Does trazodone (an antidepressant medication) improve sleep quality?

From the Guidelines

Trazodone should not be used as a first-line treatment for chronic insomnia disorder due to its adverse effect profile and limited efficacy. The 2020 clinical practice guidelines from the U.S. Department of Veterans Affairs and U.S. Department of Defense, published in the Annals of Internal Medicine 1, advise against the use of trazodone for treatment of chronic insomnia disorder. Although trazodone may improve subjective sleep quality, the evidence supporting its efficacy is low-quality and outweighed by its adverse effect profile. Some key points to consider when evaluating trazodone for sleep quality include:

• The systematic review cited in the guidelines found no differences in sleep efficiency or rate of discontinuation due to adverse events between trazodone and placebo in patients diagnosed with chronic insomnia 1.
• Trazodone was more effective at improving subjective sleep quality, but there were no differences in sleep onset latency, total sleep time, or wake after sleep onset 1.
• The review had several limitations, including studies of very short durations of therapy and follow-up of only 1 to 4 weeks 1.
• The work group advised against use of benzodiazepines or trazodone for treatment of chronic insomnia disorder due to the widely known harms and adverse effects of these medications, including risk for dependency and diversion, falls and cognitive impairment in older patients, hypoventilation in patients with respiratory conditions, and neuromuscular diseases 1.

From the Research

Effects of Trazodone on Sleep Quality

• Trazodone has been shown to improve sleep quality in patients with insomnia, as demonstrated by a systematic review and meta-analysis 2.
• The study found that trazodone improved sleep quality (SQ) with a standardized mean difference (SMD) of -0.58,95% confidence interval (CI) -0.87; -0.28, p < 0.01 2.
• Another study found that trazodone significantly increased total sleep time (TST) and non-rapid eye movement stage 3 (N3) sleep, while decreasing latency to onset of persistent sleep (LPS) and the number of awakenings (NAs) 3.
• Trazodone has also been shown to be effective in improving sleep quality in patients with depression and insomnia, with one study finding that it improved sleep and depression symptoms in patients with major depressive disorder and insomnia 4.

Mechanisms of Trazodone's Effects on Sleep

• Trazodone's effects on sleep are thought to be related to its ability to increase slow wave sleep duration, as demonstrated by a study that found that the combined approach of cognitive behavioral therapy (CBT) and trazodone resulted in a significant increase in slow wave sleep duration compared to treatment with CBT only 5.
• Trazodone has also been shown to decrease the number of nocturnal awakenings and improve sleep efficiency, with one study finding that it decreased the number of awakenings and improved sleep efficiency in patients with insomnia 2.

Safety and Efficacy of Trazodone for Sleep

• Trazodone has been shown to be generally safe and effective for the treatment of insomnia, with one systematic review finding that it was associated with a low risk of adverse effects 6.
• However, another study found that trazodone was associated with a higher risk of daytime drowsiness and decreased appetite, highlighting the need for careful consideration of the potential risks and benefits of trazodone treatment for sleep disorders 3.
• The efficacy and safety of trazodone for sleep disorders have been demonstrated in several studies, including a systematic review and meta-analysis that found that it improved sleep quality and reduced symptoms of insomnia 2.