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Sleep Disorders

Detox from trazodone

07/07/2008

Question:

Hello, I am 7 years in recovery. 7 good solid years. I have been on trazodone for the last 12 years. I take 250ml every night. I am a full time mom. I also have a new ministry that houses 6 women for treatment of drug and alcohol abuse. I am 48 years old, I weigh about 140lbs and am 5"5. I am involved in church and attend AA meetings regularly. I am pretty at peace except for this trazodone. I have tried to come off of it. It makes me useless anymore, very tired and exhausted. I really feel I could sleep, but when I try not to take it, my mind races. I obsess terribly. How can you help me? One day I will grow old and would like to be totally free from trazodone.

Answer:

12 years is a fairly long time to be on any medication and it's probably not a good idea to try and stop it suddenly. It is likely that trazodone may be treating other problems besides just insomnia and thus these issues may need to be addressed before you can come off the medication. In addition, being in recovery from drug and alcohol abuse can impact your sleep for some time and these factors may be playing a role.

The symptom you describe of trouble falling asleep due to your mind racing is fairly common in individuals who suffer from what is call "sleep-onset insomnia." Aside from anxiety, stress and obsessive-compulsive disorder, there are other factors to consider when evaluating an individual with sleep-onset insomnia. These are quite varied and may include one or more of the following; a poor sleep environment (i.e. the bedroom is too noisy, too bright or too warm), learned poor sleep habits (i.e. watching TV to fall asleep), excessive use of stimulants (both medications and common substances such as caffeine and nicotine), certain medications, pain, medical conditions that may make it uncomfortable or difficult to breath well when lying down, heartburn, restless legs syndrome (an irresistible need to move the legs when awake at night) and circadian rhythm disturbances (when the body's biologic rhythms are out of synchrony or delayed). Occasionally some individuals will not have any of these underlying causes contributing to their insomnia and their condition is labeled as primary insomnia.

As you can see, insomnia is a complex problem that requires a detailed evaluation to help sort out important underlying factors that may need to be addressed. The evaluation of insomnia often starts with your primary care physician, but may require the help of specialist in insomnia. Referral to a Sleep Specialist is necessary in some cases and likely you should ask for a referral to see one. A Sleep Specialist will take a detailed history and perform a physical examination. Based on this information, they will determine if further testing is needed or if a treatment strategy can be initiated.

The treatment of chronic insomnia depends heavily upon identifying the underlying causes. While some cases may require chronic medical therapy, many can be improved by simply changing your sleep hygiene and sleep-related behaviors. This may include simple measures such as keeping a regular sleep schedule, avoiding caffeine and alcohol within 4-6 hours of bedtime, avoiding exercise and/or hot showers near bedtime, and making sure the bedroom is quite, dark and comfortable. In your case, you should consider keeping a "worry list," or a list of your concerns, worries, and tasks you need to accomplish. The way to use this is to find a few minutes in the evening (at least 1 hour before bedtime) to write down any concerns you have or tasks you need to accomplish on a notepad. Once you have done this, place it in a spot where you will see it in the morning, but do not keep in the bedroom. This should "free your mind" of these worries and allow sleep to happen. If these maneuvers fail to work, there are other non-medication therapies that can be very effective, depending on the situation. Cognitive behavioral therapy, a structured behavioral program that addresses insomnia, has become very popular and proven to be quite effective. This could potentially be an option for you.

As far as the trazodone goes, it should not be stopped suddenly. If you would like to come of this medication, it should probably be slowly withdrawn over time under the supervision of a physician. While this is ongoing, one of the treatment strategies listed above could be implemented to help you transition off the medication.

To learn more about insomnia or other sleep disorders, please visit the American Academy of Sleep Medicine's website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. 

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University