Just incase it’s helpful, I’ve shared this previously, but in addition to many things turning my sleep around, including rapa, the addition of LDN last year was a game changer. It doesn’t work for everyone but you’ll take this stuff out of my cold dead hands.
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tj_long, Yes. I agree. It was a big disappointment. So, I wonder what is the biological difference I have that makes it useless for me?
Beth, I’ve tried Ambien, Sonata, Trazodone, Quiviviq and likely others that I don’t recall, but all of them had side effects I did not like. Either that or they just did not work for me. Currently, my common backup is diphenhydramine or doxylamine both of which are associated with Alzheimer’s. So, I continue to search for a solution.
Having said all of that above, has your husband ever tried low-dose Doxepin (3 mg to 6 mg)? Every time I use it I find it very effective in getting a good night of sleep. But, be warned that for some people, including me, it can have an irritating sleepiness effect that lasts much of the next day. Whenever I take it I plan on making no significant driving trips because that sleepiness effect comes to the forefront when you’re sitting in a comfortable seat and periodically turning a steering wheel. If I stay physically active it doesn’t bother me so much. If not for this irritating side effect it would be my only sleep aid.
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Since meditation works for you, it is possibly just a psychological problem, not the problems old age and loss of function create.
Yes and no. The root cause for me is a chronically over-activated nervous system. I won’t go into how this happened, it’s a long story. Falling asleep requires activating the parasympathetic nervous system. By practicing meditation, it’s possible to calm the nervous system and get the parasympathetic system to activate; for some reason breathing exercises don’t work for me, my HRV just drops during them. Meditation works sometimes, but it requires sessions of more than 20 minutes. When you sleep poorly for long enough, the cause also becomes psychological, you develop sleep anxiety, which worsens the state of the nervous system and the cycle gets worse. For me, H1-blockade (doxepin, mirtazapine, quetiapine, etc.) didn’t help at all in the worst phase, because those medications don’t really affect the state of the nervous system
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tj_long, Yes. I agree. It was a big disappointment. So, I wonder what is the biological difference I have that makes it useless for m
I think there’s something strange about how Quviviq (daridorexant) is absorbed. As I mentioned earlier, your stomach needs to be empty, otherwise it doesn’t seem to have any effect at all. Then there’s the mechanism itself: if you have sleep anxiety, or anxiety in general, it can completely override the effect of the medication. The drug has a very subtle effect, and if your nervous system is fairly calm and you’re not anxious, the medication can work fantastically well for some people, even for me, for a few months. The state it eventually pushed me into once the effect wore off was quite frightening.
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DS, have you moved on from trazodone? If so, why? I ask because I’ve been taking for about a year.
@desertshores, did you acquire doxepin from the Indian suppliers? Looking for 3mg tablets, which seem to be recommended for sleep, but see only 10 or 25mg tablets. Of course, could cut 10mg in 4ths and get ~2.5mg/ea, but ?? What do you do? Thank you!
I ordered doxepin 25 mg tablets from India, and they are on their way. I also ordered and received a “DUBSTAR Pill Cutter Splitter for Cutting Multiple Pills, 1/2 1/4 Pill Cutter Splitter.”
If I had to do it over again, I would opt for the 10 mg tablets.
I think the 3 mg recommended is a little on the cautious side. I am just experimenting, not planning for continuous use.
“Low-dose hypnotic use (3–6 mg) is pharmacologically quite different from antidepressant-range dosing (≥75 mg/day) – essentially antihistamine vs full-blown TCA.”
Geriatric caution: Multiple sources recommend lower starting doses in older adults (e.g., 10 mg QHS for systemic doxepin). (Means take 10 milligrams every night at bedtime. The instruction is a combination of a drug measurement and a Latin abbreviation for the timing."
“Doses of doxepin used for sleep normally range from 3 to 6 mg, but high doses of up to 25 to 50 mg may be used as well.”
“Doxepin, have been used for decades to treat insomnia. This is particularly common practice in the UK”
So, cutting the 25 mg tablets into quarters seems relatively safe."
No, I haven’t abandoned trazodone as a sleep aid. Mainly, I use trazodone to get back to sleep if something has awakened me during the night. I probably have a lifetime supply of trazodone.
I ordered trazodone initially because I was not aware of doxepin. Doxepin is more widely prescribed for sleep problems than trazodone. I just want to compare the two.
I paid $40 for 200 Doxepin 25 mg tablets. (I will split the pills into four parts.)
Doxepin seems like the better choice.
Big-picture comparison
| Feature | Trazodone | Doxepin (low-dose 3–6 mg) |
|---|---|---|
| Regulatory status for insomnia | Off-label (approved as antidepressant) | FDA-approved for sleep-maintenance insomnia (Silenor 3–6 mg) PMC+1 |
| Main sleep effect | Mild–moderate sedation, ↓ awakenings; weak effect on objective sleep measures | Stronger, consistent effect on staying asleep (↓ wake after sleep onset, ↑ total sleep time, better sleep efficiency) PMC+2ResearchGate+2 |
| Evidence quality | Several small RCTs, Cochrane & AASM rate evidence low quality, small benefits; no long-term data Wikipedia+1 | Multiple RCTs (adults & elderly) up to 12 weeks, plus FDA dossier; evidence moderate quality for sleep-maintenance insomnia PMC+2FDA Access Data+2 |
| Guideline stance | AASM, VA/DoD, ACP all recommend against using trazodone as a routine insomnia drug (harms ≥ benefits, weak evidence) AASM+1 | AASM gives a (weak) recommendation for low-dose doxepin for sleep-maintenance insomnia AASM+1 |
| Typical insomnia dose | 25–100 mg at bedtime (vs 150–400 mg for depression) MDPI | 3–6 mg at bedtime; much lower than antidepressant doses (25–300 mg) PMC+1 |
| Major concerns in older adults | Orthostatic hypotension, dizziness, falls, morning grogginess, QT-prolongation risk, rare priapism, drug interactions U.S. Pharmacist+1 | At 3–6 mg, very little anticholinergic effect, next-day sedation similar to placebo in trials; higher doses (>6 mg) behave like a typical TCA with all the anticholinergic baggage PMC+1 |
jjrap1, I’ve been using Doxepin 3 mg to 6 mg periodically for several years when I feel the need to get good sleep. I have a supply of 10 mg capsules which I take apart. Fill the smaller side of the capsule from the larger side and pour that amount under the tongue. Underfill just a bit. Then, fill the smaller part of the capsule once more (underfill just a bit) from the larger side and pour that under the tongue. Finally, put the capsule back together. It is guesswork, but it’s the simplest method I’ve found for trying to get roughly a 3 mg to 6 mg dose (2 doses per capsule). I was not able to find pills or caplets for my order several years ago, but if you do find them cutting them in half would be much less complicated than trying to equally proportion the 10 mg capsule into two reasonable doses.
Another variation on my method is to fill the shorter side of the capsule from the longer side once and pour that under the tongue (maybe ~ 3 mg). Put the capsule back together and do the same thing the next night (maybe ~ 3 mg). Do the same thing the third night to see how close the shorter side gets to being full. If it’s as full as the first two nights then you’ve successfully divided the 10 mg dose into roughly 3 portions each at ~ 3 mg.
The next-day sleepiness effect has always made me stop taking Doxepin after a few days. It has always been a potential danger when driving (from personal experience). So, I avoid anything other than short driving trips the day after having taking Doxepin. However, I’ve read that this next-day sleepiness effect may go away after a few weeks. So, with my current experiment I am going to try it for two to four weeks non-stop to see if that is true. If so, it may be a long-term solution for me.
If you experience irritating next-day drowsiness from Doxepin try taking caffeine from capsules or coffee. It may help. Or, modafinil (low dose - 50 mg). Of course, this gets into the cycle of one drug for sleep (Doxepin) and one drug upon waking (Modafinil). But, would this cycle be better than using the old OTC antihistamines Diphenhydramine or Doxylamine? I don’t know, but maybe. Plus, Modafinil seems to affect different people differently which means testing to see how it may work for you.
Of course, you could just ask your PCP for a trial prescription of Silenor (6 mg caplets) to see if it will help your sleep problems. It would likely be easy to cut a 6 mg Silenor pill into two 3 mg halves to try at first.
Suggestion: Check for contraindications of Doxepin with any other medicines you take.
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Odd from the study: Doxepin: “At 3–6 mg, very little anticholinergic effect, next-day sedation similar to placebo in trials; higher doses (>6 mg) behave like a typical TCA with all the anticholinergic baggage.” Perhaps you are inadvertently taking more than 6 mg. Or, more likely you accumulate too much taking it every day.
“The half-life of oral doxepin is typically between 8 and 25 hours, with a mean of around 15–17 hours. However, it is important to note that the active metabolite, nordoxepin, has a longer half-life of 28 to 81 hours.”
Where as “Trazodone is eliminated in two phases, with an initial half-life of 3 to 6 hours and a terminal half-life of 5 to 9 hours.” So not so much accumulation.
Trazodone: “morning grogginess”
Personally I have never experienced morning grogginess from taking a 10 mg trazodone tablet, even if I have taken it only a few hours before I get up in the morning.
desertshores, I don’t notice much anticholinergic effect at 3 mg to 6 mg of Doxepin. It’s the antihistamine effect I refer to when talking about Doxepin and next-day sleepiness. It’s just a constant feeling most of the day that I would like to lie down and take a nap. However, my thinking seems to be pretty clear when using Doxepin. An additional note is that it seems to diminish my physical stamina noticeably.
On the other hand, a strong anticholinergic effect like that from Doxylamine gives me “foggy brain” much of the next morning. My thinking and actions are slow, like that of a sloth! Well, maybe not a sloth. But, that’s what I compare it to until it wears off.
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Well, I just ordered 10mg doxepin tablets to give it a shot starting at ~2.5mg and to be able to stop using that evil anticholinergic doxylamine (aka Costco sleeping pills) waaay too frequently. Here’s hoping!
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With you on this 100%. LDN for me is the ONLY med that I can say has had the most effect (positive) in overall health and wellbeing (mainly pain and inflammation but helped me with sleep also) of all meds I’ve ever taken. I take or have taken in the past many other meds (rapa, metformin, SGLT2i, Statin etc.) but no med has had such a profound effect as LDN (3mg). The best part is the fact that it works immediately. I didn’t bother to start low and titrate, started at 3mg (3 months ago) and been there since and works great for me.
As a side note, I was having somewhat mid to high level muscle and joint pain (which clearly affected my sleep) and that is all gone on LDN. Not sure it is doing anything else, and not sure if it will do anything for those that have no pains and aches.
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What has your experience been like with doxepin so far?
It’s in the mail. Haven’t tried it yet.
I started doing Tai Chi including evening, I found it improved my sleep quality greatly.
Melatonin, Trazodone, or Doxepin for Sleep Disorders
A 6-month study compared trazodone (50mg), doxepin (10mg), and melatonin (3mg) as alternatives to benzodiazepines for insomnia in 175 psychiatric patients. All improved sleep quality, with trazodone showing slightly better efficacy but more morning grogginess than the others.
https://x.com/PsychopharmInst/status/1939655163972833681?s=20
Here is the actual paper (the link above is to a podcast):
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Do you mind telling me the brand of 10mg doxepin tablets you ordered. I’ve searched, but only find 10mg capsules.