How Can Difficulty In Falling Asleep And Restless Sleep Apart From Anxiety Be Managed?

Posted on Tue, 17 Jul 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 17 Jul 2018 Answered on

Mon, 3 Oct 2022 Last reviewed on

Question : Good evening doctor :
My medication is as under:
Quitipin 100 ( reduced from 150 gradually), mirtaz 37.5, trazodone 25 ( reduced from 50 gradually) amitryn 75 ( increased from 50) all in the night
Duolextine 60 ( reduced from 120 over a period of time), betacap tr 20 ( reduced from 40 gradually) all in the morning
After I have increased amitryn, my anxiety is much much better but still a little bit is there, which is irritating
My symptoms are as under :
A little of anxiety is still there
It takes a lot of time for me to fall asleep. Even after going to sleep, I wake up every two hours and don’t feel fresh in the morning. I get weird dreams also. I feel sedated in the morning and have been reporting late to the work. Pls suggest some tweaking in the medication that will cure my anxiety totally and will also help me to sleep better.

Answered by Dr. Seikhoo Bishnoi (15 minutes later)

Brief Answer:
In my opinion dose of Amitriptyline can be increased

Detailed Answer:

Hello,

Good that the anxiety is under control. Since you are tolerating Amitriptyline and are doing good so in current situation I'd advise you to increase the dose of Amitriptyline only. Increase the dose to 100 mg and in the same time reduce the dose of Mirtazapine to 30 mg. This will help in sound refreshing sleep, reduced anxiety and you will see improvement in functioning.

Reducing Mirtazapine will reduce the weird dreams too to some extent. This slight modification should help you.

You can talk with your doctor for this.

Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Seikhoo Bishnoi (4 hours later)

Thank you doctor for your reply. Hope making these changes don’t aggravate my anxiety. Was thinking of making these changes gradually I.e. making amitryn 85 for few days and then going to 100. Similarly reducing mirtaz to 30+1/2 of 7.5 for some days and then making it 30. Since I have suffered for a long time, small little change in the medication worries me a lot. Hope increasing amitryn does not increase the side effects and reducing mirtaz does not bring back my anxiety. Do you think it’s worth giving these changes a try?

Also, does mirtaz help better beyond 30 mg?

Answered by Dr. Seikhoo Bishnoi (12 hours later)

Brief Answer:
You can make the changes without worries.

Detailed Answer:

Hello,

Yes, these changes will not aggravate your anxiety but will definitely help you. You can go with such gradual dose reduction too if you are anxious of abrupt changes in doses. But remain assured this will not make your anxiety worse.

Yes, you should go with these changes. Reducing the dose of Mirtaz will not worsen your anxiety but will improve sleep quality.

Yes. Mirtaz can be used at around 45 mg doses to see best effects. But reducing the dose to 30 from 37.5 mg will not make situation worse.

Thanks.

Note: For further follow up on related General & Family Physician Click here.

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