Can tramadol be used for sleep?

In this article:

• Does tramadol help you sleep?
• Dosage
• Efficacy
• How does tramadol affect your sleep?
• Tramadol alternatives

In this article

• Does tramadol help you sleep?
• Dosage
• Efficacy
• How does tramadol affect your sleep?
• Tramadol alternatives

Tramadol (brand name: Ultram, Ultracet) has a long track record as a heavy-hitting painkiller. This prescription opioid analgesic medication can knock out pain and also shares some properties with antidepressants. However, as tramadol may cause drowsiness, those struggling with sleep difficulties might wonder if it could help promote restful sleep. There’s a chance, but tramadol isn’t the most reliable or safe sleep aid in most cases. Here’s why. 

Does tramadol help you sleep?

If pain keeps you awake, then tramadol can help by relieving it. Apart from pain relief, it also depresses the central nervous system (CNS), giving it sedative effects that might make it seem appealing to people with sleep disorders. However, tramadol can disrupt your normal sleep patterns and even cause insomnia or sleep disturbances.

This comes from tramadol’s mechanism of action. It works by binding to certain opioid receptors, changing the way the body perceives pain. It also boosts the neurotransmitters norepinephrine and serotonin, which play a role in sleep. Like other opioid medications, its mechanisms slow the central nervous system, which can lead to sedation.

But sedation isn’t the same as natural, healthy sleep. During natural sleep, your brain goes through several stages, each with important functions for cognitive health. Sedation doesn’t follow the same cycles and can disrupt brain connectivity, potentially depriving you of sleep’s benefits.

Besides all that, the U.S. Drug Enforcement Agency has labeled tramadol as a class IV controlled substance because it has a potential for dependence, abuse, and misuse. “Tramadol affects the same receptors as other opioids, so people experience similar physiological or mental effects as well as withdrawal symptoms when they stop taking it,” says Dr. David Hendricks, assistant medical director at Mountainside. That’s why doctors typically only prescribe it for short-term use and can only prescribe a maximum of five refills in six months.

Tramadol is only approved by the U.S. Food and Drug Administration (FDA) for pain treatment, not sleep disorders. Even so, it’s sometimes prescribed off-label for sleep. Off-label prescriptions are ones intended to treat a condition for which the drug isn’t officially approved.

How much tramadol should I take for sleep?

Because tramadol isn’t recommended as a sleep aid, there isn’t a recommended dosage for that use. However, the typical dose of tramadol for adults with moderate-to-severe acute pain is 50–100 mg in immediate-release tablets every four to six hours. For adults with moderate-to-severe chronic pain, the typical dosage is 100–300 mg in extended-release tablets daily. The doctor may adjust this dosage depending on your specific condition. 

How effective is tramadol for sleep?

Tramadol typically starts working within an hour, and its effects can last around six hours (or 12–24 hours for the extended-release version). So you may begin to feel sleepiness pretty soon after taking it. But as we already discussed, sedation isn’t the same as natural sleep. So, as a sleep aid, it’s not very effective.

That said, if chronic pain is what’s causing your insomnia, tramadol could be pretty effective. “Tramadol is an interesting drug because it works in two ways. First, it is a weak synthetic opiate, which can relieve pain – but this also means it can be addictive,” says Dr. Alex Dimitriu, double board-certified in Psychiatry and Sleep Medicine and founder of Menlo Park Psychiatry & Sleep Medicine. “Secondly, it works on the serotonin and norepinephrine systems in ways similar to some antidepressants. Most of the research on tramadol and sleep involves pain, so, unsurprisingly, tramadol improves sleep quality by reducing pain.” In one study, patients with moderate or severe pain from osteoarthritis showed “significant improvements” on the Chronic Pain Sleep Inventory after taking tramadol.

How does tramadol affect your sleep?

As we’ve already mentioned, tramadol helps sedate you rather than encouraging normal sleep. And in some cases, it can disrupt your sleep more than it helps.

Tramadol makes you sleepy, which may cause long or frequent daytime naps, throwing off your entire rhythm. Studies have shown that it also might cause sleep disturbances. So it might knock you out on the couch by 2:00 p.m., but that doesn’t mean it’s helping you get sleep or any of the benefits that come with it.

According to a European Journal of Anesthesiology 2001 study, researchers found that “people who took tramadol had less stage four restful REM sleep and woke up feeling more tired,” says Dr. Hendricks. “Over time, lack of restorative sleep can lead to symptoms of insomnia like increased fatigue, depression, stress, and anxiety.”

The  American Academy of Sleep Medicine says that chronic opioid use can decrease your sleep efficiency and reduce the amount of rapid eye movement sleep you get. REM sleep is important because it’s commonly associated with concentration, mood regulation, neurotransmitter replenishment, and short-term memory transfer.

Not only that, but tramadol can cause respiratory depression, which might lead to sleep-related breathing problems like obstructive sleep apnea. One study demonstrated that 75–85% of patients who take opioids have at least mild sleep apnea, and 36–41% have severe cases. This can lead to frequently disrupted and poor-quality sleep.

Other common side effects of tramadol, which might keep you up at night, include:

• Headaches
• Nervousness
• Uncontrollable shaking
• Mood swings
• Heartburn
• Lightheadedness
• Dry mouth
• Constipation

It may also cause certain serious side effects. If you experience the following, contact your healthcare provider immediately.

• Difficulty breathing
• Severe stomach pain
• Irregular heartbeat
• Elevated blood pressure
• Dizziness
• Fainting
• Seizures
• Rash or hives
• Signs of serotonin syndrome include increased heart rate, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, unexplained fever, and restlessness.

Like other opiates, tramadol is addictive, so it can also cause withdrawal symptoms if you cut it off abruptly. According to the American Addiction Centers, signs of tramadol withdrawal include anxiety, insomnia, body aches, sweating, runny nose, watery eyes, chills, goosebumps, stomach pain, nausea, and diarrhea.

Alternatives to tramadol for sleep 

Chances are, tramadol isn’t the best option to help you sleep. But that doesn’t mean you must lie awake every night staring at the ceiling. Healthy sleep habits and other sleep aids and supplements may work more reliably—including some that pose less risk for dependence and misuse. Here are a few of the most common options. 

Other ways to sleep better

Healthy sleep habits can also help, regardless of whether you take sleep medications. “For anyone with insomnia, the importance of looking at daytime symptoms cannot be underscored. Stress, anxiety, depression, and lifestyle habits by day can have a huge impact on sleep at night and are worth addressing,” Dr. Dimitriu says.

Here are a few other tips to improve your sleep hygiene.

• Stick to a routine: Adhering to the same bedtimes and wake-up times all week can help your body get into a rhythm and sleep better. A consistent bedtime routine can also let your body know it’s time to rest.
• Reduce screen time before bed: Screens emit blue light that mimics sunlight. This throws off your circadian rhythm and may suppress melatonin. Plus, scrolling the news or social media can keep your brain engaged and cause anxiety.
• Exercise: Physical activity during the day can improve sleep quality. Late-night exercise can make it harder for some people to sleep, but it doesn’t for others.
• Try mindfulness meditation: This can help you decompress from the day and relax your mind before bed.
• Avoid alcohol before bed: Like tramadol, alcohol can sedate you, but it reduces your sleep quality.
• Make your room comfortable: Get a mattress and pillows you like, block out light, and keep the temperature between 65°F and 68°F—the optimal conditions for sleep.