From the Guidelines
Lunesta (eszopiclone) is recommended over trazodone for treating insomnia due to its more reliable efficacy for sleep initiation and maintenance, despite a higher risk of dependence and potential for complex sleep behaviors, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1. When considering the treatment of insomnia, it's essential to weigh the benefits and risks of each medication. Trazodone, primarily an antidepressant, is often prescribed off-label for sleep, while Lunesta is a dedicated sleep medication.
- Trazodone may be preferable for patients with concurrent depression or anxiety, as it tends to be less habit-forming and is generally less expensive as a generic medication.
- However, the 2017 American Academy of Sleep Medicine clinical practice guideline suggests that clinicians should not use trazodone as a treatment for sleep onset or sleep maintenance insomnia in adults, based on trials of 50 mg doses of trazodone 1.
- In contrast, eszopiclone is suggested as a treatment for sleep onset and sleep maintenance insomnia in adults, based on trials of 2 mg and 3 mg doses 1.
- A more recent guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense also advises against the use of trazodone for chronic insomnia disorder, citing its adverse effect profile and limited efficacy 1.
- The American College of Physicians recommends cognitive behavioral therapy for insomnia as the first-line treatment, with pharmacological therapy considered only when CBT-I is unsuccessful, and eszopiclone is mentioned as one of the medications that may be used in this context 1.
- Ultimately, the choice between trazodone and Lunesta should consider the patient's specific sleep complaint, other medical conditions, medication interactions, and cost considerations, with a focus on minimizing the risk of adverse events and dependence.
From the Research
Comparison of Trazodone and Lunesta for Sleep
- Trazodone and Lunesta (eszopiclone) are two commonly used medications for treating insomnia, but they have different mechanisms of action and effects on sleep architecture 2, 3.
- Trazodone is an antidepressant that is often used off-label to treat insomnia, particularly for patients with comorbid depression or anxiety disorders 2.
- Lunesta, on the other hand, is a non-benzodiazepine hypnotic that is specifically approved for the treatment of insomnia 3.
Efficacy of Trazodone for Insomnia
- Studies have shown that trazodone is effective in improving sleep quality and duration in patients with insomnia, particularly those with secondary insomnia due to depression, dementia, or other medical conditions 2, 4.
- Trazodone has been found to increase deep sleep and improve sleep maintenance, but it may not be as effective as hypnotics like Lunesta in reducing sleep onset latency 3.
Comparison of Trazodone and Cognitive Behavioral Therapy for Insomnia
- A study compared the effects of trazodone and cognitive behavioral therapy for insomnia (CBT-I) on sleep duration and quality, and found that trazodone was more effective in increasing total sleep time and reducing salivary cortisol levels 4.
- Another study found that trazodone decreased fast-frequency EEG activity during non-rapid eye movement sleep, which is associated with improved sleep quality, whereas CBT-I did not have a significant effect on EEG activity 5.
Safety and Side Effects of Trazodone
- Trazodone is generally considered safe and well-tolerated, with common side effects including drowsiness, headache, and dry mouth 2, 6.
- Trazodone has a low risk of weight gain and addiction, making it a suitable option for long-term use in patients with insomnia 3.