Should trazodone (an antidepressant medication) be held prior to a sleep study in an adult patient with a history of insomnia or sleep disorders?

Should Trazodone Be Held Prior to a Sleep Study?

Yes, trazodone should ideally be held prior to a sleep study to obtain accurate baseline sleep architecture and avoid confounding the diagnostic results, though the specific washout period depends on the study's clinical purpose.

Rationale for Holding Trazodone

Impact on Sleep Architecture

• Trazodone significantly alters polysomnographic findings that are critical for sleep study interpretation, including:
  • Reduces Stage 1 sleep duration 1, 2
  • Increases slow-wave sleep (stages 3+4) 2
  • Reduces REM sleep duration with rebound effects after withdrawal 2
  • Decreases number of nocturnal awakenings 1
  • Halves the frequency of arousals interrupting sleep 2

Duration of Effects

• Trazodone's effects persist beyond 24 hours after the last dose, with maximal rebound effects occurring on the second withdrawal night 2
• This prolonged duration means a single-night washout is insufficient for accurate baseline assessment 2

Recommended Washout Period

Standard Approach

• Hold trazodone for at least 3-5 days before the sleep study to allow:
  • Complete drug clearance (effects persist >24 hours) 2
  • Resolution of rebound insomnia (maximal on second withdrawal night) 2
  • Return to baseline sleep architecture 2

Clinical Considerations

• The American Academy of Sleep Medicine notes that trazodone produces only modest, clinically insignificant improvements in sleep parameters (10.2 min reduction in sleep latency, 21.8 min increase in total sleep time, 7.7 min reduction in wake after sleep onset) 3, 4
• Given these minimal therapeutic effects, the diagnostic benefit of obtaining unmedicated sleep data typically outweighs the temporary discomfort of medication discontinuation 3

Important Caveats and Safety Considerations

When Continuation May Be Necessary

• If the patient has comorbid depression requiring treatment, discuss with the ordering physician whether diagnostic accuracy or symptom management takes priority 5, 6
• For patients with severe insomnia, consider whether the sleep study can still yield useful information while on medication, or if the study should be postponed 5

Rebound Effects to Anticipate

• Warn patients about potential rebound insomnia, which peaks on the second night after discontinuation 2
• Increased REM sleep rebound may occur after trazodone withdrawal 2
• These rebound effects themselves can confound sleep study results if the washout period is too short 2

Cognitive and Motor Effects

• Trazodone causes daytime impairments including short-term memory deficits, verbal learning impairment, equilibrium problems, and muscle endurance reduction 1
• These effects are relevant if daytime testing (such as Multiple Sleep Latency Tests) is planned 1

Alternative Approach for Specific Clinical Scenarios

If Medication Cannot Be Held

• Document that the study was performed on trazodone 1
• Interpret results with awareness of medication effects on sleep architecture 1, 2
• Consider repeat study after medication discontinuation if initial results are inconclusive 2

Communication with Sleep Laboratory

• Inform the sleep laboratory about recent trazodone use (including last dose timing) to aid interpretation 1, 2
• Discuss whether the study aims to evaluate treatment efficacy versus establish baseline diagnosis 1