Trazodone for Insomnia: How It Works & Side Effects

Dr. Colleen Ehrnstrom's profile picture
Dr. Colleen Ehrnstrom, PhD
Jun 2, 20225 min read
A hand holding a pill

Many people who suffer from insomnia are interested in trying medications to help them sleep better. Although antidepressants aren’t officially approved as a sleep aid, they are often prescribed for this purpose. Trazodone is the most common antidepressant taken by people with sleep problems.1

Trazodone, also available under the brand names Desyrel, Desyrel Dividose, Oleptro, and Trittico, is approved by the Food and Drug Administration (FDA) to treat major depressive disorder. Doctors sometimes also recommend this drug as a treatment for other conditions such as anxiety, substance abuse, schizophrenia, or fibromyalgia.2 4 Because tiredness/sedation is a side effect of trazodone, it is also used as an insomnia treatment.

Why Is Trazodone Prescribed as a Sleep Medication?

Trazodone is a popular sleep aid because it may work better and be less addictive compared to other sleep-inducing drugs.

Benzodiazepines have been used since the 1960s to help treat insomnia. However, these medications may not be a good long-term choice because they can cause dependence and tolerance. Tolerance occurs when a drug doesn’t work as well over time, requiring you to take more for the same effect. Dependence occurs when you feel like they have to keep taking the drugs to feel “normal”  and may experience withdrawal symptoms if you try to stop using them.5

After some of the negative effects of benzodiazepines started to become clear, doctors began looking to other drugs to help treat insomnia. Between 1987 and 1996, doctors prescribed 50% fewer benzodiazepine medications and nearly 150% more trazodone.5

Trazodone is not classified by the FDA as a controlled substance — it’s not very likely to lead to abuse or dependence, unlike some other types of sleep medications.6 7 However, there is a chance that it may cause mild withdrawal symptoms when you stop taking it, including dizziness, nausea, headaches, and sleeping problems.4

Can Trazodone Help With Insomnia?

Despite its increased use, trazodone typically has limited benefits. Research shows that trazodone may slightly increase how much time you spend asleep; however, its effects are small. For example, the original clinical trial studying the effects of trazodone on sleep found that:5

  • The drug helped people fall asleep 10 minutes more quickly at the beginning of the night.
  • People who took trazodone slept for only 22 minutes longer per night, on average.
  • Those who took trazodone did not rate their sleep quality as being any better.

These effects are small enough that experts don’t expect trazodone to make much of a difference for people who struggle to get enough rest. For this reason, the American Academy of Sleep Medicine doesn’t recommend trazodone as an insomnia treatment.5

Trazodone has also not been approved by the FDA as a sleep aid.3 However, doctors may still prescribe this medication for people with insomnia if they believe that it may help.

Trazodone Recommended Dosage

Trazodone tablets come in a few different dosages: 50 mg, 100 mg, 150 mg, or 300 mg. For people with depression, doctors usually recommend taking between 75 mg and 150 mg, and gradually increasing the dose over time if needed. Older adults typically use a lower dosage of trazodone.3

People with insomnia usually also take a lower trazodone dose — often between 50 mg and 100 mg.3 If you are taking trazodone, make sure to follow the directions that your doctor gives you. Don’t increase your dose or stop taking trazodone without first talking to your healthcare provider.

Can You Drink While Taking Trazodone?

It is a good idea to avoid drinking alcohol while you are taking trazodone. If you plan to continue drinking while taking trazodone, talk to your doctor first.

It is important to know that if you take trazodone and alcohol together, an overdose can be fatal.8 Additionally, trazodone can boost the effects of alcohol — you may feel more drunk than usual, or experience higher levels of dizziness, confusion, or impaired judgment.6

Alcohol also worsens some of the conditions that trazodone is meant to treat. Alcohol use can cause depression and anxiety or make existing mental health problems worse.9 10 In addition, alcohol can lead to worse quality sleep, especially in the second half of the night.11

Trazodone Side Effects

Like other antidepressants, trazodone may cause side effects. While taking this drug, you may notice:3 4

  • Tiredness
  • Feelings of weakness or dizziness
  • Headaches
  • Nausea or vomiting
  • Diarrhea
  • Constipation
  • Dry mouth
  • Unexpected weight changes
  • Anxiety or nervousness
  • Muscle aches and pains
  • Low sex drive or decreases in sexual function

Some trazodone side effects may be more serious. Tell your doctor right away if you notice chest pain, irregular heartbeats, fever, breathing problems, fainting, or seizures.3

Trazodone may not be a good choice for people with liver or kidney problems. It also shouldn’t be mixed with certain medications, including other antidepressants like monoamine oxidase (MAO) inhibitors or tricyclic antidepressants.3

Alternatives to Trazodone for Insomnia

The American Academy of Sleep Medicine (AASM) recommends that all people with insomnia be treated with cognitive behavioral therapy for insomnia (CBT-I) as an initial treatment.12 In their guidelines, AASM says that CBT-I has a better balance of potential benefits and risks compared to sleep medications. This treatment is also proven to be more effective than other common sleep treatments such as melatonin.5

CBT-I helps you reframe your thinking and behaviors surrounding sleep. While undergoing CBT-I treatment, you may learn more about sleep and your brain, lessen feelings of worry or frustration surrounding sleep and get support in changing your sleep habits.12

Dawn Health provides a comprehensive CBT-I program that can be accessed through an easy-to-use smartphone app. To discover whether CBT-I may be a good fit for you, fill out our online questionnaire.

References

  1. Everitt, H., Baldwin, D. S., Stuart, B., Lipinska, G., Mayers, A., Malizia, A. L., Manson, C. C., & Wilson, S. (2018). Antidepressants for insomnia in adults. The Cochrane database of systematic reviews, 5(5), CD010753. https://doi.org/10.1002/14651858.CD010753.pub2

  2. Drugs.com. (2022). Trazodone. https://www.drugs.com/international/trazodone.html

  3. Shin, J.J., Saadabadi, A. (2022, May 2). Trazodone. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470560/
    MedlinePlus. (2022, January 15). Trazodone.

  4. MedlinePlus. (2022, January 15). Trazodone. https://medlineplus.gov/druginfo/meds/a681038.html

  5. Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine, 13(2), 307–349. https://doi.org/10.5664/jcsm.6470

  6. U.S. Food and Drug Administration. (2010, January 20). Oleptro: Highlights of Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022411lbl.pdf

  7. Rush, C. R., Baker, R. W., & Wright, K. (1999). Acute behavioral effects and abuse potential of trazodone, zolpidem and triazolam in humans. Psychopharmacology, 144(3), 220–233. https://doi.org/10.1007/s002130050997

  8. University of Michigan Health. (2020, April 22). Trazodone. https://www.uofmhealth.org/health-library/d00395a1

  9. Boden, J. M., & Fergusson, D. M. (2011). Alcohol and depression. Addiction (Abingdon, England), 106(5), 906–914. https://doi.org/10.1111/j.1360-0443.2010.03351.x

  10. Anker, J. J., & Kushner, M. G. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol research : current reviews, 40(1), arcr.v40.1.03. https://doi.org/10.35946/arcr.v40.1.03

  11. Roehrs, T., & Roth, T. Sleep, Sleepiness, and Alcohol Use. National Institute on Alcohol Abuse and Alcoholism. https://pubs.niaaa.nih.gov/publications/arh25-2/101-109.htm

  12. Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of clinical sleep medicine, 17(2), 255–262. https://doi.org/10.5664/jcsm.8986


Dr. Colleen Ehrnstrom's profile picture
Dr. Colleen Ehrnstrom, PhD

Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.

It’s time to stop blaming the night monsters.

Let’s work together to transform your sleep for the better.