based therapies, medication management when appropriate, and holistic approaches, including sleep hygiene education, relaxation techniques, and behavioral strategies for better sleep.