From the Guidelines
If trazodone isn't working for your insomnia, the most effective alternative treatment is cognitive behavioral therapy for insomnia (CBT-I), which should be considered as the first-line treatment. For medications, you might try other sedating antidepressants like doxepin (3-6mg) 1. Benzodiazepines such as temazepam (15 mg) or non-benzodiazepine "Z-drugs" like zolpidem (10 mg), eszopiclone (2-3 mg), or zaleplon (10 mg) are effective but should be used short-term due to dependency risks 1.
Key Considerations
- CBT-I works by addressing thoughts and behaviors that interfere with sleep, and it has been shown to improve global outcomes and sleep outcomes in adults with chronic insomnia disorder 1.
- Medications like doxepin, temazepam, zolpidem, eszopiclone, and zaleplon can be effective for insomnia, but they should be used under the guidance of a healthcare provider and with caution due to potential side effects and dependency risks 1.
- Sleep hygiene improvements are essential alongside any treatment, including maintaining a consistent sleep schedule, creating a relaxing bedtime routine, limiting screen time before bed, avoiding caffeine and alcohol near bedtime, and ensuring the bedroom is dark, quiet, and comfortable.
Additional Options
- Other medications like suvorexant (10,15, or 20 mg) may also be considered for sleep maintenance insomnia 1.
- It's essential to consult a healthcare provider to identify underlying causes and tailor treatment to your specific needs, as insomnia can be a symptom of an underlying condition.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Alternative Treatments for Insomnia
If trazodone is ineffective for insomnia, several alternative treatments can be considered:
- Hypnotics, which have been proven effective in the treatment of sleep initiation and maintenance disorders 2
- Non-benzodiazepine hypnotics, such as eszopiclone, zolpidem, and zaleplon, which have a lower risk of tolerance, dependence, and abuse compared to benzodiazepines 3
- Melatonin receptor agonists, such as ramelteon, which is indicated for sleep-onset difficulties and is not scheduled 3
- Sedating antidepressants, such as mirtazapine, nefazodone, or tricyclic antidepressants, which are preferred for their sedative effects, although side effects may limit their usefulness 4
- Behavioral therapies, particularly cognitive behavioral therapy, and lifestyle changes, which show significant long-term efficacy as treatments for chronic insomnia 4
- Atypical antipsychotic agents, such as quetiapine or olanzapine, which may be used to lessen agitation that disrupts sleep onset or maintenance, although there is limited research on their use for insomnia 4
Considerations for Alternative Treatments
When considering alternative treatments for insomnia, it is essential to weigh the potential benefits and risks:
- Non-benzodiazepine hypnotics and melatonin receptor agonists are generally well-tolerated and have favorable safety profiles, but may be associated with some risk of dependence and abuse 3, 5
- Sedating antidepressants may have side effects that limit their usefulness, and their use should be carefully considered 4
- Behavioral therapies and lifestyle changes are generally safe and effective, but may require significant patient commitment and effort 4
- Atypical antipsychotic agents may have significant side effects and should be used with caution, particularly in patients with a history of substance abuse or psychiatric disorders 4
Efficacy and Safety of Trazodone
Trazodone has been shown to be effective for insomnia, particularly for sleep-maintenance insomnia, and has a relatively low risk of weight gain and other side effects 2, 6