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

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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.
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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.

Further reading

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

Interesting facts
Trazodone for sleep
  • Trazodone is considerably cheaper than popular hypnotics like Ambien®, Sonata®, or Lunesta®.
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