Trazodone for Sleep: What Sleep Guidelines and the Label Say

If you’ve asked for help sleeping, there’s a good chance you’ve been offered trazodone. It’s widely prescribed at low doses for insomnia. Here is what a major sleep guideline and the drug’s label say.

Approved for depression, used for sleep

Trazodone’s FDA approval is for major depression in adults.¹ Using it for sleep is off-label. The American Academy of Sleep Medicine (AASM) reviewed individual medicines for chronic insomnia, including some commonly used without an FDA approval for sleep.²

What the sleep guideline suggests

The AASM suggests clinicians not use trazodone for trouble falling asleep or staying asleep.² The recommendation is weak, based on limited evidence, meaning it may not fit every person.² The same guideline also suggests against diphenhydramine, melatonin and valerian for chronic insomnia, and gives weak support to several approved sleep medicines, including low-dose doxepin.²

The guideline is meant to be used alongside other AASM guidance on insomnia, which emphasizes behavioral treatment.² Our guides to CBT for insomnia and online CBT-I programs cover that first-line approach.

Label warnings that matter after 50

The trazodone label warns about:¹

• Dizziness or fainting when standing up (low blood pressure)
• Heart rhythm changes (QT prolongation), especially with other medicines that affect it
• Low sodium, with symptoms such as confusion and unsteadiness that can lead to falls
• Slowed thinking and coordination
• Bleeding risk with aspirin, anti-inflammatory pain relievers or blood thinners
• Serotonin syndrome, especially with other serotonin-raising medicines
• Angle-closure glaucoma in people with narrow eye angles

Getting up at night to use the bathroom while drowsy and dizzy is a fall risk to discuss with your clinician.

Questions to ask

1. Why trazodone for me, instead of CBT-I or an approved sleep medicine?
2. Do any of my medicines raise my heart rhythm or bleeding risk?
3. How should I get up at night safely?
4. What’s the plan to stop if it isn’t helping?

Our articles on low-dose doxepin, Z-drugs and nighttime sleep aids after 50 compare other options.

Try: “I’ve been on trazodone for sleep for a year. Is it still the right choice for me, given my blood pressure and other medicines, or should we try CBT-I?”

Did I Do That in My Sleep? includes a 14-Night Lights-Out Record and a Visit Brief. Use them to track your sleep, nighttime bathroom trips and any dizziness. See the book.