6 Reasons Why Trazodone Isn’t Helping You Sleep

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Trazodone is an antidepressant that is used off-label for insomnia. It has not gained US Food and Drug Administration approval due to its lack of clinical data for treating insomnia and the risk of side effects versus other medications approved for insomnia.

1. Incorrect Dosage

If trazodone is not helping your insomnia, it may be because your dosage is too low. Starting doses for insomnia are 25 milligrams (mg) to 50 mg at bedtime. If needed, your provider can slowly increase your dosage if you tolerate the medicine. Usual doses for insomnia are from 50 mg to 100 mg. In those with both insomnia and depression, doses up to 300 mg can be used. Talk with your provider if your dose is insufficient. 

2. Underlying Medical Conditions

If you are still struggling to get proper rest while taking trazodone, a chronic condition may be to blame. The following conditions may contribute to insomnia:

• Acid reflux
• Asthma
• Chronic pain
• Menopause
• Restless leg syndrome
• Sleep apnea
• Stroke
• Thyroid disorder

3. When and How You Take It

Since trazodone can make you drowsy, it is best to take it before bed. You should take it about 30 to 60 minutes before you want to go to bed, as it takes this long to work. Trazodone can be taken with or without food. Taking trazodone on an empty stomach may make it work faster, as food delays how quickly it works, but it may cause side effects. If you cannot tolerate taking trazodone on an empty stomach, you can take it with a light meal or snack. If you take trazodone with food, it may take longer to work, but its effects may last longer. 

4. Stress or Anxiety 

Stress and anxiety can impact your sleep. In the United States, about 18% of people will have an anxiety disorder at any given year. Between 70% and 80% of people with anxiety report issues with sleeping.

Getting proper sleep helps to regulate emotions. Lack of sleep can lead to worsening mood and worsening symptoms of anxiety. If anxiety is preventing you from getting adequate sleep, it is essential to talk to your healthcare provider about other options. 

5. Drug Interactions 

Trazodone interacts with many other medications. Some medications may make trazodone less effective. Your healthcare provider may increase your dosage to make it more effective or change your medication. Medications that may decrease the effect of trazodone include:

• Carbamazepine
• Phenytoin
• Rifampin
• St John’s Wort

6. Side Effect of Other Medications

A side effect of some medications can be insomnia. The following medications and substances can contribute to insomnia:

• ADHD medications
• Alcohol
• Antidepressants
• Appetite suppressants
• Asthma medications, including albuterol and theophylline
• Beta-blockers
• Caffeine
• Corticosteroids
• Diuretics
• Nicotine
• Over-the-counter decongestants and cold medicine

How Trazodone Works for Insomnia

Trazodone is a serotonin antagonist and reuptake inhibitor. It helps with insomnia by acting on neurotransmitters in the brain, specifically the histamine, alpha-1 adrenergic, and serotonin receptors.

Histamine helps to regulate our sleep-wake cycle. Trazodone blocks the H1 histamine receptor and causes drowsiness. Cortisol levels are elevated when stressed, and can affect sleep. Trazodone reduces cortisol levels by blocking alpha-1 adrenergic receptors.

Trazodone also affects the levels of serotonin in the brain. Serotonin is a chemical that regulates sleep, mood, hunger, and body temperature. Serotonin is also necessary to make melatonin, which regulates the sleep-wake cycle.

How Long Does It Take for Trazodone to Work for Sleep?

Trazodone should help you sleep better soon after taking it. It should make you drowsy within 30 to 60 minutes. If you take trazodone on an empty stomach, it will work faster. Food will delay the time it takes to work.

What to Do If Trazodone Isn’t Working

Trazodone may not work well for everyone. Make sure you have a healthy bedtime routine and take trazodone as instructed. If you are still struggling to sleep despite taking trazodone, it’s important to talk to your provider. If you have been taking trazodone for 2 weeks or longer, speak with your provider before stopping this medication. It must be slowly tapered down to limit withdrawal symptoms.

Talking to Your Healthcare Provider

If you are still having trouble falling asleep, staying asleep, or feel tired throughout the day, it may be time to talk to your provider.

They may need to run additional tests to check for underlying health conditions, or they may need to change your dosage. Mention all medications you take, and be sure to mention any bothersome side effects you have. Common side effects include:

• Blurred vision
• Dizziness
• Drowsiness
• Dry mouth
• Fatigue
• Headache
• Nausea
• Nervousness
• Vomiting

Alternative Medications and Therapies

Research, although limited, has shown that supplements and relaxation therapies may help improve sleep and reduce insomnia. Be sure to choose a high-quality supplement, as they are regulated differently from prescription medications.

Talk with your healthcare provider before adding any supplements to your routine. Your provider will make sure it is safe and appropriate for you to take. Supplements and complementary therapies that may help you sleep better include:

• Acupuncture
• Chamomile
• Cognitive behavior therapy
• L-theanine
• L-tryptophan
• Magnesium
• Melatonin
• Tart cherry
• Tai Chi
• Valerian Root
• Yoga
• Zinc

Lifestyle Tips for Improving Sleep

Not getting enough sleep can not only leave you feeling tired, but it can also lead to chronic conditions. The following healthy habits can help ensure you get a better night’s sleep:

• Allow enough time to get proper sleep, ideally 7 to 8 hours
• Avoid alcohol before bed
• Avoid electronic devices an hour before bed
• Avoid large meals within a few hours before bed
• Avoid nicotine use in the evening
• Exercise daily for at least 20 minutes
• Get 30 minutes of sunlight exposure every day, preferably in the morning
• Invest in a supportive mattress and pillow
• Limit caffeine after 2 pm
• Limit naps to 20 minutes
• Minimize noise
• Reduce light by using blackout shades and eye masks
• Set the thermostat between 65 and 68 degrees Fahrenheit
• Wake up at the same time every day