Trazodone for Sleep

Joseph Krainin1 comment

Trazodone is the most commonly prescribed medication for sleep despite not having an FDA indication for sleep. Trazodone is generic and very inexpensive so there is little incentive for pharmaceutical companies to do the drug trials necessary to get trazodone approved for sleep. Why is trazodone the most popular prescription sleep medication among doctors? It is a non-controlled substance, meaning that there is no risk for addiction, tolerance, or withdrawal, its side effect profile is benign, and it has minimal (and perhaps some positive) impact on sleep architecture. 

trazodone molecular structure

Molecular Structure of Trazodone

Of note, the majority of doctors who prescribe trazodone are primary care doctors. Sleep medicine physicians tend to not use it as their go-to medication. This is probably because we are generally more comfortable with using controlled substances like Ambien due to our training. However, I have become much more of a trazodone enthusiast in recent years due to the increasing side effect profile of Ambien.

Trazodone for Sleep FAQS: 

What class of medications is trazodone in?

Trazodone is a sedating antidepressant. Its exact mechanism of action is unknown but it is felt to work on the serotonin system. It is not as effective of an antidepressant as the newer classes of antidepressants such as SSRIs and SNRIs so it is rarely used for this indication. However, it is very good at helping people sleep.  

What is the trazodone dosage for sleep?

The typical trazodone dosage for sleep is 50 m.g. before bed. Dosages above 100 m.g. per night rarely have any additional benefit for sleep.

What are the side effects of taking trazodone for sleep?

In my practice, I have not encountered side effects besides rarely hearing from patients that the medication caused intense, unpleasant dreams. Trazodone, like all antidepressants, has a "black box warning" - the highest level of warning that the FDA issues - for an increased risk of suicidality in children adolescents, and young adults with major depressive or other psychiatric disorders. The drug should be used with caution in people <24 years of age. 

Besides that psychiatric side effects, trazodone's most common side effects include orthostatic hypotension and syncope, cardiac arrhythmias, and priapism.¹ Again, at the dosage that is used for sleep, these side effects are exceedingly rare. 

When should I take trazodone for sleep?

Take the medication 30-45 minutes before your desired bedtime.

How long does trazodone last for sleep?

Trazodone's half-left is 5 hours, which is relatively long-acting for a sleep medication (Ambien's half-life is 2.5 hours) so it should be beneficial for both sleep onset and sleep maintenance insomnia.² 

What effects does trazodone have on sleep cycles?

Trazodone has been shown to increase N3 sleep, which is the stage of deep, restorative sleep. Trazodone does not impact REM sleep. 

Can I take melatonin with trazodone for sleep?

There is no drug-drug interaction between melatonin and trazodone so it is safe to take both together. However, it should be noted that if trazodone is working well for you then you shouldn’t need another sleep medication. Taking both trazodone and melatonin together increases your risk for sedation. 

How long does it take trazodone to work for sleep?

The effects should be immediate, meaning that trazodone does not have to “build up in your system” to help you sleep. The first pill taken on the first night will be just as effective as subsequent nights.

Does trazodone have any other names?

The brand name is called Desyrel.

Are there any things that I should be concerned about with long-term use of trazodone?

No, there are no known cumulative toxic effects or concerns for addiction with trazodone.

Can trazodone be taken as needed for sleep?

Yes, at the typical dose of 50 m.g. there are no withdrawal symptoms so trazodone can be taken as needed. Like all antidepressants, if trazodone is being used for depression at higher doses (usually 100-300 m.g.) then the medication should be taken consistently every night and changes should only be made in consultation with the prescribing provider. 

If I have sleep apnea, is it OK to take trazodone?

Trazodone will not make sleep apnea worse. However, it is very common for people with untreated sleep apnea to have insomnia, particularly trouble staying asleep. If you are at risk for sleep apnea - you have symptoms like chronic snoring, are overweight or obese, or stop breathing in your sleep - make sure to get a sleep apnea test. I see a lot of patients who are merely trying to suppress the brain awakenings due to sleep apnea by taking sleep medications. This is not good – you need to get at the root cause of the problem and fix it instead of just trying to put a Band-Aid on it. Untreated sleep apnea can cause a number of medical problems including high blood pressure, heart disease including sudden cardiac death, and stroke.

How can I get a prescription for trazodone for sleep? Can I get trazodone online?

You can consult your doctor about it or make an appointment to see me online below to discuss whether trazodone is right for you and, if appropriate, get a trazodone prescription:

 sleep apnea test home sleep study Joseph KraininJoseph Krainin, M.D., FAASM is the founder of Singular Sleep, the world's first online sleep center.  He is a Fellow of the American Academy of Sleep Medicine and board-certified in both sleep  medicine and neurology. He has been practicing medicine for over 10 years.

¹Epocrates

²The Effects of Psychotropic and Neurotropic Effects on Sleep, Sleep Review

1 comment

Natalie
Natalie
Are Pcp doctors able to prescribe to patients for sleep?

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