American Academy of Sleep Medicine Recommendation Against Trazodone for Insomnia

Primary Recommendation

• The American Academy of Sleep Medicine (AASM) recommends against prescribing trazodone for either sleep‑onset or sleep‑maintenance insomnia in adults, based on clinical trials using 50 mg doses. [1][2]3

Evidence‑Based Alternative Pharmacologic Options

Sleep‑Onset Insomnia

• Zaleplon 10 mg is recommended as an alternative for initiating sleep. [1][2]
• Triazolam 0.25 mg is recommended as an alternative for initiating sleep. [1][2]
• Ramelteon 8 mg is recommended as an alternative for initiating sleep. [1][2]

Sleep‑Maintenance Insomnia

• Suvorexant 10–20 mg is recommended as an alternative for maintaining sleep. [1][2]
• Doxepin 3–6 mg is recommended as an alternative for maintaining sleep. [1][2]

Both Sleep‑Onset and Sleep‑Maintenance Insomnia

• Eszopiclone 2–3 mg is recommended for treating both sleep‑onset and sleep‑maintenance insomnia. [1][2]
• Zolpidem 10 mg is recommended for treating both sleep‑onset and sleep‑maintenance insomnia. [1][2]
• Temazepam 15 mg is recommended for treating both sleep‑onset and sleep‑maintenance insomnia. [1][2]

Risk of Dementia with Benzodiazepine and Z‑Drug Use in Older Adults

Comparative Safety

• Observational cohort data show that use of hypnotic drugs (benzodiazepines and non‑benzodiazepine Z‑drugs) in elderly patients is associated with a 2.34‑fold higher hazard of developing dementia compared with non‑users, representing moderate‑quality evidence. 4