Does trazodone help sleep apnea? (+3 studies)

In this article, we will discuss whether trazodone helps sleep apnea. We will share how trazodone helps with sleep apnea, the benefits of using trazodone for sleep apnea, evidence of trazodone’s efficacy in sleep apnea from literature, and other relevant information.

Does trazodone help sleep apnea?

Yes, trazodone does help sleep apnea. Trazodone is used off-label to improve episodes of apnea in patients with obstructive sleep apnea (OSA). It has shown effectiveness and advantages in managing OSA in patients. 

Trazodone belongs to the class of antidepressants called serotonin antagonists and reuptake inhibitors (SARIs). It is primarily used to manage major depressive disorder (MDD). It induces sedation so it also helps to manage sleep issues (1). 

OSA is a type of sleep apnea in which the upper airway is partially or completely blocked which reduces or stops the air flow during sleep. This occurs many times and the breathing stops and restarts, causing the person to wake up (2). 

The symptoms of OSA include arousal from sleep and disturbed and fragmented sleep. The individual may snore loudly while sleeping and remain sleepy throughout the day. OSA has several mental and physical health implications (2). 

How does trazodone help sleep apnea?

The mechanism of action of trazodone is to inhibit serotonin reuptake which increases serotonin levels. It is also an antagonist of some serotonin receptors, histamine (H1) receptors, and alpha-1 adrenergic receptors (1). 

The antagonist effect of trazodone at different receptors contributes to its sedative properties (1). The role of trazodone as a hypnotic is also studied for its potential to manage OSA. 

In OSA, while the individual sleeps, their throat closes up and the breathing is interrupted. The oxygen level decreases and ultimately the individual wakes up. The arousal from sleep was considered important to restore normal breathing (3)

Later, it was discovered that arousal from sleep is not required for airway opening and to re-establish normal breathing. Moreover, arousal can further exacerbate OSA and promote breathing instability (3). 

Based on this concept, the use of sedatives like trazodone was considered to manage sleep apnea. It increases the arousal threshold, which means it makes it harder for the body to wake up due to minor interruptions in breathing (3). 

The sleep interruptions in sleep apnea are due to increased respiratory effort and higher CO2 levels. Trazodone increases the arousal threshold so the person does not wake up easily and their condition is not exacerbated (3). 

Serotonin is known to stimulate the upper airway muscle activity. The serotonergic activity of trazodone also prevents the throat muscles from relaxing excessively while reducing arousal from sleep. 

What does research suggest?

Several studies have explored the effectiveness of trazodone in managing sleep apnea. In one study, nine patients with OSA were observed for two nights and were given trazodone on one of the nights (3). 

The results from this study revealed that trazodone improved OSA as it increased the arousal threshold associated with increased efforts to breathe and the patients could tolerate higher levels of CO2 without waking up (3). 

Another study revealed that trazodone increases the arousal threshold in OSA patients without negatively affecting the oxygen levels. It did not exacerbate or prolong the hypoxemic (low oxygen levels) episodes in the subjects (4). 

One study evaluated trazodone’s efficacy in patients with OSA who had a low arousal threshold. The results demonstrated an improved respiratory threshold without relaxing the upper airway muscles too much (5). 

What are the benefits of using trazodone for sleep apnea?

Trazodone is beneficial for OSA in those patients where non-anatomical factors play a role in the development of OSA. Some patients have a low arousal threshold which means that they wake up early when the airway narrowing starts (4). 

Literature suggests that a delay in arousal can allow the neuromuscular compensatory mechanisms to work and re-establish normal airflow. Moreover, easy arousals further worsen the issue of OSA (4). 

The benefit of using trazodone for sleep apnea is that it increases the arousal threshold and allows the person to delay their awakening (4). It promotes deep sleep in which the breathing patterns are more stable (5). 

Other sedatives like benzodiazepines have also been studied in OSA. However, they are not as effective as trazodone because they have a myorelaxant effect on the upper airway muscles, unlike trazodone which has a stimulant effect (3). 

Thus, trazodone is beneficial for OSA as it does not impair muscle activity in the upper airways and delays arousal. 

What doses of trazodone are used for sleep apnea?

Trazodone exerts its sedative effects at lower doses starting from 25 mg and the maximum strength of trazodone used for sleep is 100 mg. At higher doses, trazodone produces antidepressant effects along with sedative effects. 

For sleep apnea, although no specific dose is established, different studies have used trazodone in a dose of 100 mg (3,4,5). At 100 mg dose, trazodone has shown effectiveness in managing OSA. 

Trazodone should only be used for sleep apnea if prescribed by your healthcare provider. If you have sleep apnea, contact your healthcare provider. 

What are other treatment options for sleep apnea?

The treatment of OSA is based on its etiology and primarily involves the following interventions (2). 

Lifestyle modifications: 

Being overweight is a major risk factor for OSA. Therefore, changes in lifestyle to reduce weight like exercise and healthy eating are important to reduce the severity of OSA. Individuals should avoid smoking and alcohol consumption. 

Treatment of underlying health conditions:

Health conditions that may result in OSA should be treated to reduce the events of OSA. Different conditions can lead to OSA including nasal obstruction, endocrine disorders, lung diseases (asthma), and heart diseases. 

Continuous positive airway pressure therapy (CPAP): 

It is the golden standard treatment for OSA and it has a high efficacy. This requires a machine that delivers a continuous stream of pressurized air through a mask worn over the nose or mouth while the individual sleeps to keep the airways open. 

Oral appliance:

They are customized devices that are worn by the patients in the mouth while sleeping. The devices bring the lower jaw forward which keeps the airway open while sleeping.

What other medications are used for sleep apnea?

OSA is a complex disease with multiple reasons and risk factors. It can be due to anatomical reasons or non-anatomic risk factors like obesity. Lifestyle factors like alcohol and smoking also contribute to OSA (2). 

Based on the etiology, different medications have been studied to treat OSA. They include (6):

• Medications for obesity like phentermine/topiramate combination
• nasal decongestants 
• serotonergic drugs
• noradrenergic medications
• potassium channel blockers 
• benzodiazepines 

In my perspective, trazodone helps sleep apnea and is widely used to manage obstructive sleep apnea (OSA). It helps in OSA by delaying the time to wake up caused by a blockage in airflow. 

Arousals during OSA episodes are known to exacerbate OSA. Trazodone increases the arousal threshold therefore allowing the neuromuscular compensatory mechanism to re-establish the air flow. 

The efficacy of trazodone in managing OSA is well established. A 100 mg dose is effective in improving OSA. Different treatment options are available for OSA. If you have OSA you must contact your healthcare provider. 

References