Mirtazapine Alternative - Insomnia

[Shwampa]

Before we start encouraging ourselves into popping sleeping tablets (hum..guilty here) we should try to find the culprit behind the insomnia.

It's funny how doctors send us patients for OTC promethazine or diphenhydramine thinking they're safer than for example Zopiclone! People start to wonder from what planet I'm when I ask about their eyes (NA glaucoma), urinary obstruction and heart arrhythmia?

Late onset of sleep or less need for sleep could be related to ADHD or Bipolar Disorder. The good news your posts are very tidy and very humble that shows for me it's surely not the case ;-)

Seriously, my preference goes to Zopiclone which is out of your system by the morning. It helps inducing sleep without the hideous anticholinergics effects of TCA or AH.

[Pipps]

Dear Friends

I am fascinated by this discussion, because I have recently found myself in exactly the same position.

I have never suffered from terminal insomnia - ie waking up at 4am. But I have been unable to fall asleep since early childhood. I have simply felt too hyperactive all the time, and this continued and became even more pronounced in adult life. I believe I am hyperthymic, but as the UK NHS doesn't care for even diagnosing such non-life-threatening complaints, I have simply been supplied Mirtazapine as a sedative in the hope that it may provide a short-cut to an easy solution. I am delighted to report that it has.

After starting on 15mg per day for two weeks, during the first few days I experienced a little dizziness, whilst my brain and eyes no doubt recalibrated. Mirtazapine is of course more sedative at lower doses. But when I stepped up to the 30mg daily dose, I found the enormous assistance which it provides in terms of immediate sleep onset remained equally as effective.

Even turning all lights off in the home three hours before bed and taking high doses of Melatonin could not produce this quality of immediate sleep onset - even with a busy and active daily lifestyle.

However, my only complaint of Mirtazapine is the excessive tiredness and grogginess in the morning. On a weekday morning, getting up is harder, so I set up a series of spot lights connected to a daily plug timer in order to blast me with bright light at the same time that my alarm clock goes off at 6am. Anything less, and I simple do not wake. Worse still, on weekends, I feel unable to even get up. This is unknown to me - as I was always the sort of person to spring out of bed at 6am on weekends and holidays and bounce around with zest and glee.

I now have great difficulty finding the energy that I need to be as productive as I was before, but at least I can fall asleep as soon as my head hits the pillow, and this for me is a great source of relief and comfort.

If there was some way of deriving the same sleep-onset benefits produced by Mirtazapine, but without the morning grogginess, I would be grateful beyond description.

I will investigate Zopiclone as my next step forward. Thank you for the recommendation.

Pipps

[johnep]

Midazolam is an ultra short acting benzodiazepine that has been used for sleep induction, would not have thought mirtazepine drug of choice. I am a cyclothymic with mainly high levels of serotonin. Occasionally I wake up thinking about a problem and find it hard to go back to sleep. 2mg diazepam sends me off in 15-20mins. Also used on overnight plane journeys.
johnep

[Pipps]

Johnep

Are you seriously recommending taking Diazepam, a benzodiazepine, on a daily basis?

And do you honestly think that someone who requires a drug as strong as Mirtazapine to get to sleep would find any benefit from just 2mg, or any dose, of Diazepam at bed-time?

I hope these questions do not sound confrontational. I am grateful for your input. I just hope to clarify exactly what you mean to say by your last post. My interpretation of your comments is one of shock and confusion!

Best wishes

Pipps

[johnep]

No not at all, a pack of 28 tabs last me over a year. If the inability to get to sleep is chronic, then it needs investigating.
My wife would suggest watching some of the progs on Discovery. Claims I often fall asleep watching them. It maybe means you do not need so much sleep as others. Stay up late watching TV or on the computer or read a book.
Mrs Thatcher said she only needed four hours.
johnep

[Pipps]

I have been unable to sleep since I was an infant. I have always been a very happy person. Arguably, too happy. I have long-believed that I am either hyperthymic or Type II bi-polar.

Not all sleep problems are caused by depression, you know. Many are simply bio-psychological. For such people, Diazepam in any dose will be useless. It is a nice drug, but not at all sufficient for sleep inducement.

Mrs Thatcher did indeed claim only four-hours were required. She was almost undoubtedly hyperthymic, too. She also had a very challenging and fulfilling vocation. But for those of us who don't quite live in those upper-most echelons of society, sometimes a little help is needed in order to induce a decent night's sleep and keep us performing at our more mundane daily toils.

Mirtazapine is an excellent sleep provider. But the excessive sedative effects the following day, and the intolerable morning comatose state of uselessness, is in my opinion unbearable. It is, however, otherwise a very useful drug for sleep.

Has anyone else tried Zopiclone or can report on its effects for inducing sleep?

[VChan]

Personally, I only sleep 5-6 hours every night, but I feel fine I feel fine i the morning. It's not about how much sleep you get or how much the 'experts' recommend you get, it's how much your own body needs. If you find that even a short amount of sleep is adequate, don't think that you have to sleep more.

If, like Ms Thatcher, you only need the four, then use the other twenty hours to be constructive - read a book, learn a language!

[Pipps]

To bring things back on-track, the purpose of this thread is for people to seek help where they want to sleep more but can't.

[johnep]

Concensus appears in favour of Zopiclone,
johnep

[Pipps]

After reading only the very basic preliminary Zopiclone information on the Wikipedia page, I am more concerned about Zopiclone than I have been about Mirtazapine.

Zopiclone - Wikipedia, the free encyclopedia

In particular:

EEG and sleep
...Zopiclone causes similar alterations on EEG readings and sleep architecture as benzodiazepines and causes disturbances in sleep architecture on withdrawal as part of its rebound effect.[74][75] Zopiclone reduces both delta waves and the number of high-amplitude delta waves whilst increasing low-amplitude waves.[76] Zopiclone reduces the total amount of time spent in REM sleep as well as delaying its onset.[77][78] Cognitive behavioral therapy has been found to be superior to zopiclone in the treatment of insomnia and has been found to have lasting effects on sleep quality for at least a year after therapy.[79][80][81][82]

On this basis, it would appear to provide no benefit over Mirtazapine, and seem to be even less desirable.