Has anyone experienced Mirtazapine making sleep worse?
Posted , 5 users are following.
I was prescribed Mirtazapine 30mg and Escitalopram 5mg for a bout of severe insomnia and the related crippling anxiety, which meant I didn't sleep for nearly 2 weeks. Zopiclone, Diazepam and Phenergen didn't help me sleep and I concede that Mirt was the thing that helped me turn a corner and at least start getting at least a little sleep, starting from 2 weeks ago today.
However the sleep I am getting is extremely fragmented - it takes me 2 or 3 hours to get off but then I wake up literally every 30 mins or so and I wake feeling completely unrefreshed. It feels as though I'm in a dream like light sleep all night. The exception to this is 2 nights I've had where I wake up and immediately know I've had a better sleep... you KNOW when you've been properly asleep... and I then feel significantly better that day. But that has been 2 nights out of 14.
I am convinced that the Mirt is causing this fragmented sleep because it's not the normal kind of insomnia I always have, which is a problem going to sleep. I never have problems with constant waking and I really feel the Mirt is not creating a normal sleep cycle in me. It's been 2 weeks now and it hasn't changed or improved at all and so I want to already try to taper off it because the anxiety is under control (I can feel the Escitalopram kicking in, I am familiar with SSRIs and I know they help me with that) but at the same time I am scared of setting myself back to the previous horrific "no sleep" insomnia.
Has anyone else experienced Mirt causing this fragmented constant dream like sleep for them? Am I the only one?
1 like, 13 replies
SerotoninSurfer gillian62018
Posted
Hi Gillian, Mirtazapine has the peculiar contradiction of being more sedating the lower the dose. When you get up to 30 and 45mg, this can cause over-stimulation as norepinephrine effects overwhelm the sedating effects of serotonin.
This might be causing you waking up rather than sleeping right through. Have you tried 15mg or lower doses, e.g. split 15mg in half to provide 7.5mg. Probably something to talk with your GP about if you are struggling on 30mg
jules27056 gillian62018
Posted
Hi, yes the lower the dose the more sedating I've found anyway.
When I was on 30mg of mirtazapine I had the same sleep pattern as you describe, I discovered while tapering down that for a better night's sleep 7.5mgs is better, although I have anxiety creeping back.?
gillian62018
Posted
Hi both, thanks for your replies! Yes I had heard / read about the sedating at lower doses, though my Psychiatrist had not heard of this and seemed to rubbish the idea. This isn't the only thing that has made me question how good he actually is 😃 I hadn't made the connection about the wakefulness possibly being from the over stimulation though.
When I started on Mirt I started at 15mg buy only for 4 days before I upped it to 30mg after having a night of not being able to sleep at all. I have wondered a number of times if this was the wrong thing to do and I just panicked. I'm going to reduce to 15mg tonight and see how I get on, and possibly even taper slowly to 7.5mg after that. If I was consistently getting a good night of sleep on it then I would maybe stay on it, but it seems a bit pointless when I'm not and if anything I suspect it's causing the constant waking.
The anxiety is definitely a factor to consider in lowering or stopping it, however because I also started on Escitalopram 5mg two weeks ago, I am hopeful that I'll be able to cope with this - I have found SSRIs to help me previously in the past if i can just hold on through their initial horrid side effects.
Would be really interested to hear of people's opinions / experiences on the sedation at lower doses thing and if it is actually true
x
SerotoninSurfer gillian62018
Posted
Hi Gilian, Mirtazapine is defintely more sedating the lower the dose. There are scientific papers written on it and it is even prescribed at low doses for insomnia when other medications have failed. 15mg used to knock me out and i still sleep right though on 30mg. I used to wake up really early on Sertraline but i often have a lie in at the weekend when on Mirtazapine now my kids have got older and not up at the crack of dawn 😉
Liam36009 gillian62018
Posted
Mirtazapine is a strange drug in that lower doses are more sedating than higher doses. I've done some experiments on it & for instance if you ingested just 1mg (pretty much a speck of it) it would be 14x more sedating than 15mg. I find a dose between 7.5mg & 15mg the best dosage so I don't feel too sedated the next day. Anything higher & I don't sleep as good.
gillian62018
Posted
Hey Liam - I find that fascinating. What kind of experiments out of interest? The last two nights I took 15mg and slept much better. I'm still a bit nervous of my insomnia creeping back but I'll see how I go. The problem is that for most of the day until about 7pm I still feel exhausted / low energy and also quite irritable and angry, which isnt my usual personality.
My intention is to taper off it completely but I'm super nervous of having rebound insomnia, just because i get it so severely.
Liam36009 gillian62018
Posted
Hi Gillian, It was just a gradual lowering of the dose (without risking going into withdrawal) to see how sleepy it made me & without a doubt the lower I went the more sedated I was & into the next day. In fact below 7.5mg wasn't pleasant at all. It was an effort getting out of bed, I stumbled around like a drunk, felt like my body was weighed down too.
If I was you I would carry on the 15mg dose.
Personally the tiredness does get better a few weeks on that dose but of course some people take less time or longer. I understand your concern about rebound insomnia because when I try to come off Mirtazapine altogether I have terrible sleep - waking up every hour or no sleep at all, I'm in zombie mode 24/7. So I end up going back to taking the Mirtazapine at 15mg or no lower than 7.5mg.
gillian62018
Posted
Well after two nights in a row of relatively on sleep on 15mg, I had a dreadful night again last night where I just lay there till 2am and eventually took another 7.5mg which seemed to do the trick (psyhically or psychologically, who knows) And get me over at about 3am till 7am. Of course I feel dreadful this morning. I'm completely at a loss now as to what the best thing to do is.
The problem is that any dose is making me feel rubbish the next day, up until about 5pm when it eases a bit. And I hate the horrific groggy drunk feeling in the morning - I've been a morning person why whole life and would wake up after 7 hours of sleep with boundless energy, so it's horrible feeling so rubbish in the mornings
The problem is I have this sneaking suspicion that the only reason I am sleeping at all is due to the Mirt - I don't know if my brain has actually got over the initial severe insomnia episode where I didn't sleep for almost 2 weeks - it was like my brain literally got jammed in the fight or flight mode and couldn't switch off, I was in a terrible physical and mental state. I'm no longer sure what the right course of action is and if I should continue to stay on Mirt and at what dose, or if I'm just avoiding the problem and I should try to taper off and hope for the best.
Any thoughts welcomed... I'm a total loss as to the best course of action now. And my psychiatrist hadn't even heard of Mirtazapine being more sedating at lower doses so I don't feel like he's actually any good either....
Liam36009 gillian62018
Posted
I still have the odd bad night now & again even on Mirtazapine. Sometimes for myself I reckon it can be too much caffeine/coca cola or foods that are stimulating to the brain. Sometimes simply feeling a bit more stressed than usual can override the Mirtazapine.
gillian62018 Liam36009
Posted
Thanks Liam, I think you're right. I had a good night again last night, probably the most normal I've had since all this started over a month ago. That's 3 decent nights and 1 rubbish night since I dropped to 15mg (after reading comments here about 30mg possibly being over stimulating). On any of those nights I haven't had any of the "waking up every 30 mins" thing that I had every night on 30mg so it was definitely the right thing to drop and was being caused by that. The bad night was just a problem getting off to sleep and I think Liam you're right I probably need to accept that is still going to happen while my body is settling down.
I still seem to be feeling pretty rubbish during the day even on 15mg and a decent night of sleep (tired, no energy or enthusiasm, irritable and angry) but I'm hoping that is going to ease - I've only been on Mirt for 17 days. If those side effects do ease I think it makes sense to stay on 15mg for now before I look to drop again. Fingers crossed so far the weight gain hasn't been a thing for me.
Thanks for all your advice and comments here, they have really helped x
Liam36009 gillian62018
Posted
No problem. The key is to keep stress to a minimum - I know that's difficult in this day & age but if you can avoid stressful situations as much as possible (stress increases cortisol the stress hormone which is bad for sleep) then I've found the Mirt works well. Definitely avoid caffeinated drinks too & other brain stimulants. Good luck.
ted46777 gillian62018
Posted
Just started taking mirtazapine at 7.5mg last week. The first night I had the best sleep ever in years. Since then I have really vivid nightmares./dreams and wake repeatedly.
On the plus side my anxiety is down and I don't worry as much.
SerotoninSurfer ted46777
Posted
Hi Ted,
I had really vivid dreams when i first started taking Mirtazapine. That went away after a few weeks. I quite miss it now as some of the dreams felt like full hollywood movies 😉 Best of luck!