Trazodone for Sleep: What You Need to Know

What Is Trazodone?

Trazodone is an FDA-approved antidepressant used to manage and treat major depressive disorder. FDA approval means that the medication has been found to be safe and effective for a specific use based on data from clinical trials. Trazodone belongs to a class of medications called serotonin antagonist and reuptake inhibitors.¹ Because all brand-name versions have been discontinued, trazodone is only available as a generic medication.

How Does Trazodone Work?

Trazodone works by influencing the amount of serotonin available for the body to use. Serotonin is a body chemical that works with many functions in the body, including your mood. It is unknown exactly how trazodone works.^{1, 2}

Does Trazodone Help With Sleep?

While trazodone is approved as a treatment for depression, it can also be used off-label for other conditions. An off-label use of a medication is one that is not specifically FDA-approved. However, a doctor may prescribe the medication if they believe the benefits outweigh the risks for a patient.

Some off-label uses for trazodone are for the treatment of sleep problems, anxiety, Alzheimer’s disease, substance abuse, bulimia nervosa, and fibromyalgia. It has also been used for the treatment of post-traumatic stress disorder (PTSD) if the standard SSRI treatment does not show that it is effectively controlling the symptoms. Research has also suggested that trazodone can improve breathing in patients with obstructive sleep apnea.²

Benefits of Taking Trazodone for Sleep Issues

While trazodone is a medication primarily approved for depression, it may be helpful for treating sleep issues that occur along with depression, such as insomnia. Trazodone is also a medication that is well-tolerated, non-addictive, and relatively inexpensive.

Benefits of taking trazodone for sleep may include:

• Being a non-addictive medication: Trazodone has a low risk of being habit-forming and addictive, unlike other medications that may be used for sleep, such as benzodiazepines.³
• Causing few adverse reactions: Trazodone has few adverse reactions with some exceptions, such as drug interactions. SSRIs, the class of medication trazodone belongs to, are known to be safe as well as tolerable in terms of side effects³
• Being helpful for coexisting conditions: Trazodone is approved for use in depression. It may be potentially helpful with other psychiatric conditions, insomnia in patients with PTSD, and those with somatoform pain disorders.³
• Being an accessible and inexpensive treatment: Trazodone is a widely available and relatively inexpensive treatment for insomnia.⁴

How Effective is Trazodone for Sleep?

Trazodone appears to be an effective treatment option for insomnia, potentially decreasing the time to fall asleep. It appears to be especially effective in treating those who have insomnia and other simultaneously occurring conditions, such as certain psychiatric disorders. While findings suggest trazodone may be beneficial for insomnia, more research is needed to prove its effectiveness.³

How Quickly Does Trazodone Work for Sleep?

The time it takes for trazodone to work can vary. It can work as quickly as 30 minutes for some people, but it may take longer to take effect for some individuals, sometimes up to 2 hours.^{3, 5} If you do not feel like trazodone is helping with your insomnia, contact your doctor.

How Long Do the Effects of Trazodone Last?

Sleep promoting effects of trazodone can last between 5 to 9 hours. The length of time can vary depending on the individual and factors such as the dosage prescribed and if the patient has other medications that might affect how trazodone works.⁵ Some patients may experience lingering drowsiness when they wake, and should let their doctors know if this side effect continues throughout their treatment.

Can Trazodone Be Used for Long-term Sleep Problems?

Trazodone may be useful short term, but there is limited research on using it long-term for sleep.⁶ Take it exactly as prescribed and let your doctor know if trazodone is not helping as intended with your sleep issues.

Who Might Benefit From Taking Trazodone for Sleep?

Trazodone could be beneficial for those with depression who may also have insomnia.³ A higher dose of trazodone may treat depression symptoms and produce sedative effects. This effect may help if their sleep problems are caused by depression. It is suggested in some studies that people who have insomnia and other coexisting conditions may also benefit from using trazodone, such as with those with PTSD.

Research data on using trazodone for sleep for older adults, children, and adolescents is minimal. In these populations, non–medication treatments are prioritized, such as cognitive behavioral therapy and sleep hygiene.⁷

Side Effects of Trazodone for Sleep

Trazodone, like all medications, may cause side effects ranging from mild to serious. Some patients experience common temporary effects when they first start trazodone. These effects are typically mild and should go away when the body becomes used to the medication. For some patients, side effects may last until the medication is stopped and may require immediate medical attention if the side effect become serious.

Common side effects of trazodone for sleep include*:¹

• Swelling
• Blurred vision
• Drowsiness
• Fatigue
• Headache
• Nasal congestion
• Weight loss
• Dry mouth
• Dizziness
• Nausea

*All medications, including trazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious side effects of trazodone for sleep that require immediate medical attention include*:¹

• Suicidal behavior/ideation
• Serotonin Syndrome
• Irregular or fast heartbeat or fainting
• Prolonged and painful erection
• Mania
• Vision problems
• Withdrawal symptoms
• Unusual bruising or bleeding
• Low blood pressure
• Low sodium in your blood (hyponatremia)

*All medications, including trazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

If your symptoms become severe, seek immediate medical care by calling 911 or visiting the nearest emergency room.

Trazodone for Sleep Dosage

Because it is an off-label use, there is no standardized trazodone dosage for sleep problems. Typically, a low dose of trazodone (25-100 mg) is prescribed when it is used for sleep, although these dosages can vary from person to person due to individual factors.³

Trazodone for Sleep Warnings & Precautions

Trazodone has some serious health complications where the risks may be higher within certain groups. These warnings and precautions do not mean that you will experience them, but it is good to be aware of them so you know when to seek medical attention since many of these warnings require immediate medical care. If you are concerned about these warnings, talk with your doctor.

Warnings and precautions for taking trazodone include:¹

• Suicidal thoughts and behaviors in pediatric and young adult patients: Trazodone may worsen depression or cause suicidal thoughts or behaviors, particularly in those aged 24 years and younger. Patients should seek medical care if they experience worsening depression or suicidal ideations.
• Serotonin syndrome: Trazodone can cause serotonin syndrome, a potentially life-threatening condition. Signs and symptoms may include, agitation, hallucinations, delirium, coma, fast heart rate, dizziness, sweating, flushing, hyperthermia, tremor, rigidity, twitching or jerking muscles, incoordination, seizures, nausea, vomiting, and diarrhea.
• Heart rhythm problems: Trazodone may affect your heart rhythm, especially for those who have preexisting cardiac disease, are on drugs that may change your heart rhythm, on certain antibiotics, and certain antipsychotics. It may be serious or life-threatening.
• Low blood pressure and fainting: It has been reported that some patients on trazodone may experience low blood pressure, including orthostatic hypotension, and fainting. Those who are also on medications to control high blood pressure may require a dosage change in their blood pressure medication.
• Increased risk of bleeding: Trazodone can increase the risk of bleeding events. Those who take anti-inflammatory drugs (NSAIDs), antiplatelet drugs, warfarin, and other anticoagulants may add to this risk.
• Prolonged and painful erection: Also called priapism, this condition can cause irreversible damage to erectile tissue if not treated immediately. If an erection lasts longer than 4 hours, whether it is painful or not, the patient should seek emergency medical attention.
• Mania or hypomania: In patients with bipolar disorder, trazodone may trigger a mixed or manic episode.
• Cognitive and motor impairment: Trazodone could potentially impair judgment, thinking, and motor skills. Patients should be cautious when operating heavy machinery or performing other hazardous activities until they are certain that trazodone does not affect them negatively.
• Discontinuation syndrome: When a serotonergic antidepressant is stopped, especially when done abruptly, adverse reactions may occur, including nausea, sweating, dysphoric mood, and irritability (among other symptoms). A gradual reduction in dosage is recommended whenever possible.
• Glaucoma: Trazodone can trigger angle-closure glaucoma in certain patients. Contact your provider immediately if you notice changes in your vision after starting trazodone.
• Low blood sodium levels: Low blood sodium levels may occur as a result of taking trazodone, and the elderly, patients taking diuretics, and those who are volume-depleted may be at greater risk of developing this condition. Immediate medical attention is required, and signs and symptoms include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness. Signs and symptoms associated with more severe and/or acute cases include hallucination, fainting, seizure, coma, respiratory arrest, and death.

Can You Become Addicted to Trazodone?

It is unlikely to become dependent or addicted to trazodone mentally or physically. It is not a controlled substance, which is when a drug is evaluated for its acceptable medical use and the drug’s potential to cause abuse or dependency. Drugs that may have a potential for substance abuse are assigned a schedule by the FDA.

How To Take Trazodone for Sleep Problems

You should take trazodone exactly as prescribed by your doctor. Do not take more or less of it, or more often than prescribed. Trazodone should be taken with a light snack or shortly after a meal around the same time every day. Likely, your doctor will prescribe trazodone to be taken before bed if you are using it for sleep. Tablets should be swallowed whole or broken in half on the score mark. When starting trazodone, your doctor will start you on a low dose and gradually increase your dose.

What Happens If I Miss a Dose of Trazodone?

If you miss a dose of trazodone, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, you should skip the missed dose and continue your regular dosing schedule. You should not double up on your medication to make up for a missed dose. Do not stop taking the medication abruptly as well as it can result in trazodone withdrawal symptoms.

What Is the Best Time to Take Trazodone?

The best time to take trazodone would be before bed. The time it takes for you to fall asleep can range from 30 minutes to 2 hours which can influence when you take your medication. More importantly, you should follow the instructions your doctor gives on how to take trazodone for sleep.

What Should I Do if I Take Too Much Trazodone?

If you take too much trazodone, contact your doctor or the poison control helpline – available 24/7 online or at 1-800-222-1222). If you are showing symptoms of an overdose (ie vomiting, seizures, difficulty breathing, changes in heartbeat, drowsiness, and painful erection that will not go away), immediately call 911 and seek immediate medical care.⁸

Can I Stop Taking Trazodone on My Own?

It is important to not stop trazodone without talking to your doctor as this can lead to withdrawal side effects. This condition is called antidepressant discontinuation syndrome, with symptoms including dizziness, nausea, agitation, anxiety, confusion, burning or tingling in the hands or feet, sweating, pain, ringing in the ears, and difficulty falling asleep or staying asleep.⁸ If you wish to stop trazodone, consult your physician first.

What Does Trazodone Feel Like for Sleep?

Trazodone may make you feel relaxed after you take it. Due to its sedating effects, it can leave you feeling sleepy. Medications can affect people differently, and how a person feels on the medication can vary. When starting trazodone, keep note of how it affects you and report any concerns to your doctor.

How to Get a Prescription for Trazodone for Sleep

Trazodone is available only through a prescription written by a licensed physician. If you wish to take trazodone for insomnia, discuss your symptoms with your doctor. They will ask you questions about your sleep, overall health, and potential treatments or methods for managing your symptoms. If you are unable to meet with a doctor in person, online psychiatry services may be a helpful option.

How to Know if Trazodone for Sleep Is Working

When taken for sleep problems, trazodone may help you to fall asleep and increase the amount of time you are asleep. If you are not falling asleep within a reasonable amount of time or you cannot stay asleep, contact your doctor. You should also contact your doctor if drowsiness affects you after you wake.

Alternative Treatments for Sleep Problems

Insomnia is a very common sleep problem that trazodone may be able to improve. Although, it is not the only solution available. Other medications can be used for insomnia as well as non-medication options such as behavioral therapy that may target underlying issues that could be preventing you from obtaining quality sleep.

Alternative treatments for sleep issues include:⁹

• Benzodiazepines: Benzodiazepines are a type of anxiety medication known to produce sedative effects. It may be prescribed for insomnia if other treatments have not worked.
• Non-benzodiazepine hypnotics: These include Lunesta (eszopiclone), Sonata (zaleplon), and Ambien (zolpidem), and they are used short-term to treat insomnia.
• Cognitive behavioral therapy: CBT for insomnia helps patients restructure their beliefs, attitudes, and expectations about sleep through education and behavioral changes. It is a 6- to 8-week program that consists of relaxation therapy, sleep education, sleep restriction therapy, and stimulus control therapy.
• Hypnosis for sleep: Hypnosis for sleep promotes physical and mental relaxation. It is meant to help with changing negative thoughts or habits related to one’s sleep in order to achieve better sleep once hypnotherapy is done.
• Light therapy: Light therapy involves sitting in front of a light box that produces light similar to sunlight. Light therapy may help adjust the amount of melatonin, a hormone that controls your sleep-wake cycle, in your body to help reset your circadian rhythm.
• Stress inoculation training (SIT): If your sleep issues are due to anxiety or stress, SIT may be helpful. SIT is a type of psychotherapy, also known as talk therapy, that teaches you coping skills to help you manage anxiety symptoms and stress from life events.
• Melatonin: Melatonin, a naturally-produced substance in the body, may be used in supplement form to help regulate your sleep-wake cycle.

Questions to Ask Your Healthcare Provider About Trazodone for Sleep

When considering trazodone for treating insomnia, you may have questions about the risks, potential benefits, and how it may affect you. Always inform your physician or psychiatrist and your therapist if you start a new medication.

Questions to ask your care team when considering using trazodone for sleep issues may include:

• Can I use trazodone along with therapy for sleep problems?
• How long will it take for me to adjust to taking trazodone?
• Am I at risk for more severe symptoms if I am already taking other medications, such as another antidepressant?
• What is the best dosage to ensure fewer side effects?
• Are there drugs I am taking that could have negative interactions?
• When should I reach out to you if I am experiencing side effects?
• Is there anything I should tell my therapist about this new medication?
• Are there non-medication methods to help my sleep?
• How do other medications compare as treatments for insomnia, such as Ambien vs. Belsomra?
• How does trazodone compare to over-the-counter sleep aids as an effective treatment for insomnia?