Sleep Disorders Treatment Considerations Before Taking Trazodone for Insomnia By Brandon Peters, MD facebook twitter Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist. Learn about our editorial process Brandon Peters, MD Medically reviewed by Medically reviewed by Rochelle Collins, DO on May 08, 2020 linkedin Rochelle Collins, DO, is a board-certified family medicine doctor currently practicing in Bloomfield, Connecticut. Learn about our Medical Review Board Rochelle Collins, DO on May 08, 2020 Print Table of Contents View All Table of Contents Uses Contraindications Side Effects Warnings The pharmaceutical drug trazodone is a commonly prescribed antidepressant that is also used off-label as a hypnotic to initiate sleep. It has been used for decades as a sleep aid, but how does trazodone work? How well does it work on average to improve falling asleep or sleeping more at night? What are the common side effects? Tim Hall / Getty Images Learn whether trazodone is right for you and what alternatives may be helpful to consider, including the need for a sleep test if chronic insomnia persists. 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. It is not known precisely how trazodone works. What is known is that it 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 its uptake into the nearby cells. It also seems to interact with histamine (and antihistamines like diphenhydramine are well known as sleep aids). These effects seem to collectively enhance slow-wave (or N3) sleep. The American Academy of Sleep Medicine does not currently recommend the use of trazodone to treat insomnia, suggesting that the potential risks and harms outweigh the benefits. This is based on research that suggests the time it takes to fall asleep is only reduced by an average of 10 minutes with the use of trazodone compared to placebo. In addition, the amount of time spent awake at night is only reduced by eight minutes on average with trazodone. Precautions and Contraindications If you decide to use trazodone, there are certain people who should further reconsider its use. 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, as well as in those at risk for suicide. Use trazodone with caution if you have heart or cerebrovascular disease, seizures, or kidney or liver problems. Trazodone has the potential to interact with many other drugs, so your medications should be carefully reviewed by your health care provider before you start to take trazodone. No deaths or heart complications have been reported in people who are taking trazodone alone. Stopping the medication abruptly should be avoided; instead, it may need to be tapered under doctor's supervision. Side Effects There are many potential side effects of any drug. Common Although an individual would not be expected to experience most side effects (and may indeed not have any of them), some that may commonly occur with trazodone include: SleepinessDizzinessLightheadednessDry mouthHeadacheBlurred visionNausea or vomitingNervousnessFatigueConstipationPalpitationsRapid heart rateLow blood pressureSkin reactions, such as a rashConfusionMuscle painWeight changesDiarrheaTremor (shakiness)Difficulties with walking or coordination Severe With the use of any drug, there are also risks of serious side effects. These occur more rarely. When using trazodone, these may include: Priapism (persistent painful erection)Orthostatic hypotension (low blood pressure when standing)Abnormal heart rhythmsHypertension (high blood pressure)FaintingStrokeHeart attackExtrapyramidal symptomsTardive dyskinesiaHypomania/maniaPsychosis exacerbationWorsening depressionSuicidal thoughtsHallucinationsSeizuresNeutropenia (low white blood cell count)AnemiaHepatitis (liver inflammation)Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) Warnings As noted above, certain people should use the medication with caution or not at all. It is important that you are monitored by your doctor as the medication is started or changes in the dose are made. In particular, symptoms of suicidality or unusual behavior changes should be watched for. If you experience any difficulties, you should be in close contact with your primary health provider. If insomnia persists, consider treating it with the use of cognitive behavioral therapy for insomnia (CBTI). You can use our Doctor Discussion Guide below to start that conversation with your doctor. Insomnia Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. A Word From Verywell If you find that insomnia has taken hold, prompting the consideration of sleep aids including prescription medications like trazodone, consider the need for an evaluation by a board-certified sleep specialist. Sleep disorders, including sleep apnea, may commonly contribute to difficulty sleeping through the night. Treatment of this condition may allow insomnia to resolve. Moreover, conditions like sleep apnea may undermine the efficacy of medications and lead to long-term consequences if left untreated or masked by drugs. Fortunately, effective treatments may allow improvement while avoiding the ongoing need for potentially harmful medications. Was this page helpful? Thanks for your feedback! Tossing and turning night over night can have a big impact on your quality of life. Our free guide can help you get the rest you need. Sign up for our newsletter and get it free. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Jaffer KY, Chang T, Vanle B, et al. Trazodone for insomnia: A systematic review. Innov Clin Neurosci. 2017;14(7-8):24-34. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307-349. doi:10.5664/jcsm.6470 Nezafati MH, Vojdanparast M, Nezafati P. Antidepressants and cardiovascular adverse events: A narrative review. ARYA Atheroscler. 2015;11(5):295-304. El zahran T, Morgan BW, Hon S, Herrington L, Geller RJ. Unintentional trazodone overdoses in children ≤6 years of age: data from poison center over a period of 16 years. Clin Toxicol (Phila). 2019;57(1):56-59. doi:10.1080/15563650.2018.1485928 Ram D, Gandotra S. Antidepressants, anxiolytics, and hypnotics in pregnancy and lactation. Indian J Psychiatry. 2015;57(Suppl 2):S354-71. doi:10.4103/0019-5545.161504 Creado S, Plante DT. An update on the use of sedative-hypnotic medications in psychiatric disorders. Curr Psychiatry Rep. 2016;18(9):78. doi:10.1007/s11920-016-0717-y Shin JJ, Saadabadi A. Trazodone. StatPearls. Updated June 5, 2019. Additional Reading Cooper, DH et al. The Washington Manual of Medical Therapeutics. 32nd edition, 2007. 14. Lippencott, Williams & Wilklins. New York. Sateia MJ et al. 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. 2017;13(2):307-349. Trazodone. Epocrates Rx Pro. Version 16.4, 2016. Epocrates, Inc. San Mateo, California. Katzung, BG. Basic & Clinical Pharmacology. 9th edition, 2004. The McGraw-Hill Companies, Inc. New York.