Of course, medication is sometimes needed for persistent insomnia—when nondrug treatment is refused, unavailable, or ineffective, or when the sleep disturbance is affecting your ability to carry out your daily activities. Here are the main considerations for using drug trazodone to treat insomnia:
- Insomnia without depression. Because there's so little supporting evidence, sleep experts generally recommend trazodone for insomnia only after the newer sleep drugs have failed. Trazodone may improve sleep initially, as found in one small study, but that effect could fade after several weeks. Researchers theorize that this could be due to residual sleepiness in the daytime, so a person is less physically active , which may contribute to the ability to sleep well at night.
- Insomnia with depression. Some conditions, such as depression, have a complex and intertwined relationship with insomnia, and the best treatment for these two issues together has not been determined. If you have both, discuss the options with your doctor, based on the severity of the depression, the nature of your sleep problem, your medical history and susceptibility to side effects, any possible drug interactions, and, of course, your personal preferences.
Usually, the most important consideration is managing the depression, which should be treated separately with a more effective antidepressant medication, counseling, or both. A separate drug can then be prescribed for the insomnia—either a newer sleep medication or low-dose trazodone. Studies have suggested that trazodone plus another antidepressant can improve sleep in these cases. Alternatively, trazodone might be taken alone, at a higher, antidepressant dose, to treat both problems.
Although trazodone may improve sleep at first, the effect may not continue past several weeks. Taking trazodone may also worsen sleepiness during the daytime, and morning grogginess. Plus, the side effect of sedation may not actually improve depression or insomnia.