It’s been a stretch for me to accept that trazodone, a sedating antidepressant, is such a popular treatment for insomnia. Clinical trials have never shown it helps put people to sleep or keeps them sleeping longer. And even at low doses (50 mg.), the drug is known to produce cognitive and motor impairments the following day.* Trazodone has never been approved for the treatment of insomnia, yet it rose to the top of the bestseller charts as a medication for sleeplessness in the 1990s and enjoys great popularity still.

Trazodone

Confession: this is the sort of knotty paradox that keeps me awake at night.

Now, I have insomniac friends who swear by trazodone, and I know they’re not delusional. They use low-dose trazodone because it works for them, and they don’t need to understand why.

But I’m a stickler for evidence, and this gap between subjective experience and objective proof is a real sore point. So imagine my thrill at finding a paper that explains why it might be that trazodone works.

Trazodone and REM Sleep

The traditional view of insomnia holds that it’s basically a problem of non-REM (or quiet) sleep. Insomniacs may not be getting the same percent of deep sleep as good sleepers, or the problem may be in how deep sleep is discharged. Deep sleep is the restorative stuff, the kind that “knits up the raveled sleeve of care.” Alternatively, the quality of non-REM sleep may be compromised by lots of high-frequency brain activity that enables you to sense things even while you’re asleep.

But for insomniacs who struggle with frequent awakenings in the middle of the night, the problem may in fact be occurring during REM (or active) sleep, when you’re dreaming. A new analysis shows that percent-wise, people with sleep maintenance insomnia get less REM sleep and awaken more often during REM sleep than good sleepers. The hypothesis is that these insomniacs may be suffering from “REM sleep instability.”**

Despite its otherwise underwhelming characteristics as a sleep medication, trazodone does cut down on nighttime awakenings and make sleep feel easier. Unlike most other antidepressants, the drug does not suppress REM sleep. So as a sleeping pill, trazodone may have a claim to legitimacy after all.

Perhaps you’re one who knew it all along, but I was a skeptic, and this bit of news has done wonders for my sleep!

Effects of Trazodone

** REM Sleep Instability

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

13 Comments

  1. There are equal numbers of “experts” saying trazadone doesn’t affect rem sleep as those who say it does. How is one supposed to know? Is there really a definitive answer?

    Like

    Reply

  2. It is true that some studies have shown that trazodone alters the amount or percentage of REM sleep in human subjects. But the remarkable thing about trazodone to keep in mind is this: for as much as it’s been prescribed for people with insomnia (a lot!), very few investigators have studied its effects on insomniacs. (Most studies have assessed its effects on people with depression.) The studies that DO exist are small and short term.

    Is there a definitive answer to the question of how trazodone affects sleep staging in people with insomnia? No. In the study I cited above, it did not alter the amount or percentage of REM sleep. In a paper on the effects of psychiatric medications on sleep and sleep disorders (CNS & Neurological Disorders – Drug Targets, 2007), N. DeMartinis & A. Winokur state that “trazodone exerts minimal, if any, suppression of REM sleep.”

    But I wouldn’t stake my life on this. It may be, though, that trazodone has less of an effect on REM sleep than many other antidepressants.

    Like

    Reply

  3. The only real time I experience true deep, REM sleep is when I am camping in a wilderness. There is an old rhythm we have lost.

    Like

    Reply

  4. A lot of people experience camping in the same way. Enforced detachment from work, responsibilities, devices, and so forth. I’ll agree with you, we need more of that!

    Like

    Reply

  5. I’m intrigued by this line of research (or relative lack of it) on a link between trazodone and REM sleep. My psychiatrist prescribed low-dose trazodone for me as a sleep aid a few years ago, along with lamictal for my bipolar type 2. My wife recently revealed to me that I have been having spells of twitching in the night for a few years now. For example, last night I had a spell starting around an hour and a half after I went to bed, that lasted for 20 minutes. The whole-body jerks are strong enough to keep her awake, which is a net loss for the family, I think.

    My lightly informed guess is that the trazodone might be modifying my sleep in a way affects the usual body paralysis that accompanies REM phase.

    My doctor gave me latitude on dose: half or whole pill (25 or 50 mg), and “as needed”, so I’m going to start tracking what I take and whether have have my twitchy spells. If the trazodone doesn’t seem to be correlated, that leaves me with lamictal as a possible cause, and that’s something I’m not willing to mess with by myself, and it might not be worth it… maybe better to figure out different sleeping arrangements at that point.
    ——
    Also, re: camping and sleep. I’ve heard it argued that when we are in wilderness, we are also away from all the artificial lighting that messes with our circadian rhythms.

    Like

    Reply

    1. Hello Joseph,

      I’m sorry to hear about the twitchy spells at night. Looking at lists of adverse effects caused by trazodone, I don’t see this one listed (although numbness, burning, or tingling sensations are listed, and seizure is listed as a very rare adverse effect). But that doesn’t mean the twitchiness isn’t related to the trazodone. The way you’re going to investigate that sounds just right.

      Involuntary quivering is listed as a common side effect of Lamictal, however, on Web MD, as is chronic trouble sleeping. If after investigation you find the trazodone doesn’t seem to be related to the twitchiness, then it’s time for another consult with the psychiatrist, who will know more about side effects of Lamictal and be able to advise you on meds for the bipolar disorder.

      It’s not the worst thing to have to sleep in separate beds. My husband and I do, and here’s the post I wrote about it:

      https://thesavvyinsomniac.com/a-light-sleepers-take-on-snorin/

      Apparently artificial lighting can disrupt circadian rhythms. You may be interested in reading this post:

      https://thesavvyinsomniac.com/artificial-lighting-harmful-to-sleep-and-health/

      Good luck with figuring out the cause of the twitchiness at night. If you weren’t taking medication, I’d suggest that you be evaluated for restless legs syndrome. In your case, though, the meds are the first place I’d look for an explanation.

      Like

      Reply

  6. I was recently prescribed trazodone, and here is my experience.

    I tried many antidepressants of the SSRI variety with no success over the years. My insomnia started with zoloft. While giving Zoloft a try, I found myself unable to sleep for 2 weeks. Ambien helped me to sleep for exactly 3 hours per night at that time, and I eventually lost my wits and quit taking them. Since then, I have had chronic insomnia.

    Over the last 10 years I have also had some experience with benzodiazepines. There have been a few times where in depression I abused the benzos. I had no idea that addiction was a problem or that withdrawal was possible. So when my doctor recently started me on lexapro and alprazolam, I took them 3-4 x per week, just one pill each time. When I started the trazodone, I quit the alprazolam, and I believe I had withdrawal for about 2 weeks from the alprazolam. After the withdrawal wore off, the trazodone seemed to be absolutely shining.

    I was taking 10mg lexapro and 75mg of trazodone, and the obsessive thoughts and crazy anxiety that I have felt for my entire life felt like they belonged to someone else. After about one week, I had one nervous episode and took an aprazolam. Since then, about 5 days ago, I have felt that the trazodone isn’t working and I’m not having that good solid sleep that I have had so far on it. My sincerest hopes are that I am indeed suffering withdrawal from benzos (though I feel shame that I allowed it to happen) and that the trazodone will start working again once the benzo is out of my system.

    If it does begin working once again, I will be floating on air to know that I have my solution still. I’ll return to share once I know.

    Like

    Reply

    1. Thanks for sharing your experience here, Dawn. It may be that taking so many different drugs for insomnia has exacerbated rather than helped your sleep problem.

      I do hope that as you come off the benzodiazepines, the situation improves. You might also want to investigate cognitive behavioral therapy for insomnia (CBT-I). I’ve written many blog posts about it. To access them, go to Blog on the menu bar above and type “CBT” into the site search box. Best of luck.

      Like

      Reply

      1. Thanks for the advice, Lois. I am feeling much better today. I am once again feeling the positive affects of trazodone.

        No grogginess, no zombie feeling like many have. I feel just wonderful.

        Like

      2. I’m glad to hear your sleep is back on track!

        Like

    2. Hello Dawn, have yo tried taking your Zoloft in the morning and the Trazadone 1 hour before you want to go to sleep? It works for me.
      Best wishes

      Like

      Reply

  7. Trazadone has been real effective for me as a sleeping aid, 50 mg I’m prescribed nightly, one hour before I need to fall asleep. I also take 150 mg of Zoloft in the morning. I am able to fall asleep quickly and get sufficient deep sleep and less wake ups for the past year. I am now monitoring my sleep patterns with a vivofit band providing me sleep data to focus on getting the best quality sleep that I can. Does anyone know if Trazadone is effective over many years?
    Thank you and rest well everyone.

    Like

    Reply

    1. Hello,

      The problem with trazodone and most other antidepressants used as sleep aids is that nobody’s done long-term testing on them to discover whether people who take them for sleep develop tolerance to them or not.

      But antidepressants used to treat depression are not considered to be habit forming or associated with drug abuse. Doctors may prescribe them for several years.

      Like

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s