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Suggest Treatment For Insomnia

Posted on Mon, 14 Apr 2014

Question: I am taking mitrazapine 15mg for about 6 months now as prescribed by my pcp for insomnia. It worked really well for my insomnia and anxiety. I had been taking .5mg xanax initially but was able to reduce their use. Recently, I have had suddenly had more trouble sleeping. Should I increase my mitrazapine dosage? I had heard that higher doses didn't help as much with sleep. I don't want to get stuck in the insomnia cycle again, because it very negatively affects my mood and causes a big increase in anxiety. I have had to start taking the xanax again with my 15mg of mitrazapine and still not sleeping all that great. It isn't horrible, but I really don't want to start taking a lot of xanax again and would love for the mitrazapine to work like it used to. I am really nervous about this because in the past when my insomnia got really bad I completely fell apart. I have tried zolpidem in the past and that caused very bad mood changes as did elavil. I also tried trazadone, but didn't find that helpful. My pcp said it was fine to increase my mitrazapine dose, but like I said I am worried that an increasing the dose would make my sleep even worse because of reading that it was less sedating at higher doses.

Answered by Dr. Manisha Gopal (38 minutes later)

Brief Answer: dont fear, mirtazapine will.b very helpful Detailed Answer: hello & welcome to hcm! From my clinical experience I can tell you that the seative componenet of mirtazapine doesnot becomes inefective at all with increasing dosage; it actually becomes better. Moreover, the drug has helped you significantly at such a low dose that it is almost for sure that the acute increase in symptoms can be controlled efectively with dose hike. There is almost always increase in sedation when mirtazapine is increased-- that many a times it is undesirable foebsome cases. So, please donot worry, go ahead with your PCP advice fearlessly. The requirement of xanax will surely decrease and you will be able to quit it altogether. Also practice sleep hygine tips for quicker response. Hope the reply is useful Please feel free to ask more queries for any clarification. Dr. Manisha Gopal MD psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manisha Gopal (19 hours later)

Hi, I took 30mg mitrazapine last night with .5mg xanax last night. I went to bed at my normal time. I go to bed the same time ever every night, and wake up the same time every morning. After laying there for an hour, and not falling asleep I began to feel more and more anxious. I then took another .5mg xanax and did fall asleep. I feel very anxious today because I am really upset that the mitrazapine increase didn't work, and whenever I have to increase xanax I get real anxious about that. I am not sure what to do. Will it take a few nights of increasing the mitrazapine to get relief or would of it worked the first night. I am just so scared that this isn't working out for me. In the past when I had horrible insominia and couldn't sleep, I would reach a point that I can only describe as a complete nervous breakdown. Extreme anxiety with overwhelming fear about having to take xanax. I always get so nervous that I will get addicted to it, and increasing the dose needed just makes me worry more. My dr. has reassured me that I need the medicine, and that I shouldn't worry about it so much, but I still do. Should I give the increased mitrazapine more time to work? Should I just take 1mg of xanax for a few nights until my sleep schedule gets restored? I hate so much that I have this problem.

Answered by Dr. Manisha Gopal (14 minutes later)

Brief Answer: give it some time & there r many options left Detailed Answer: Hello, It is ok for the first few days or a week for any drug to take / begun its action. THERE IS No need to fear at all. please get a grip on yourself... 0.5-1mg of xanax is nothing at all. what you are doing now can be more harmul for your sleep- fear. Please try to replace fear with trust that mirtazapine had worked wonders for.you before and would do so even now.. If you are so anxious about sleep, it would be better that you take zolpidem 12.5mg aling with mirtazapine for a week. Zolpidem is non addicting and a potent short term sleep inducer drug . It is quite safe and effective. Please give time to the increased dosage to work. I can understand that it is some fear plus more of syndromic anxiety that is leading to so much trouble..but this will go. And there are so many options available even apart from mirtazapine to manage your problem that there is no need to worry. As your doctor said that drug needs some time...and I would suggest that it will be better that you take xanax or zolpidem along with mirtazapine for few days. Hope you get a good sleep! Wish you speedy recovery Dr. Manisha Gopal MD Psychiatry

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar