Is Trazodone a Good Medication for Sleep?

Trazodone is an antidepressant that causes drowsiness, and it is sometimes prescribed for insomnia, but it is not FDA-approved for sleep. Its label lists one use: the treatment of major depressive disorder in adults. MedlinePlus, from the National Library of Medicine, notes that trazodone "is also sometimes used to treat insomnia," which makes sleep an off-label use.

Sleep specialists have looked at it and come down on the cautious side. The American Academy of Sleep Medicine's clinical practice guideline on insomnia medication states: "We suggest that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia" in adults. The academy graded that as a weak recommendation, which it says reflects lower certainty and "should not be construed as an indication of ineffectiveness." This post covers what trazodone is, what the guidelines say, the side effects, and what has stronger support for chronic insomnia.

This article is for general education and is not medical advice. Talk with your prescriber before starting, stopping or changing any medication.

What Is Trazodone?

Trazodone is a prescription antidepressant. MedlinePlus describes it as a serotonin modulator used to treat depression.

Sleepiness is one of its known effects. The FDA label warns that trazodone "may cause somnolence or sedation" and may impair the mental or physical ability needed for tasks such as driving. That effect is why it is used at bedtime.

It is not a sleeping pill in the regulatory sense. No sleep indication appears on the label.

Is Trazodone FDA Approved for Insomnia?

No. The label states that trazodone tablets "are indicated for the treatment of major depressive disorder (MDD) in adults." Insomnia is not listed.

Off-label prescribing means using an approved medication for a purpose the FDA has not reviewed. For trazodone and sleep, that means the FDA has not approved it for that purpose.

If trazodone is suggested for your sleep, it is reasonable to ask why it was chosen over a medication that does have an insomnia indication, and how long you are expected to take it.

What Do Sleep Medicine Guidelines Say About Trazodone?

A key U.S. guideline on insomnia medication comes from the American Academy of Sleep Medicine and was published in the Journal of Clinical Sleep Medicine in 2017. A task force of four sleep medicine experts reviewed randomized trials for each drug commonly used for insomnia, including several that are used without an FDA indication.

Trazodone landed on the "suggest not using" side, for both trouble falling asleep and trouble staying asleep. It shares that position with the antihistamine diphenhydramine and with melatonin, valerian and tryptophan.

On the other side, the guideline suggests that clinicians may use several medications for insomnia, among them zolpidem, eszopiclone, zaleplon, temazepam, ramelteon, suvorexant and doxepin. Each of those suggestions was also graded weak.

The grading matters. The academy explains that weak recommendations reflect a lower degree of certainty and that the final judgment belongs to the clinician, based on the individual patient. So the guideline does not say trazodone never helps anyone sleep. It says the evidence was not strong enough to recommend it for insomnia.

Why Might a Prescriber Still Choose Trazodone?

Guidelines describe the average patient, and prescribers treat individuals. One situation where trazodone can make sense is when depression and insomnia occur together, since depression is what the drug is approved to treat. Poor sleep is a common part of depression, as covered in the post on how sleep is connected to mental health and mood.

A prescriber may also weigh your other health conditions, other medications and past responses to sleep medicines. The post on how a prescriber chooses the right medication describes that process.

What should not happen is trazodone becoming a permanent nightly habit that nobody reviews. If you have taken it for sleep for a long time, ask at your next visit whether it is still the best plan.

What Are the Side Effects and Risks of Trazodone?

Trazodone carries the same boxed warning as other antidepressants. The label states that antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies, and it calls for close monitoring of all patients for clinical worsening.

The label lists other warnings as well:

• Drowsiness and impaired thinking or coordination. Be careful with driving until you know how it affects you.

• Orthostatic hypotension and fainting, which means a drop in blood pressure when you stand up.

• Heart rhythm changes. Trazodone increases the QT interval, and the label says to avoid it with other drugs that do the same.

• Increased risk of bleeding when combined with aspirin, NSAIDs or blood thinners.

• Priapism, a painful and prolonged erection. The label says to seek immediate medical attention. MedlinePlus puts it plainly: get care for an erection lasting more than 6 hours.

• Activation of mania or hypomania in people with bipolar disorder.

The label also recommends a gradual reduction in dose instead of stopping abruptly whenever possible. Do not stop trazodone on your own. A broader overview is in the post on side effects of common mental health medications.

What Works Better for Chronic Insomnia?

The first-line treatment for chronic insomnia is not a pill. The American College of Physicians recommends that all adults with chronic insomnia disorder receive cognitive behavioral therapy for insomnia, known as CBT-I, as the initial treatment. It is graded as a strong recommendation.

CBT-I is a structured therapy focused on sleep habits and the thoughts around sleep. The VA's National Center for PTSD reports that CBT-I improves sleep in 7 out of 10 people who complete it.

Medication comes second. The American College of Physicians recommends a shared decision between patient and clinician about adding a medication for short-term use when CBT-I alone has not worked.

Chronic insomnia has a definition. The National Heart, Lung, and Blood Institute describes it as trouble sleeping 3 or more nights a week for more than 3 months that cannot be fully explained by another health problem. If that describes you, the post on recognizing and treating insomnia is a useful next read.

What Should You Ask Your Prescriber About Trazodone for Sleep?

A few direct questions can make the visit more useful:

• What is causing my insomnia, and have depression, anxiety, sleep apnea and my other medications been considered?

• Why trazodone instead of CBT-I or a medication with an insomnia indication?

• How long should I take it, and when will the plan be reviewed?

• What side effects should make me call you?

• Does it interact with anything else I take, including over-the-counter products?

Sleep problems and mental health conditions can occur together, which is the subject of the post on how sleep disorders and mental health are connected.

FAQ

Is trazodone a sleeping pill?

No. It is an antidepressant that causes drowsiness. The FDA has approved it only for major depressive disorder in adults.

Do sleep experts recommend trazodone for insomnia?

The American Academy of Sleep Medicine suggests that clinicians not use trazodone for insomnia in adults. It graded the recommendation as weak, meaning the evidence was limited.

Can trazodone be stopped suddenly?

The label recommends a gradual reduction in dose instead of abrupt cessation whenever possible. Talk with your prescriber before stopping.

Can I take trazodone every night?

That is a decision for your prescriber. Because sleep is an off-label use, ask how long the plan is meant to last and when it will be reviewed.

What is the most serious side effect of trazodone?

The label highlights several serious risks, including suicidal thoughts in young people, heart rhythm changes, fainting from low blood pressure and priapism. Call 911 for chest pain or fainting, and seek immediate care for a prolonged erection.

What is the best treatment for chronic insomnia?

The American College of Physicians recommends cognitive behavioral therapy for insomnia as the initial treatment for all adults with chronic insomnia disorder.

Insomnia Care in Greensburg, PA

T and C Psychiatric Services LLC in Greensburg, PA offers evaluations and assessments, medication management and ongoing monitoring for insomnia. Its board-certified nurse practitioners can also connect you with trusted local therapists. Visits are available in person and through online and remote services.

If you or someone you know is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, text HOME to 741741 to reach the Crisis Text Line, or call 911 for an immediate emergency.

Visit T and C Psychiatric Services or call 724-951-2413 today. Contact us for more information.