Trazodone's Effect On Rem Sleep: What You Need To Know

Trazodone is a drug that has been prescribed to treat insomnia, and it has been found to have an impact on REM sleep. However, the effects of trazodone on REM sleep are not yet fully understood, and studies investigating its effects have produced mixed results.

Some studies have found that trazodone reduces REM sleep. For example, a 1992 study found that trazodone suppressed REM sleep, and a 2022 meta-analysis found that trazodone reduced REM sleep in patients with insomnia.

On the other hand, a 2022 study found that trazodone had no significant effect on REM sleep in patients with cerebral small vessel disease and insomnia. Additionally, a 2004 study found no effect of trazodone on sleep continuity or slow-wave sleep in patients with major depression.

Further research is needed to clarify the effects of trazodone on REM sleep and to determine whether these effects vary depending on the patient population or other factors.

Trazodone and REM sleep in patients with Alzheimer's disease

Trazodone is a widely used antidepressant that is also useful in the control of agitation and insomnia in Alzheimer's disease. Trazodone has been shown to be a good option for the treatment of the elderly with dementia and associated sleep disorders. It has been found to improve sleep quality and sleep parameters including sleep efficiency, N3 sleep ratio, and sleep continuity. Trazodone has also been found to improve concentration and recall abilities in patients with arteriosclerotic cerebral small vessel disease and insomnia.

Trazodone has a variety of effects on several monoaminergic mechanisms. It is a potent serotonin 5-HT2A and α1-adrenergic receptor antagonist, a weak serotonin reuptake inhibitor, and a weak antihistamine or histamine H1 receptor inverse agonist. Trazodone uniquely improves the deeper phases of slow-wave sleep (SWS) early in the sleep cycle and delays REM onset.

Trazodone has been found to have a dual effect on human cognition, with acute utilisation associated with impaired cognitive function and long-term use with preventing cognitive deterioration. There is no clinical evidence that trazodone could be used as a specific treatment for neurodegenerative diseases.

Trazodone and REM sleep in patients with insomnia

Trazodone is a widely prescribed medication for insomnia, a common sleep disorder characterised by difficulty falling or staying asleep. It is a second-generation triazolopyridine derivative and a serotonin antagonist and reuptake inhibitor (SARI) drug, typically used as an antidepressant. However, due to its sedative and hypnotic effects, trazodone is often used off-label as a sleep aid.

Trazodone has been shown to enhance sleep quality without increasing sleep duration. It reduces the time spent in REM sleep and increases slow-wave sleep. These effects on sleep architecture are particularly beneficial for patients with insomnia.

Several studies have demonstrated the efficacy and safety of trazodone for treating primary and secondary insomnia. A meta-analysis of 11 randomised controlled trials found that trazodone significantly increased total sleep time and slow-wave sleep while decreasing sleep latency, wake after sleep onset, and the number of awakenings. These findings suggest that trazodone improves sleep by changing sleep architecture in patients with insomnia.

Trazodone's effects on sleep may be due to its ability to block certain receptors, including 5-HT2 serotonin receptors, H1 histamine receptors, and alpha-1 adaptive receptors.

A retrospective study found that trazodone reduced waking time after sleep onset, prolonged non-rapid eye movement sleep, and shortened REM sleep. Another study showed that trazodone improved sleep quality and cognitive function in patients with arteriosclerotic cerebral small vessel disease and chronic insomnia.

However, it is important to note that trazodone may cause side effects such as daytime drowsiness and decreased appetite. Therefore, it should be used with caution, especially in combination with other therapies.

Further research is needed to fully understand the effects of trazodone on REM sleep and its potential benefits for patients with insomnia.

Trazodone and sleep quality in patients with cerebral small vessel disease

Trazodone is a second-generation triazolopyridine antidepressant, often used as a sedative for treating insomnia. It is approved for the treatment of depression and is effective in blocking histamine 1, 5 hydroxytryptamine 2A, and α1-adrenergic receptors.

A study published in Frontiers in Psychiatry assessed the effects of trazodone on sleep quality and cognitive function in patients with cerebral small vessel disease (CSVD) comorbid with chronic insomnia. The study was a randomized, double-blind, placebo-controlled pilot study, involving 40 patients suffering from arteriosclerotic CSVD and insomnia. The participants were randomly assigned to the trazodone group or the placebo group for 4 weeks. The primary outcome was the cognitive score on the Montreal Cognitive Assessment scale (MoCA).

The results showed that trazodone caused significantly better improvements in concentration and recall abilities, as well as in polysomnography (PSG) parameters such as sleep efficiency, N3 sleep ratio, and sleep continuity than the placebo, with no significant differences in the occurrence of side effects. The improvement of sleep quality was correlated with increased concentration and recall abilities.

The study concluded that a low dose of trazodone is acceptable and effective in reducing insomnia severity and improving concentration and recall abilities in patients with CSVD comorbid with chronic insomnia. The improvement of cognition could be achieved by alleviating insomnia severity. Considering the high incidence of insomnia in CSVD patients, the results support the use of low-dose trazodone to deal with insomnia and cognitive impairment in CSVD.

Trazodone and sleep in patients with major depression

Trazodone is a widely used drug for treating major depressive disorder. It is a triazolopyridine serotonin receptor antagonist and reuptake inhibitor (SARI) antidepressant. It is effective for a range of depression symptoms, including insomnia, which is one of the most common and bothersome symptoms of depression. Trazodone has a rapid onset of action and is generally well-tolerated by patients with major depressive disorder. It has a low risk of causing insomnia, anxiety, and sexual dysfunction, which are often associated with other antidepressants.

Trazodone has a dose-dependent mechanism of action. At low doses (25-150 mg), it acts as a hypnotic agent by blocking 5-HT2A, H1, and α1-adrenergic receptors. At higher doses (150-600 mg), it acts as an antidepressant by inhibiting serotonin transporters and antagonizing 5-HT2A and 5-HT2C receptors. This multifunctional action of trazodone makes it effective in treating insomnia and other symptoms of depression.

The immediate-release formulation of trazodone is typically administered in divided doses throughout the day, with a total daily dose of 150-300 mg. The once-daily extended-release formulation provides controlled release of trazodone over 24 hours, maintaining effective blood levels while avoiding concentration peaks associated with side effects. This improves tolerability and increases treatment adherence.

Trazodone is generally well-tolerated, and the most common adverse effects include somnolence, headache, dizziness, and xerostomia. It has a low risk of anticholinergic side effects and sexual dysfunction. However, it may be associated with orthostatic hypotension, especially in patients with cardiovascular disease or older adults. Rare cases of priapism have also been reported.

Trazodone is effective in treating residual insomnia in patients with major depressive disorder. It improves sleep quality and reduces sleep disturbances. It is often used off-label for this indication due to its hypnotic effects at lower doses.

Trazodone can be used as monotherapy or in combination with other antidepressants. It is particularly useful for patients with accompanying symptoms such as insomnia, anxiety, irritability, or psychomotor agitation. It has a rapid onset of action and improves symptoms such as insomnia, anxiety, and psychomotor agitation, making it a valuable option for treating major depressive disorder.

Trazodone and sleep in mice with tauopathy

Trazodone is a licensed antidepressant with hypnotic efficacy in dementia. It has been found to improve sleep in male rTg4510 mice with a tauopathy-like phenotype. Trazodone decreased microglial NLRP3 inflammasome expression and phosphorylated p38 mitogen-activated protein kinase levels, which correlated with the NLRP3 inflammasome, the UPR effector ATF4, and total tau levels. Trazodone reduced theta oscillations during rapid eye movement (REM) sleep and enhanced REM sleep duration. Olfactory memory transiently improved, and memory performance correlated with REM sleep duration and theta oscillations.

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