Managing Excessive Sleep Due to Mirtazapine: A Patient's Dilemma

Q: Managing Excessive Sleep Due to Mirtazapine: A Patient's Dilemma

Hello, Lin： I see that you are very meticulous in addressing medication consultation opinions, which shows you are a diligent researcher. <br>Mirtazapine generally allows the body to adapt to its effects and maintain stable results after administration. <br>It is less common, as

Mirtazapine causing excessive sleep duration issues?

Hello Doctor, this is Lin, a student who wrote to you recently.
Fortunately, the issue regarding my ADHD medication has been resolved (the doctor is willing to prescribe Strattera for me to try).
However, as I continue to take Mirtazapine 30mg, the impact on my sleep seems to be becoming more pronounced, causing me to sleep until noon.

Let me explain my situation: I usually take my medication around 11:30 PM, and I have also tried taking it earlier (around 9 PM), going to bed around 12:30 AM.
Although I set an alarm for around 9 AM and can wake up, I feel extremely sleepy, which leads me to turn off the alarm and go back to sleep until 11 or 12.
Given this situation, I have started to consider stopping the medication, as this is unacceptable for me, especially with my upcoming study abroad in Japan in October (where punctuality seems to be highly valued, and I am just a freshman and a foreigner).
Actually, I have been taking 30mg of Mirtazapine at bedtime again since early July, which has been about a month (the last time I took it was from February to September of last year), and the factors that prompted me to start the medication have mostly been resolved.
I wonder if, under these circumstances (considering that my anxiety has eased and that I may find it difficult to accept such prolonged sleep), it would be possible for me to stop the medication after just over a month? Or would the doctor recommend that I experiment with taking the medication in the morning, and if it continues to affect my daily life, then consider stopping it?

Lin Tongxue, 20~29 year old female. Ask Date: 2020/08/08

Dr. Wang Yazhen reply Psychiatry

Hello, Lin: I see that you are very meticulous in addressing medication consultation opinions, which shows you are a diligent researcher.
Mirtazapine generally allows the body to adapt to its effects and maintain stable results after administration.
It is less common, as you mentioned, for it to significantly extend sleep duration.
Therefore, your experience may warrant consideration of other factors, such as the concurrent use of other medications like Sertraline.
Mirtazapine is typically recommended to be taken at bedtime and not during the day.
Since an online consultation is not possible, I recommend discussing whether to discontinue the medication with your prescribing physician.
A comprehensive evaluation will help determine the best course of action for adjustment.
Thank you!

Reply Date: 2020/08/08

More Info

Managing excessive sleep due to Mirtazapine can indeed be a complex issue, especially for someone like you who is preparing for an important transition, such as studying abroad. Mirtazapine is an antidepressant that is often prescribed for anxiety and depression, but one of its common side effects is sedation, which can lead to excessive sleepiness or prolonged sleep duration, as you've experienced.

Understanding Mirtazapine's Effects
Mirtazapine works by increasing the levels of certain neurotransmitters in the brain, particularly norepinephrine and serotonin. While this can help alleviate symptoms of depression and anxiety, it can also lead to increased drowsiness, especially when taken at higher doses or at bedtime. The sedative effects are often more pronounced in the initial weeks of treatment, which may explain why you are experiencing excessive sleep now that you've been on the medication for about a month.

Evaluating Your Current Situation
Given that your anxiety has improved and you are experiencing excessive sleep, it is reasonable to consider adjusting your medication regimen. Here are a few options to discuss with your healthcare provider:
1. Tapering Off Mirtazapine: Since you've been on Mirtazapine for a relatively short period (about a month), it may be possible to discontinue it without significant withdrawal symptoms. However, it’s crucial to do this under medical supervision. Your doctor may suggest a gradual tapering schedule to minimize any potential withdrawal effects or return of anxiety symptoms.

2. Adjusting the Timing of Dosage: Another option could be to change the timing of your Mirtazapine dose. Taking it in the morning instead of at night may help reduce the excessive sleepiness during the day. However, this adjustment should be made cautiously, as it may also alter the medication's effectiveness in managing your symptoms.

3. Exploring Alternative Medications: If Mirtazapine is not suitable for you due to its sedative effects, your doctor might consider prescribing a different medication that has a lower risk of causing excessive sleepiness. There are various antidepressants and anxiolytics available that may be more appropriate for your situation.

Lifestyle Considerations
In addition to medication adjustments, consider incorporating lifestyle changes that can help improve your sleep quality and overall well-being:
- Sleep Hygiene: Establish a regular sleep schedule by going to bed and waking up at the same time every day, even on weekends. Create a relaxing bedtime routine to signal your body that it’s time to wind down.

- Limit Naps: If you find yourself sleeping excessively during the day, try to limit naps to 20-30 minutes and avoid napping late in the day.

- Physical Activity: Regular physical activity can help regulate your sleep patterns and improve your mood. Aim for at least 30 minutes of moderate exercise most days of the week.

- Mindfulness and Relaxation Techniques: Practices such as meditation, yoga, or deep breathing exercises can help manage anxiety and improve sleep quality.

Conclusion
It’s essential to have an open dialogue with your healthcare provider about your concerns regarding Mirtazapine and its effects on your sleep. Given your upcoming plans to study in Japan, addressing these issues promptly will be beneficial. Your doctor can help you weigh the pros and cons of continuing, adjusting, or discontinuing the medication based on your current mental health status and lifestyle needs. Remember, any changes to your medication should always be done under the guidance of a healthcare professional to ensure your safety and well-being.

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