From the Guidelines
Trazodone is effective in improving subjective sleep quality, but its benefits are limited by its adverse effect profile and lack of differences in sleep onset latency, total sleep time, or wake after sleep onset compared to placebo 1. When considering the use of trazodone for sleep quality, it's essential to weigh its potential benefits against its risks. The most recent and highest quality study, published in 2020, found that trazodone was more effective at improving subjective sleep quality, but it did not differ from placebo in terms of sleep efficiency or rate of discontinuation due to adverse events 1. Key points to consider when prescribing trazodone for sleep quality include:
- Starting with a low dose, typically 25-50mg, to minimize side effects
- Taking the medication 30-60 minutes before bedtime to optimize its effects
- Regularly reassessing the need for continued use with a healthcare provider
- Combining trazodone with good sleep hygiene practices, such as maintaining a consistent sleep schedule and avoiding screens before bedtime It's also important to note that the evidence supporting the efficacy of trazodone is outweighed by its adverse effect profile, and other treatments, such as cognitive behavioral therapy for insomnia (CBT-I), may be more effective and safer in the long run 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Trazodone's Effect on Sleep Quality
- Trazodone has been shown to be effective in treating insomnia, with studies demonstrating its efficacy in improving sleep quality 2, 3.
- The medication has been found to be particularly effective in treating sleep-maintenance insomnia, especially in patients with comorbid mental disorders or those being treated with activating antidepressants 3.
- Trazodone's mechanism of action, which involves antagonizing 5-HT2 serotonin receptors, is associated with an increase in deep sleep duration, leading to better sleep quality as assessed by patients 3.
- However, some studies have raised concerns about the risk-benefit ratio of using trazodone for insomnia, citing potential side effects such as sedation, dizziness, and psychomotor impairment 4.
- A systematic review and meta-analysis found that trazodone improved sleep quality, reduced nocturnal awakenings, and increased sleep efficiency, but was associated with a higher risk of adverse effects, including sleep-related adverse effects 5.
Comparison to Hypnotics
- Trazodone has been compared to hypnotics in terms of its effect on sleep, with studies suggesting that it is less effective than hypnotics in treating sleep onset insomnia, but more effective in treating sleep-maintenance insomnia 3.
- Unlike hypnotics, which decrease slow-wave activity in sleep EEG, trazodone increases deep sleep duration, which is associated with better sleep quality 3.
Dosage and Administration
- The dosage and administration of trazodone can impact its effectiveness in treating insomnia, with earlier administration (at least 1 hour before bedtime) and lower doses often recommended 3.
- High doses of trazodone (≥100mg/d) have been used in the past to treat insomnia, but lower doses are now more commonly recommended, especially for non-depressed patients with insomnia 2, 4.