There are two primary divisions of insomnia.
The treatment for primary insomnia is simply to address the sleep issue, whereas the treatment for secondary insomnia would involve addressing the condition that is producing the insomnia and perhaps addressing the insomnia itself medically or behaviorally. Most people suffer from temporary insomnia at some point in their lives, and issues with temporary insomnia that resolve over time are usually not problematic.
Chronic insomnia is defined as insomnia that occurs at least three times a week and has been consistently occurring at least one month.
Ambien is believed to work by increasing the availability of the primary inhibitory neurotransmitter in the brain and spinal cord GABA (gamma-aminobutyric acid). This neurotransmitter is a chemical that is released by the neurons in the brain and spinal cord (referred to as the central nervous system) that reduces the actions of other neurons in the brain. This leads to its ability to produce sedation.
Ambien works relatively quickly compared to many similar drugs, and it has a very short half-life (the time it takes the system to metabolize or reduce the concentration of a drug to half its original concentration). This means that Ambien works quickly, does not remain in the body very long, and can help to induce sleep with lower doses than similar drugs (e.g., benzodiazepines like Xanax). When individuals experience the type of insomnia that does not involve problems falling asleep, but instead involves waking up in the middle of the night and not being able to go back to sleep, higher doses of Ambien or an extended-release version may be used.
Trazodone works by increasing the availability of the neurotransmitter serotonin in the CNS. It is categorized as a serotonin antagonist reuptake inhibitor (SARI), meaning that it primarily blocks the ability of neurons to reabsorb serotonin once it has been released into the central nervous system. This leaves serotonin available in the central nervous system for longer periods of time and theoretically addresses issues with depression.
Because of the chemical composition of trazodone, it has been found to have mild sedating effects, and it is less effective than other antidepressants for the treatment of depression. Therefore, trazodone has found greater utility as a sleep aid than it has as an antidepressant medication.
Both drugs have the risk for very rare and more serious side effects that would need to be addressed by a physician if they occur. Higher doses are more likely to produce more severe side effects. Trazodone is generally better tolerated in most people than Ambien because trazodone is not specifically designed to produce sedation. However, the actual side effects than any person will experience are difficult to predict, and physicians typically wait and see how the person reacts to the drug.
Ambien as a sleep aid:
There are some downsides to Ambien.
Trazodone as a sleep aid:
There are some downsides to trazodone.
Both Ambien and trazodone use may produce a syndrome of physical dependence (withdrawal symptoms when the person cuts down on using the drug or stops using it altogether). The symptoms of withdrawal associated with Ambien include insomnia, anxiety, flulike symptoms, and stiffness or muscle cramps. The symptoms associated with antidepressant discontinuation syndrome (withdrawal from antidepressants like trazodone) include anxiety, depression, irritability, and mild flulike symptoms.
In general, both withdrawal syndromes are addressed by slowly tapering down the dosage of the drug over time to allow the system to get used to decreasing amounts and then finally discontinuing it altogether. The withdrawal syndrome associated with Ambien is considered to be more severe and more potentially serious than withdrawal from antidepressants like trazodone. Likewise, the potential to develop a withdrawal syndrome is higher with Ambien than it is with trazodone.
The data indicates that trazodone will most likely produce fewer side effects and complications than Ambien; however, trazodone may not help some individuals with sleeping. The choice of using trazodone or Ambien is really dependent on the particular needs of the person being treated, their medical history, and the other medications they are taking.
That being said, using medications to treat insomnia is not considered to be the best overall choice. Instead, using Cognitive Behavioral Therapy to help people sleep is a better long-term solution than the use of any medication. For instance, an article in TIME compared the effects of medications and psychotherapy, and came to the conclusion that Cognitive Behavioral Therapy is the best long-term solution to insomnia.
Thus, medications like Ambien, trazodone, and even natural substances like melatonin should only be used as temporary aids for sleep while an individual attempts to address the primary problem that is producing their sleep difficulties. Using behavioral techniques allow the person to address their issue, develop a program of healthy sleep, and continue to implement this program over the long-term without experiencing significant side effects.