[BenjaminR]

Hello insomnia folks – I would like to hear of your experiences with Doxepin for insomnia.

At age 80, I have come to accept that my sleep architecture is just not what it was 20, 40, 60 years ago. I have tried all sorts of remedies, none of which have been very effective for long, if at all, and have learned that there is no magic bullet.

My problem is mainly sleep maintenance, often waking up alert and staying awake for 30 minutes or more. I do try to make myself get up when that happens and read a book, which does help. Sleep onset is rarely a problem, and a really boring and pointless podcast helps greatly.

I used Ativan 1mg for years and finally and slowly tapered off a year ago, so my GABA receptors are probably still 6-12 months away from being totally resensitized. Tried various forms of prescription cannabis and became frustrated with trying to find the right combination and dosage, so I gave that up. Herbal remedies have not helped. I’m doing just about everything that would be recommended by CBT, other than sleep restriction (which sounds like absolute torture).

A few months ago I read about Doxepin and decided to give it a try. Sounded promising – it seems to be more of a remedy for problems with sleep maintenance, sort of levelling you out in the night so that when you wake up, it’s not as sharp, and you tend to go back to sleep more easily. I’ve been trying a 3mg dosage for almost two months, with what appeared to be some success. However, I’ve become concerned about some of the side effects: excessive morning drowsiness (which I have been experiencing and is not good for seniors), constipation, and weight gain (possibly).

I decided to try doing without, and the subsequent three nights have been terrible, great difficulty falling asleep, which is odd. I’ve never had consecutive nights of sleep onset issues, and it is a rare thing. Supposedly there is no risk in going cold turkey with Doxepin, so I’m wondering whether it is the cause of this, or is it just an anomaly? I would be very interested in others’ experience with this drug.

[Martin Reed]

I don’t have personal experience with that medication but what I can say is this — I am yet to meet someone with chronic insomnia who identified any specific medication as the long-term solution to their struggle with sleep. And, quite often, medication can come with virtually the same side-effects associated with insomnia that we are trying to avoid!

That’s not to say that medication is the “enemy” or even a problem — just that it doesn’t seem to be the long-term solution that many people are looking for.

You shared that you’ve tried alternatives to medication — and sometimes CBT techniques can trip us up as they can easily become a whole new set of sleep efforts (and sleep doesn’t usually respond well to effort).

An alternative approach could involve something more aligned with ACT for insomnia — what shows up for you when you consider that kind of approach?

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[hiker]

Hi Benjamin R, I used Doxepin with some success for about a year or two, many years ago. I recall it left me very drowsy in the morning, but I didn’t care because I slept enough. And I was desperate for sleep.

But eventually it stopped working. I went through 15-20 different meds, and none lasted even that long.

I agree with Martin, and in fact if there were a surefire pill for insomnia (really surefire, not just Internet hype), people would be lined up for blocks, there would be well-publicized legislation to make it affordable, etc. i am 74, dealt with insomnia on a regular basis for 40 years. The pill in question does not exist.

When I have a setback, my go-to remedy is related to CBT, I believe. I might add that the setbacks are more likely to show up when I have slacked off mindfulness exercises.

I remind myself that trying harder to get to sleep and to stay asleep does not work. I try to pinpoint anything which might be going on in my life to create situational insomnia. Maybe that exchange with a difficult neighbor has left me angry, even though I logically thought the situation was resolved. Or worries about health, obsessing about political news, etc.

I end by acknowledging that of course I would prefer to get a good night’s sleep tonight. But if I don’t, this isn’t my first rodeo. I can handle this. And usually I am back to sleeping better within a few nights.

Take care.

[BenjaminR]

Thank you. I have decided to stop the Doxepin. It did seem to be doing what it is supposed to, but the next day drowsiness was problematic, and I finally decided to just stop. I’ve had a couple of bad nights since but mostly pretty good (for me). As you say there is no magic bullet, pill or otherwise. I’ve learned to accept the fact that my sleep is going to be less than “perfect”, whatever that is, simply take it as it comes, and not obsess about it.

[Author]

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