Considerations Before Taking Trazodone for Insomnia

The pharmaceutical drug trazodone is a commonly prescribed antidepressant that is also used at times to help with insomnia. It has been used for decades as a sleep aid. Its use for insomnia is considered off-label, which means it hasn't been officially approved for that condition. But how does it work, and who should use it?

This article discusses how trazodone is used and how it works. It also covers side effects, precautions to take, who should avoid using it, and when to check with your doctor.

Uses

Trazodone is an older drug that has been used to treat depression and severe anxiety for many years. Since it has sedative or hypnotic effects, meaning that it causes drowsiness, it is also helpful for treating insomnia or acute insomnia.

Acute insomnia is short-term and may last for days or weeks. Insomnia is long-term, or chronic, occurring at least three nights a week and lasting three months or more.

Trazadone acts on neurotransmitters, which are chemical messengers within the brain. It allows a specific neurotransmitter called serotonin to build up in the spaces between nerve cells by blocking it from entering nearby cells. This increases serotonin in your brain, helping to improve your mood.

Trazodone also seems to act on histamines, another neurotransmitter. Histamines are released by your immune system to help your body fight foreign substances. In the brain, they also help keep you alert and awake.

Trazodone can make you sleepy by blocking these histamines. This is similar to the effects of another common antihistamine, Benadryl (diphenhydramine). In a research study, trazodone also seemed to improve slow-wave or deep sleep.

The American Academy of Sleep Medicine does not currently recommend the use of trazodone to treat insomnia. This suggests that the potential risks and harms outweigh the benefits.

Their stance is partly based on research suggesting it only takes about 10 minutes less time to fall asleep with trazodone. In addition, the amount of time spent awake at night is only reduced by eight minutes on average.

Precautions and Contraindications

There are certain instances where you may want to avoid using trazodone for insomnia.

Trazodone should not be used in people who are recovering from a heart attack. It should also not be used by people under 25 years old, and the elderly should use the drug with caution. Trazodone should be avoided if you are pregnant or breastfeeding.

Trazodone may also not be appropriate for people who have psychiatric illnesses, including bipolar disease and schizophrenia. It shouldn't be used by those at risk for suicide. Check with your doctor if you have heart disease, cerebrovascular disease (affecting blood flow in the brain), seizures, or kidney or liver problems.

Trazodone has the potential to interact with many other drugs. Your medications should be carefully reviewed by your healthcare provider before you start to take trazodone. No deaths or heart complications have been reported in people who are taking trazodone alone.

You shouldn't stop taking the medication abruptly. Instead, it may need to be slowly reduced under a healthcare provider's supervision.

Side Effects

You may experience side effects with trazodone. Some of them are common, and others are rare but can be severe.

These possible side effects include the following.

Common

You may or may not experience any side effects when taking trazodone. When reported, some of the most common side effects include:

• Dizziness
• Lightheadedness
• Dry mouth
• Headache
• Blurred vision
• Nausea or vomiting
• Nervousness
• Fatigue
• Constipation
• Palpitations
• Rapid heart rate
• Low blood pressure
• Skin reactions, such as a rash
• Confusion
• Muscle pain
• Weight changes
• Diarrhea
• Tremor (shakiness)
• Difficulties with walking or coordination

Severe

With the use of any drug, there are also risks of serious side effects. When using trazodone, these may include:

• Priapism (persistent painful erection)
• Orthostatic hypotension (low blood pressure when standing)
• Abnormal heart rhythms
• Hypertension (high blood pressure)
• Fainting
• Stroke
• Heart attack
• Extrapyramidal symptoms (movement and coordination problems)
• Tardive dyskinesia (uncontrollable facial movements)
• Hypomania (elevated mood and increased energy) or mania (elevated mood, intense energy, and possible delusions)
• Worsening psychosis (losing touch with reality, experiencing delusions and hallucinations)
• Worsening depression
• Suicidal thoughts
• Hallucinations
• Seizures
• Neutropenia (low white blood cell count)
• Anemia
• Hepatitis (liver inflammation)
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH, a condition where the body retains too much water)

Check With Your Doctor

As noted above, certain people should use the medication with caution or not at all. Your doctor will need to monitor you when starting the medication or making dose changes. In particular, you should watch for any symptoms of being suicidal or unusual behavior changes.

If you experience any difficulties, you should be in close contact with your primary health provider. If insomnia persists, consider treating it with cognitive behavioral therapy for insomnia (CBTI), which involves professional guidance on healthy sleep behaviors.

You can use our Healthcare Provider Discussion Guide below to start that conversation with your healthcare provider.

Insomnia Healthcare Provider Discussion Guide

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Summary

Trazodone is an antidepressant that also causes drowsiness. Because of its sedative effects, it's sometimes used off-label to treat insomnia, either short-term or long-term.

Trazodone may have sedative effects because it blocks histamines in the body. Histamines in the brain usually keep you alert.

Trazodone may not be safe for some people to use, especially those who have heart disease, psychiatric illnesses, or are pregnant or breastfeeding. It also shouldn't be used by people under 25 or the elderly.

Talk with your doctor about the possible side effects and whether it's safe for you to take trazodone.

A Word From Verywell

If you have insomnia and are considering a medication like trazodone, schedule an evaluation by a board-certified sleep specialist.

Sleep disorders, including sleep apnea, often contribute to difficulty sleeping through the night. Getting treatment for this condition may take care of your insomnia.

Moreover, conditions like sleep apnea may have long-term health consequences if left untreated or masked by drugs. Getting treated for the right condition can help with improving symptoms while avoiding unnecessary or potentially harmful medication.