Managing Sleep Medications: Finding the Right Balance for Mental Health

Q: Managing Sleep Medications: Finding the Right Balance for Mental Health

Hello： Jing An Ning is classified as a sedative, and long-term use can indeed lead to dependence and tolerance, so it is not recommended for prolonged use. <br>It is acceptable to alternate between half a tablet and a quarter tablet. <br>If you wish to taper off the medication, t

Medication issues

Thank you for your detailed response last time, Doctor.
You asked why I take Mirtazapine first and then take Anxiolytic before bed a few hours later.
This is because my psychiatrist mentioned that taking Mirtazapine a few hours before bedtime is more effective, and it can even be taken earlier, after dinner.
My medication bag also indicates to take it after dinner.
However, I have tried taking Mirtazapine earlier a few times, but I’m not sure if it’s due to the dosage, as it doesn’t seem to help with sleep.
Instead, I often feel excessively drowsy the next day, sometimes sleeping over ten hours a day.
The drowsiness, along with dizziness and unsteady gait as side effects, has made me quite uncomfortable.
Therefore, I stopped taking Mirtazapine about two to three weeks ago, and I have not experienced any physical discomfort since then.
The original side effects have significantly reduced or disappeared.
For now, I am maintaining a routine of taking half or a quarter of an Anxiolytic before bed (as the hospital and clinic have switched to using Quetiapine).
My sleep is okay; although I don’t fall asleep quickly every night, I can still manage five to six hours of restful sleep, and I feel good upon waking, sometimes even taking a nap afterward.
I maintain a weekly exercise routine of four to five days, including walking and swimming, about an hour of walking and swimming 1000 meters each time.
So, I don’t think I have depression, perhaps just a bit of anxiety, but it’s not severe.
I wonder if it’s related to my history of hyperthyroidism, which makes me more prone to nervousness.
However, according to my recent blood test report, hyperthyroidism has not recurred.

I would like to ask you, Doctor, whether Quetiapine (or Anxiolytic, or Zolpidem) is suitable for long-term use in my situation? (I have been taking it intermittently for four to five months, with a dosage of half or a quarter of a tablet before bed each day.) Is it appropriate to alternate between half and a quarter of a tablet? Based on my personal experience, taking half a tablet causes slight dizziness the next day, while taking a quarter seems to have almost no side effects.
If I want to taper off the medication gradually, what would be the best approach? A community pharmacist suggested a method of taking it every other day for two weeks, then every two days for another two weeks, and then every three days for two weeks, with the entire tapering process taking about one and a half to two months.
However, I am hesitant to proceed with this, as I once stopped for a day and experienced insomnia that same day.
Additionally, if Mirtazapine could replace Anxiolytic, I would be very interested in trying it since it is non-addictive, but it seems to have too strong side effects for me.
I wonder if there are any other similar medications with fewer side effects that can help with sleep in the long term? Thank you, Doctor.

Ong Picton, 60~69 year old female. Ask Date: 2022/01/14

Dr. Lin Mianzhang reply Psychiatry

Hello: Jing An Ning is classified as a sedative, and long-term use can indeed lead to dependence and tolerance, so it is not recommended for prolonged use.
It is acceptable to alternate between half a tablet and a quarter tablet.
If you wish to taper off the medication, the principle is to do it gradually.
You can start by taking a quarter tablet daily, and after one to two weeks, switch to an eighth of a tablet (as long as it is less than a quarter, it doesn't have to be a specific fraction).
If you can adapt, you can then discontinue use.
It is normal to experience discomfort when first reducing or stopping the medication, as the body has developed a dependence on it, so rebound insomnia is quite common; generally, it will improve after a few days.
Besides Metoprolol, Mirtazapine and Trazodone are also considered effective for sleep, but the former can affect blood pressure, and the latter may cause abnormal liver function tests in a small number of individuals, requiring regular monitoring.
It is advisable to discuss with your physician to find the most suitable medication for you! Wishing you a speedy recovery!

Reply Date: 2022/01/14

More Info

Managing sleep medications can be a complex process, especially when considering the balance between achieving restful sleep and minimizing side effects. Your experience with medications like Melatonin (美妥平) and Anxiolytics (安邦錠) highlights the challenges many face in finding the right treatment for sleep disturbances.
Firstly, it’s important to understand that sleep medications, while effective for some, can come with a range of side effects, including drowsiness, dizziness, and balance issues, as you have experienced. These side effects can be particularly concerning if they interfere with your daily functioning. The fact that you have been able to reduce your dosage and maintain a reasonable sleep schedule with just half or a quarter of Anxiolytics is a positive sign. It indicates that you are actively managing your medication and are aware of how it affects your body.

In terms of long-term use of Anxiolytics, it is crucial to have a conversation with your psychiatrist or healthcare provider. While these medications can be effective for short-term management of anxiety and sleep issues, they can lead to dependence if used for extended periods. Your observation of feeling better with a lower dose is significant; it suggests that you may be sensitive to the medication's effects, and finding the lowest effective dose is essential.

As for tapering off medications, the method suggested by your community pharmacist—gradually reducing the frequency of doses—is a common approach. This method allows your body to adjust to lower levels of medication, potentially minimizing withdrawal symptoms or a return of insomnia. However, it’s vital to tailor this approach to your specific needs and to do so under the guidance of your healthcare provider. They can help monitor your progress and make adjustments as necessary.

Regarding alternatives to Melatonin, there are several options that you might consider discussing with your doctor. Some individuals find success with herbal supplements like valerian root or chamomile, which are known for their calming effects. Additionally, cognitive behavioral therapy for insomnia (CBT-I) is a highly effective non-pharmacological treatment that addresses the underlying thoughts and behaviors contributing to sleep issues. This therapy can help you develop better sleep hygiene practices and reduce anxiety related to sleep.

Moreover, since you mentioned a history of hyperthyroidism, it’s essential to consider how this condition might influence your sleep patterns and anxiety levels. Even if your thyroid levels are currently stable, fluctuations can still affect your mood and sleep. Regular follow-ups with your healthcare provider to monitor your thyroid function can help ensure that it remains within a healthy range.

In summary, managing sleep medications requires a careful balance of efficacy and side effects. Your proactive approach to adjusting your medication and maintaining a healthy lifestyle through regular exercise is commendable. Continue to communicate openly with your healthcare provider about your experiences, and consider exploring non-pharmacological options alongside your current regimen. This comprehensive approach can help you achieve better sleep quality while minimizing potential side effects from medications.

Similar Q&A

Managing Sleep Issues and Mental Health: Strategies for Stress Relief

Hello Doctor, I am currently studying at a university in Japan, but I am stuck in Taiwan and unable to return to my studies. I am taking online courses, and the daily stress is overwhelming due to the large number of reports and papers. I have been receiving medical treatment for...

Dr. Huang Xiaoxian reply Psychiatry
Dear Sammi, Thank you for your question regarding insomnia. It can indeed be challenging to address when faced with life stressors, and it's common for dreams to increase during such times (dreams are a physiological mechanism by which our brain attempts to process emotion...

Understanding Long-Term Effects of Psychiatric Medications on Sleep and Wakefulness

Hello Doctor: I have been taking psychiatric medication for five years, during which I have switched between many different medications because I couldn't adapt to them and felt worse instead. Currently, I take half a tablet of Mirtazapine before bed, along with 0.5g of Clon...

Dr. Zhang Fangrong reply Psychiatry
Dear Sir/Madam, Based on your description, you have had nine hours of sleep from 11 PM to 8 AM, which should be sufficient. However, you are having difficulty getting up in the morning. Although the dosages of the medications you are taking are not high and most of them are shor...

Effective Strategies for Managing Sleep Disorders and Anxiety

Hello, doctor. Recently, a friend of mine has been having trouble sleeping. Her stressors have accumulated over a long period, and she tends to keep her issues to herself, so I only know a little about her situation. She has been seeing a psychiatrist for 2 to 3 years, primarily ...

Dr. Zhong Mingxun reply Psychiatry
For this friend, the most important thing is to provide care and companionship. Additionally, you can encourage her to seek psychotherapy, as medication treatment seems to have reached its limits. Psychotherapy can help her address the underlying issues; otherwise, she may easily...

Managing Sleep Aid Dependency: Strategies for Healthier Sleep

Hello Dr. Yeh, thank you for your response. Continuing with my walking exercises seems to have improved my heart condition. However, I still rely on sleep medications to fall asleep peacefully. I am very grateful for my doctor’s ongoing patience and listening. Will I become overl...

Dr. Ye Boshou reply Neurology
Thank you for the encouragement! For sleep issues, it's important to first restore normal daily habits and maintain a positive outlook. Medication can then be reduced or even discontinued without too much concern.