Trazodone for Insomnia & Sleep Problems

written by eMedExpert staff
medical references reviewed August 08, 2019

Uses & efficacy

Trazodone, a sedating antidepressant, is not FDA-approved for insomnia and is used off-label for sleep problems. Despite the lack of official indication, trazodone is among the most widely prescribed sleep aids in the United States.

Reasons for trazodone popularity as a sleeping pill:

Proven sedative properties
Relatively safe - low risk of serious side effects
Lack of restrictions for long-term use
Not a controlled substance
Very inexpensive

trazodone for sleep & insomnia Infographic

Despite the absence of official approval for treating insomnia, several clinical studies and practical experience support trazodone efficacy and safety for the following sleep problems:

Primary insomnia2
Medication-induced insomnia1
Depression-associated insomnia1
Sleep disorders associated with dementia3, Alzheimer’s disease 4
Post-menopausal women with insomnia5
Insomnia and nightmares associated with Post-traumatic stress disorders6
Sleep disturbance during methadone maintenance7
Insomnia in chronic pain (somatoform pain disorders)8
Insomnia during the third trimester of pregnancy9

Dosage and timing for sleep problems

Dosage range: 50 mg to 100 mg of trazodone at bedtime1.
Dosing time: trazodone has a narrow "window" of sleep-promoting effect. It is better to go to bed within 60-90 minutes after taking trazodone dose. If you miss that window, you may feel very sleepy but unable to fall asleep.
Onset of hypnotic effect: 1-2 hours
Duration of hypnotic effect: about 8 hours.

Safety

The most common side effects of trazodone are relatively mild and include daytime sleepiness, drowsiness, headache, dizziness and dry mouth11.
Concomitant use of trazodone with medications known to prolong the QT interval should be avoided.

How Trazodone works

The main pharmacological action of trazodone is blockade of the serotonin 5-HT2A receptor10.
Trazodone has moderate antihistamine and low anticholinergic activity.
Trazodone decreases sleep latency and increases sleep duration.
Trazodone induces and maintains sleep without causing significant daytime drowsiness mainly because of its short half-life.

References

1. Roth AJ, McCall WV, Liguori A. Cognitive, psychomotor and polysomnographic effects of trazodone in primary insomniacs. J Sleep Res. 2011;20(4):552–558.
2. Morin CM, Edinger JD, Krystal AD, Buysse DJ, Beaulieu-Bonneau S, Ivers H. Sequential psychological and pharmacological therapies for comorbid and primary insomnia: study protocol for a randomized controlled trial. Trials. 2016 Mar 3; 17(1):118.
3. Camargos EF, Pandolfi MB, Freitas MP, Quintas JL, Lima Jde O, Miranda LC, Pimentel W, Medeiros-Souza P. Trazodone for the treatment of sleep disorders in dementia: an open-label, observational and review study. Arq Neuropsiquiatr. 2011 Feb; 69(1):44-9.
4. Camargos EF, Louzada LL, Quintas JL, et al. Trazodone improves sleep parameters in Alzheimer disease patients: a randomized, double-blind, and placebo-controlled study. Am J Geriatr Psychiatry. 2014;22(12):1565–1574.
5. Eraslan D, Ertekin E, Ertekin BA, Ozturk O. Treatment of insomnia with hypnotics resulting in improved sexual functioning in post-menopausal women. Psychiatr Danub. 2014;26(4):353–357.
6. Warner MD, Dorn MR, Peabody CA. Survey on the usefulness of trazodone in patients with PTSD with insomnia or nightmares. PharmacoPsychiatry. 2001;34(4):128–131.
7. Stein MD, Kurth ME, Sharkey KM, et al. Trazodone for sleep disturbance during methadone maintenance: a double-blind, placebo-controlled trial. Drug Alcohol Depend. 2012;120(1-3):65–73.
8. Saletu B, Prause W, Anderer P, et al. Insomnia in somatoform pain disorder: sleep laboratory studies on differences to controls and acute effects of trazodone, evaluated by the Somnolyzer 24 × 7 and the Siesta database. Neuropsychobiology. 2005;51(3):148–163.
9. Khazaie H, Ghadami MR, Knight DC, et al. Insomnia treatment in the third trimester of pregnancy reduces postpartum depression symptoms: a randomized clinical trial. Psychiatry Res. 2013;210(3):901–905.
10. Stahl SM. Mechanism of action of trazodone: a multifunctional drug. CNS Spectr. 2009;14(10):536–546.

Published: August 08, 2019
Last updated: August 08, 2019

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