Clonazepam Vs. Trazodone: Which Is Better For REM Sleep?

Todd asked

I have problems sleeping. I have 2 drugs that my Dr. gave me to help me sleep. He gave me clonazepam 1mg and trazodone 100mg. Which is better to get REM sleep? ​

Answer

Hello there! We can certainly provide some information for you on how each of the drugs that were prescribed to you (trazodone and clonazepam) for insomnia affect REM sleep.

Insomnia is a very common disorder that is presented in a variety of ways. We think of it as simply having trouble falling asleep but typically, there are multiple characteristics used to evaluate overall sleep health:

• Sleep Latency (Difficulty falling asleep)
• Sleep Maintenance (Difficulty staying asleep)
• Sleep Quality (Feeling rested after a night's sleep)

Different sleep medications can affect different stages of sleep. An interruption of REM sleep, for example, tends to affect sleep quality (feeling rested after sleeping) and can lead people to feel unrested upon waking.^[1]

Trazodone For Sleep

While Trazodone is not labeled or FDA approved for use as a sleep aid, it nonetheless is prescribed for insomnia very frequently by practitioners.^[2]

Trazodone is technically classified as an antidepressant but has a fairly strong sedating effect and is generally perceived to have a safer side effect profile than many other prescription medications.

In addition, several studies have shown that the use of low-dose trazodone as a sleep aid can help treat insomnia in those also suffering from depression. Unfortunately, few trials have evaluated trazodone for how effective it is for primary insomnia (i.e. insomnia not caused by another disease state).^[3]

In regard to how trazodone affects REM sleep, the studies I found that discuss it have noted that it does not significantly change time spent in REM sleep vs. placebo.

While many sleep medications & antidepressants do appear to affect REM sleep, the consensus, based on the results I found, shows that trazodone exerts minimal, if any, REM sleep suppression.^[4]

For what it's worth, The American Academy of Sleep Medicine guidelines recommends the use of low-dose trazodone as a second-line treatment option for secondary insomnia when treating concurrent depression or anxiety. The drug is a third-line agent in cases of first and second-line treatment failures (e.g., melatonin agonists, benzodiazepine agonists such as zolpidem & temazepam) in chronic primary insomnia. There just isn't a lot of data out there regarding trazodone for primary insomnia which is reflected in the recommendations.^[5]

Clonazepam For Sleep

Clonazepam, like trazodone, is used off-label for insomnia (i.e. it is not FDA-approved for this purpose).

It belongs to a class of medications known as benzodiazepines and, in general, benzodiazepines have more side effects and have a higher potential for dependence, tolerance, and rebound insomnia. They certainly do have a sedative effect but unfortunately, they are known to inhibit or decrease the amount of REM sleep.^[6]

In fact, clonazepam is used to treat a condition known as REM Sleep Behavior Disorder (Rapid Eye Movement Sleep Behavior Disorder). It is a sleep disorder in which you physically act out dreams, specifically during the REM phase of sleep. Since benzodiazepines like clonazepam suppress REM sleep, they can be effective for this disorder.^[7]