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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).
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Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.