Trazodone for sleep: What you need to know

Is trazodone an approved sleep aid? | Trazodone dosage | Trazodone advantages | Side effects | Alternatives | FAQs 

Trazodone is a prescription drug FDA approved to treat individuals with depression or major depressive disorder. It works by regulating certain chemicals in the central nervous system (CNS), such as serotonin. Trazodone is similarly effective to other antidepressants, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs), but it is classified as a serotonin antagonist and reuptake inhibitor (SARI). Trazodone is a generic drug that can be purchased under the brand name Desyrel or Oleptro. 

Although it is mainly prescribed for depression, trazodone can be prescribed off-label to treat insomnia because of its sedative properties. Trazodone may be especially useful for people who experience insomnia caused by depression. 

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Is trazodone approved as a sleep aid?

Trazodone is not approved as a sleep aid by the Food and Drug Administration (FDA), but rather as a treatment of depression. Although not approved as a sleep aid by the FDA, trazodone is sometimes prescribed for insomnia. The use of a medication for something other than its intended FDA-approved use is called off-label use, and it is a common practice by healthcare providers. Prescribing a drug off-label is up to the discretion and judgment of a healthcare provider. 

Some research suggests that trazodone can be an effective medication for treating primary and secondary insomnia. Primary insomnia is not caused by a medical condition or problem, while secondary insomnia typically develops due to a health condition, such as a mental health disorder, lung disease, or cancer. 

One systematic review compiled and analyzed various studies on trazodone for insomnia, and it concluded that low doses of trazodone could be a safe and effective way to help treat insomnia. Studies analyzed in the review found that trazodone may help improve sleep latency, duration, and quality. In addition, trazodone may help improve deep sleep, or slow-wave sleep. In other words, trazodone can be a useful drug to help a person fall asleep faster and stay asleep throughout the night. However, more large-scale clinical trials are needed to evaluate these findings. 

The American Academy of Sleep Medicine (AASM) recommends avoiding trazodone for chronic insomnia. Trazodone guidelines from the AASM are based on a short-term clinical trial that compared 50 mg of trazodone to 10 mg of Ambien (zolpidem) and placebo. The AASM task force determined that trazodone produced no significant improvement in sleep and is linked to various side effects. Instead, the AASM recommends other sleep medications, such as Belsomra (suvorexant), Lunesta (eszopiclone), or Sonata (zaleplon).

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How much trazodone should I take for sleep?

The trazodone dosage for insomnia ranges from 25 mg to 150 mg, although it is typically started at 25 to 50 mg at bedtime. The dosage may be increased gradually depending on the person’s response to the drug. 

“Typically a starting dose of trazodone as a sleep aid is between 25 to 50 mg at bedtime, but max doses can go higher,” says Sean Kiesel, DO, who practices family medicine in Utah. “This is ultimately determined by you and your physician.” The maximum dose of trazodone for insomnia is 200 mg. 

Trazodone is usually only recommended for short-term treatment of insomnia. People who are on long-term treatment with high doses of trazodone will need to gradually decrease their dosage when discontinuing the drug. 

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Advantages of taking trazodone for sleep

Typically, trazodone is not a first choice for the treatment of insomnia. Medical experts may recommend trying lifestyle changes or cognitive behavioral therapy first to help treat chronic insomnia. If these methods are not enough, a healthcare provider may prescribe an FDA-approved sleep disorder medication, such as Lunesta (eszopiclone) or Ambien (zolpidem). 

A healthcare provider may prescribe trazodone for sleep in different scenarios. For example, if you are taking an SSRI for depression and experience insomnia, a healthcare provider may prescribe trazodone as a sleep aid. Taking trazodone for sleep may have some advantages, including:

• Trazodone is a non-addictive, non-controlled medication. Some medications used in the treatment of insomnia can cause dependence, which can lead to addiction and abuse. One class of medications approved to treat insomnia is benzodiazepines, such as Restoril (temazepam) and Halcion (triazolam). However, these medications are Schedule IV controlled substances only recommended for short-term use due to the potential for dependence and addiction. 
• Since it is a generic medication covered by most insurance plans, trazodone can be cheaper than other treatment options, especially brand-name drugs.
• Trazodone is rapidly absorbed within 30 minutes to 2 hours. It can work quickly as a nighttime sleep aid to help an individual fall asleep faster. 
• Trazodone may be helpful for those with sleep apnea, as studies have shown it improves the apnea/hypopnea index (AHI) and promotes stable breathing.

Side effects of trazodone

If you’re considering taking trazodone as a sleep aid, there are potential side effects to be aware of. The most common side effects include:

• Blurred vision
• Dizziness
• Swelling in the arms or legs
• Fatigue
• Diarrhea
• Stuffy nose
• Dry mouth
• Nausea and vomiting
• Weight loss

Serious side effects

• Suicidal thoughts and behaviors in children, adolescents, and young adults
• Serotonin syndrome
• A prolonged, painful erection (priapism)
• Irregular heartbeat or heart rhythm problems (arrhythmias)
• Low blood pressure when moving from a sitting or lying position to standing up (orthostatic hypotension)
• Mania or hypomania
• Angle-closure glaucoma
• Low blood sodium levels (hyponatremia)
• Withdrawal symptoms after discontinuing the drug, such as agitation and anxiety
• Allergic reactions with symptoms such as itching or hives, swelling of the face or throat, chest tightness, or difficulty breathing

If you experience any serious side effects or worsening side effects, it is important to seek medical attention and contact a healthcare provider.

It is important to tell your doctor about all medications you are taking, as trazodone is known to have drug interactions with several medications. If trazodone is taken with another medication that affects serotonin, there may be an increased risk of a life-threatening condition called serotonin syndrome. 

Also, let your doctor know if you are pregnant or breastfeeding before taking this medication. Trazodone may cause harm to an unborn baby if taken during pregnancy. Trazodone is also passed into breast milk, although the effects of trazodone in breastfed babies are not entirely unknown. It’s important to weigh the benefits and risks of taking trazodone with the guidance of a healthcare provider.

It’s important to consult a healthcare provider for medical advice about discontinuing trazodone, as there is a risk of withdrawal symptoms.

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Trazodone alternatives

Trazodone is not typically prescribed as a first-line agent for sleep disorders, as FDA-approved alternatives are available to treat insomnia. The following table shows some examples of different types of prescription sleep aids. 

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More insomnia remedies

Medications are not your only option if you are having difficulty sleeping. Lifestyle changes and home remedies can be helpful to get a good night’s sleep. Some possible options include:

• Melatonin is a natural sleep aid that can be purchased without a prescription. “Melatonin in addition to sleep hygiene would be appropriate to try before trazodone,” says Dr. Kiesel. Although evidence surrounding its efficacy as a sleep aid is still lacking, many health professionals consider melatonin to be a safe sleep aid to try.

• Diphenhydramine is an antihistamine known by the brand name Benadryl, and it is used to treat the symptoms of allergies and allergic reactions. Because of its sedating effects, diphenhydramine may be used for the short-term treatment of acute insomnia. It is also available over the counter. 
• Practice good sleep hygiene. “According to the American Sleep Association, you should be going to bed at the same time and waking up at the same time, if your schedule allows,” explains Lindsey Hudson, APRN, NP-C, CDCES, a family nurse practitioner in Charleston, South Carolina and member of the SingleCare Medical Review Board. “Also, don’t watch TV, read, or use any electronics (like your phone, tablet, or computer) while in bed.”
• Exercise earlier in the day. Vigorously exercising within an hour of bedtime could increase the time it takes to fall asleep and cause poor sleep quality. “Try to avoid rigorous exercise too close to bedtime, as this can circulate endorphins and disrupt sleep,” says Hudson.
• Meditation is a great way to help treat insomnia, and studies have shown the effectiveness of this relaxation technique for improving sleep.
• Cognitive behavioral therapy has been shown to have positive results in treating insomnia. Significant improvements in sleep latency and sleep efficiency have been found up to a year after treatment.
• Drink warm milk and tea. While there is not much evidence to support that these work, many people use these beverages to unwind in the evening. Skip the alcohol, as it can lead to sleep disturbances and other sleep problems. 
• Chinese herbal medicine was found in one study to help the treatment of insomnia. The most common herbs used to treat insomnia include Suanzaoren, Fuling, and Gancao. 

Frequently asked questions about trazodone for sleep

How quickly does trazodone work for sleep?

Trazodone works quickly as a sleep aid, usually taking around 30 minutes to feel its sedative effects. Healthcare providers will typically recommend taking trazodone within 30 minutes of bedtime. However, it can take up to two hours for trazodone to reach peak levels in the blood after taking it. 

Is it ok to take trazodone every night?

Trazodone is generally recommended for the short-term treatment of insomnia. However, compared to other medications like benzodiazepines, trazodone is less likely to cause serious side effects with long-term use. In addition, the use of trazodone is not linked to a risk of dependence, abuse, or addiction. It is not recommended to stop taking trazodone abruptly, especially after taking it on a regular basis in higher doses. Instead, the dosage should be gradually decreased over time to avoid potential withdrawal symptoms. 

Is it safe to take trazodone for insomnia?

Trazodone can be a safe and effective treatment option for insomnia. However, the lowest effective dose of trazodone should be taken for insomnia. High doses of trazodone may cause an increased risk of side effects. The potential risks of trazodone use will depend on the individual’s response to the medication and the dosage prescribed. 

Is Ambien or trazodone better for insomnia?

Ambien is FDA-approved for the short-term treatment of insomnia, with the main symptom of trouble falling asleep. It can help decrease the time it takes to fall asleep (sleep latency). On the other hand, trazodone is used off-label for insomnia, and it is not preferred as a first-line treatment for insomnia. In addition, the American Academy of Sleep Medicine (AASM) recommends Ambien (zolpidem) over trazodone for insomnia. 

How is trazodone different from other sleeping aids?

Trazodone is different from other sleeping aids because it is primarily prescribed to treat depression. It is an antidepressant medication that has mild sedating effects, which makes it useful as a potential sleep aid at lower doses. Trazodone is not used as a first-line agent for insomnia. Instead, a healthcare provider may recommend sleep hygiene methods and an FDA-approved prescription medication for insomnia, such as Ambien (zolpidem) or Belsomra (suvorexant), before recommending Trazodone. A healthcare provider may prescribe trazodone for someone who experiences insomnia from SSRI antidepressants or someone with depression who has trouble sleeping. 

Is trazodone addictive?

Trazodone is not considered an addictive drug, and it is not a controlled substance, according to the FDA label. Unlike other prescription sleep medications, such as benzodiazepines, trazodone does not carry a risk of addiction. However, trazodone can be habit-forming, especially if it is used long-term for insomnia.