OriginalDrugs

Trazodone for Sleep & Insomnia

Effectiveness

Trazodone hcl (Desyrel) is a relatively safe and non-habit-forming hypnotic. It is technically considered to be an antidepressant, but due to its sedative properties is actually used more often as sleep aid for insomnia.

Trazodone promotes sleep onset as well as sleep maintenance.
It is a good choice for:

  • Insomnia caused by SSRIs or other antidepressants 1
  • Depressed people with difficulty sleeping
  • Sleep disorders in elderly with dementia4
  • Insomnia during recovery from alcohol dependence
  • Insomnia and nightmares in posttraumatic stress disorder

Because trazodone has virtually no potential for abuse and addiction, it may be preferred to benzodiazepines in persons with a history of substance abuse.

Trazodone decreases night-time awakening, REM sleep, and increases slow-wave sleep duration2. However, it can produce small impairments of short-term memory, verbal learning, and equilibrium.

Dose range for insomnia

The initial hypnotic dosage is 25 mg at bedtime. If necessary, it can be slowly titrated up to 200 mg. The usual effective dogage is 100 mg at bedtime5.

Trazodone works fairly quickly - most people fall asleep within 15 minutes after taking it.

Trazodone and Sleep apnea

Sleep apnea (or sleep apnoea) is a disorder characterized by a marked reduction or pause of breathing during sleep followed by brief arousal to restart breathing. Sometimes, normal breathing restarts with a loud snort or choking sound.

Trazodone has an advantage over benzodiazepines and other hypnotics in that it does not depress respiration. It is very important attribute for patients with sleep apnea.

Recently researchers found that trazodone allowed patients with obstructive sleep apnea to tolerate a higher CO2 level without arousal3. Trazodone has been shown to increases the arousal threshold and to be a stimulant of upper airway muscle activity6.

See also

References

  • 1. Kaynak H, Kaynak D, Gözükirmizi E, Guilleminault C. The effects of trazodone on sleep in patients treated with antidepressants. Sleep Med. 2004 Jan;5(1):15-20.
  • 2. Roth AJ, McCall WV, Liguori A. Cognitive, psychomotor and polysomnographic effects of trazodone in primary insomniacs. J Sleep Res. 2011 Dec;20(4):552-8. PubMed
  • 3. Heinzer RC, White DP, Jordan AS, Lo YL, Dover L, Stevenson K, Malhotra A. Trazodone increases arousal threshold in obstructive sleep apnoea. Eur Respir J. 2008 Jun;31(6):1308-12 PubMed
  • 4. Camargos EF, Pandolfi MB, Freitas MP, et al. Trazodone for the treatment of sleep disorders in dementia: an open-label, observational and review study.Arq Neuropsiquiatr. 2011 Feb;69(1):44-9.
  • 5. Mashiko H, Niwa S, Kumashiro H, Kaneko Y, Suzuki S, Numata Y, Horikoshi R, Watanabe Y. Effect of trazodone in a single dose before bedtime for sleep disorders accompanied by a depressive state: dose-finding study with no concomitant use of hypnotic agent. Psychiatry Clin Neurosci. 1999 Apr;53(2):193-4.
  • 6. Smales ET, Edwards BA, Deyoung PN, et al. Trazodone Effects on Obstructive Sleep Apnea and Non-REM Arousal Threshold. Ann Am Thorac Soc. 2015 May PubMed

Author: OriginalDrugs Team
Last reviewed: June, 2015

Quick facts

desyrel
  • Because Trazodone has strong sedating properties it is often used in a single nighttime dose as sleep aid.
  • It is prescribed at lower dosages when used for sleep than for depression.
  • Trazodone is often too sedating during the day when given in antidepressant doses. That is why it is not used frequently as monotherapy for depression.