table of contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
You know how terrible you feel after a bad night of sleep, but you may not know just how far the effects extend.
Just one night of sleep deprivation can increase symptoms of anxiety and depression and even change our appetites (Babsen, 2010; Hogenkamp, 2013). Chronic insomnia is sleep deprivation amplified and lasts a month or more (Schutte-Rodin, 2008).
If you’re experiencing this kind of insomnia, you may be wondering if trazodone can help you get your sleep schedule back on track. First, let’s dig into insomnia a little more.
Insomnia is a common sleep disorder characterized by trouble falling asleep, staying asleep, or both. In the United States, research has found that around 25% of adults reported occasional sleep problems and 9% reported regular sleep disturbances. Despite how common sleep problems are, two-thirds of people with insomnia aren’t aware of their treatment options (Ancoli-Israel, 1999).
Insomnia is generally treated with a combination of behavioral therapy and short-term prescription medications. The prescription drug your healthcare provider chooses depends on many factors. These may include how you respond to other medications and whether your insomnia is caused by an underlying condition (Schutte-Rodin, 2008).
How trazodone helps with sleep
Trazodone (brand name Desyrel; see Important Safety Information) is a medication approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder, but it can be used off-label to treat insomnia (NIH, 2017).
Trazodone has a slight sedative effect because of how it works in the body. The drowsiness trazodone causes makes it a good treatment for trouble sleeping––especially at low doses.
Trazodone isn’t unlike allergy medications known for making you drowsy. Antihistamines such as diphenhydramine cause drowsiness because they block histamines. That’s why diphenhydramine is found both in allergy medication like Benadryl and ZzzQuil, an over-the-counter sleep aid. Part of why trazodone helps with sleep is that it also blocks histamines (Shin, 2020).
Amitriptyline for sleep: a common off-label use
How trazodone may be used
You likely won’t be prescribed trazodone for sleep unless you also suffer from depression or anxiety (Schutte-Rodin, 2008).
It isn’t entirely clear whether depression causes insomnia or vice versa, but researchers know that these conditions often appear together (Fang, 2019; Staner, 2010). Since trazodone is an antidepressant, it may help with both conditions simultaneously.
Your healthcare provider may use doses of 50–100 mg to help get your sleep back on track. One study found that participants given trazodone reported fewer sleep disturbances after just one day on 50 mg. By day seven, those taking trazodone also spent more time in deep sleep compared to those who didn’t take it (Roth, 2011).
Another study found that taking 100 mg trazodone alone or combined with cognitive-behavioral therapy effectively managed insomnia and increased deep sleep (Zavesicka, 2008).
Overall, trazodone is considered safe and effective for the treatment of insomnia. A meta-analysis found it improves perceived sleep quality by decreasing the number of times participants woke up throughout the night. More research noted that trazodone also increased the amount of time participants with depression and insomnia spent asleep (Yi, 2018; Saletu-Zyhlarz, 2002).
Side effects of trazodone
The most common side effects of trazodone are drowsiness, nausea, dizziness, and dry mouth (Zhang, 2014).
Clinical trials have reported other side effects, including blurry vision, constipation, confusion, fatigue, nervousness, tremors, and weight gain or loss (FDA, 2017).
Taking certain medications with trazodone may increase the likelihood you’ll experience side effects. A system in your liver called CYP3A4 breaks down trazodone (Rotzinger, 1998). Certain medicines interfere with this system, which could prevent your body from breaking down trazodone normally. That means more of the drug would end up in your system, leading to an increased risk of side effects (NIH, 2017).
Talk to a healthcare provider about the potential side effects and drug interactions before taking trazodone. They may opt for a different medication if you’re taking certain prescription drugs or over-the-counter supplements that increase serotonin levels. Taking these with trazodone can lead to a potentially life-threatening condition called serotonin syndrome.
If you are experiencing insomnia, there are other treatment options available.
Ambien (also called zolpidem) is a sedative approved for short-term treatment of insomnia––specifically in people who have difficulty falling asleep (FDA, 2008).
Zolpidem is considered a first-line treatment for insomnia along with similar sleep aids. Most clinical trials showed that non-nightly generic Ambien could safely treat insomnia symptoms for 8-12 weeks (Walsh, 2000; Perlis, 2004). Another study found that the prescription drug still worked after eight months of nightly use (Randall, 2012).
An important side effect to note is this type of medication may cause sleepwalking, which could potentially lead to serious injury (FDA, 2019). Taking higher doses of sleep aids can also slow reaction times and impair driving abilities the morning after (FDA, 2013).
The most common side effects of zolpidem taken short-term (up to 10 days) are headache, drowsiness, dizziness, and diarrhea.
When taken for longer (up to 35 days), adverse reactions include dry mouth, allergies, back pain, heart palpitations, drowsiness, dizziness, drugged feeling, lightheadedness, abnormal dreams, and digestion issues (NIH, 2020). Research suggests there’s also a risk of becoming dependent on this medication (Göder, 2001).
Trazodone and zolpidem may be prescribed together for insomnia if neither treatment works alone (Schutte-Rodin, 2008).
- Ancoli-Israel, S., & Roth, T. (1999). Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep, 22 Suppl 2, S347–S353. Retrieved from https://pubmed.ncbi.nlm.nih.gov/10394606/
- Babson, K. A., Trainor, C. D., Feldner, M. T., & Blumenthal, H. (2010). A test of the effects of acute sleep deprivation on general and specific self-reported anxiety and depressive symptoms: an experimental extension. Journal of behavior therapy and experimental psychiatry, 41(3), 297–303. doi:10.1016/j.jbtep.2010.02.008. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862829/
- Cheung, V., Yuen, V., Wong, G., & Choi, S. (2019). The effect of sleep deprivation and disruption on DNA damage and health of doctors. Anaethesia, 74, 417-419. doi:10.1111/anae.14533. Retrieved from https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.14533
- Fang, H., Tu, S., Sheng, J., & Shao, A. (2019). Depression in sleep disturbance: A review on a bidirectional relationship, mechanisms and treatment. Journal of Cellular and Molecular Medicine, 23(4), 2324-2332. doi:10.1111/jcmm.14170. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/jcmm.14170
- Food and Drug Administration (FDA). (2013, May 14). Drug Safety and Availability – FDA Drug Safety Communication: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). Retrieved November 18, 2020, from https://wayback.archive-it.org/7993/20170404172106/https:/www.fda.gov/Drugs/DrugSafety/ucm334033.htm
- Food and Drug Administration (FDA). (2017, June). Desyrel Label. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf
- Food and Drug Administration (FDA). (2019, May 14). Boxed Warning for risk of serious injuries caused by sleepwalking. Retrieved November 18, 2020, from https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-boxed-warning-risk-serious-injuries-caused-sleepwalking-certain-prescription-insomnia
- Göder, R., Treskov, V., Burmester, J., Aldenhoff, J. B., & Hinze-Selch, D. (2001). Zolpidem: Zur Entwicklung von Toleranz und Abhängigkeit anhand von Fallberichten, systematischen Studien und aktuellen molekularbiologischen Daten [Zolpidem: the risk of tolerance and dependence according to case reports, systematic studies and recent molecularbiological data]. Fortschritte der Neurologie-Psychiatrie, 69(12), 592–596. doi:10.1055/s-2001-19179. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11753748/
- Hogenkamp, P. S., Nilsson, E., Nilsson, V. C., Chapman, C. D., Vogel, H., Lundberg, L. S., . . . Schiöth, H. B. (2013). Acute sleep deprivation increases portion size and affects food choice in young men. Psychoneuroendocrinology, 38(9), 1668-1674. doi:10.1016/j.psyneuen.2013.01.012. Retrieved from https://www.sciencedirect.com/science/article/pii/S0306453013000176
- National Institutes of Health (NIH). (2017, April 15). Trazodone: MedlinePlus Drug Information. Retrieved November 13, 2020, from https://medlineplus.gov/druginfo/meds/a681038.html
- National Institutes of Health (NIH). (2020, July 22). DailyMed – AMBIEN- zolpidem tartrate tablet, film coated. Retrieved November 18, 2020, from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c36cadf4-65a4-4466-b409-c82020b42452
- Perlis, M. L., McCall, W. V., Krystal, A. D., & Walsh, J. K. (2004). Long-term, non-nightly administration of zolpidem in the treatment of patients with primary insomnia. The Journal of clinical psychiatry, 65(8), 1128–1137. doi:10.4088/jcp.v65n0816. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15323600/
- Portas, C. M., Bjorvatn, B., & Ursin, R. (2000). Serotonin and the sleep/wake cycle: Special emphasis on microdialysis studies. Progress In Neurobiology, 60(1), 13-35. doi:10.1016/S0301-0082(98)00097-5. Retrieved from https://www.sciencedirect.com/science/article/pii/S0301008298000975
- Randall, S., PhD, Roehrs, T. A., PhD, & Roth, T., PhD. (2012). Efficacy of Eight Months of Nightly Zolpidem: A Prospective Placebo-Controlled Study. Sleep, 35(11), 1551-1557. doi:10.5665/sleep.2208. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3466802/
- Roth, A. J., McCall, W. V., & Liguori, A. (2011). Cognitive, psychomotor and polysomnographic effects of trazodone in primary insomniacs. Journal of sleep research, 20(4), 552–558. doi:10.1111/j.1365-2869.2011.00928.x. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3165092/
- Rotzinger, S., Fang, J., & Baker, G. B. (1998). Trazodone is metabolized to m-chlorophenylpiperazine by CYP3A4 from human sources. Drug metabolism and disposition: the biological fate of chemicals, 26(6), 572–575. Retrieved from https://pubmed.ncbi.nlm.nih.gov/9616194/
- Saletu-Zyhlarz, G. M., Abu-Bakr, M. H., Anderer, P., Gruber, G., Mandl, M., Strobl, R., Gollner, D., Prause, W., & Saletu, B. (2002). Insomnia in depression: differences in objective and subjective sleep and awakening quality to normal controls and acute effects of trazodone. Progress in neuro-psychopharmacology & biological psychiatry, 26(2), 249–260. doi:10.1016/s0278-5846(01)00262-7. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11817501/
- Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 4(5), 487–504. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576317/
- Stahl, S. (2009). Mechanism of Action of Trazodone: A Multifunctional Drug. CNS Spectrums, 14(10), 536-546. doi:10.1017/S1092852900024020. Retrieved from https://www.cambridge.org/core/journals/cns-spectrums/article/abs/mechanism-of-action-of-trazodone-a-multifunctional-drug/336DB6B060471BA6C675337CC8AA637C
- Staner L. (2010). Comorbidity of insomnia and depression. Sleep medicine reviews, 14(1), 35–46. doi:10.1016/j.smrv.2009.09.003. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19939713/
- Walsh, J. K., Roth, T., Randazzo, A., Erman, M., Jamieson, A., Scharf, M., Schweitzer, P. K., & Ware, J. C. (2000). Eight weeks of non-nightly use of zolpidem for primary insomnia. Sleep, 23(8), 1087–1096. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11145323/
- Ware, J. C., & Pittard, J. T. (1990). Increased deep sleep after trazodone use: a double-blind placebo-controlled study in healthy young adults. The Journal of clinical psychiatry, 51 Suppl, 18–22. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2211560/
- Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of Antidepressants on Sleep. Current psychiatry reports, 19(9), 63. doi:10.1007/s11920-017-0816-4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5548844/
- Yamadera, H., Suzuki, H., Nakamura, S., & Endo, S. (1999). Effects of trazodone on polysomnography, blood concentration and core body temperature in healthy volunteers. Psychiatry and clinical neurosciences, 53(2), 189–191. doi:10.1046/j.1440-1819.1999.00531.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/10459685/
- Yi, X., Ni, S., Ghadami, M. R., Meng, H., Chen, M., Kuang, L., . . . Zhou, X. (2018). Trazodone for the treatment of insomnia: A meta-analysis of randomized placebo-controlled trials. Sleep Medicine, 45, 25-32. doi:10.1016/j.sleep.2018.01.010. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1389945718300248
- Zavesicka, L., Brunovsky, M., Horacek, J., Matousek, M., Sos, P., Krajca, V., & Höschl, C. (2008). Trazodone improves the results of cognitive behaviour therapy of primary insomnia in non-depressed patients. Neuro endocrinology letters, 29(6), 895–901. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19112384/
- Zhang, Y., Ren, R., Lei, F., Zhou, J., Zhang, J., Wing, Y. K., Sanford, L. D., & Tang, X. (2019). Worldwide and regional prevalence rates of co-occurrence of insomnia and insomnia symptoms with obstructive sleep apnea: A systematic review and meta-analysis. Sleep medicine reviews, 45, 1–17. doi:10.1016/j.smrv.2019.01.004. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30844624/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.