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.
I took low-dose Doxepin (3 mg to 6 mg) nightly for two weeks. The next-day sleepiness effect did not go away. And, the reduced stamina while taking it did not diminish. Caffeine and modafinil helped some, but did not resolve the problem. So, I will go back to my old plan of using it only when necessary.
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Yes, I found the same effect from using doxepin. It does differ from trazodone in that it has “hypnotic” effects, and when coupled with galantamine or donepezil, produces effects that are very similar to lucid dreaming, in that you are aware and have some control and guidance of the dream.
Unfortunately, this does not result in a good night’s sleep. (Of course, results may vary.)
And also, unfortunately, at the rate that I will be using it, I have more than a lifetime’s supply. 
My go-to stack when I have a disturbing day or activities that make me restless and mind racing at bedtime is:
100 mg melatonin ~ 1hr before sleep (tells the body it’s time to go to sleep)
2 grams l-tryptophan ~ 1/2 hr before sleep (shortens sleep onset)
10 mg trazodone ~ 1/2 hr before sleep (shortens sleep onset)
50 mg quetiapine ~ 1/2 hr before sleep (shortens onset and maintains longer sleep times)
This combo for my particular physiology works great and feels “clean” with no morning-after effects.
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Dr Frasers AD thread got me interested in DORA’s so I asked by new best friend Perplexity a few questions about the opportunity to use peptides for this function.
One of my questions was if the sleep improvement was the key to the benefit, it is definitely part of the benefit but may not be the entire benefit from DORA’s
Since my current obsession is peptides I asked about that and found some interesting info on DSIP, my new fav peptide for increasing the quality of my sleep. One thing is does, it “concentrates” sleep patterns. We go in and out of the various stages of sleep in what looks like random cycles. It helps to concentrate deep sleep phases earlier in the sleep cycle and increase the duration of deep sleep, for me it was a significant improvement.
Deep sleep is important for clearing out the physical aspects of the brain.
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@Jay, Well… I did get capsules even tho’ I ordered tablets 
Oh well, I have a scale, and this is just an experiment to see if I can improve my sleep-maintenance. Sort of like what you did, I took one 10mg capsule opened it. There is 120mg of media (active ingredients + fillers) in each capsule. A white powder. Presuming the active ingredients are uniformly distributed in the filler, to get 3mg of doxepin would be 40mg of media. But there will be some loss in the capsule-making process, so I’m starting with making 3 capsules and tossing out the residual … starting below 3mg and going slow. I didn’t taste it to see if your method was tolerable.
jjrap1, If 3 mg helps you get a good night’s sleep, then that is the right dose for you. I found that around 5 mg worked better for me. The scale method sounds precise and I have tried it. I also tried mixing the capsule contents with a specific amount of liquid using an oral syringe. With a 1 ml oral syringe I drew tap water and put it into a small dropper bottle 2 times for a total of 2 ml of water. (In your case it would be 3 times to get 3 doses.) I then poured the contents of the capsule in, closed the bottle and swirled the contents trying to keep the mixture near the bottom of the bottle. I let it set for a few hours for the Doxepin HCL to dissolve in the water. At that point I drew 1 ml of liquid out of the bottle as the first dose using the oral syringe. I placed the bottle in the fridge for a 2nd dose if needed. Of course, the bottle needs to be swirled before use each time. With this method some of the ingredients that are mixed with the Doxepin won’t dissolve and will coat the inside of the bottle with a white film. Assuming some of that white film to be Doxepin I thought swirling would be better than shaking in order to reduce the total amount of the white film.
The sleep is good when needed, but the unfortunate problem is that the next-day lingering sleepiness and reduced energy and stamina may hit you as it has other people on the forum. So, I try to limit use to only when needed and for a short period of time. It usually takes me a few days after this for energy and stamina to come back up to normal.
I believe hospitals commonly use Trazodone, Tempazepam and possible Silenor (Doxepin) as sleep aids, but I wonder about nursing homes. Doxepin would seem to be a good choice in a nursing home for an elderly invalid who needs good sleep and calming of nerves when next-day physical activity and alertness is not a big priority. I’m just thinking ahead about possibilities in case that’s in my future!
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@desertshores, @Jay: doxepin is a bust for me; tho’ mildly effective as a sleep even at 3mg, the next day haze is a show-stopper; no amount of caffeine cuts through the fog… it’s really unpleasant! Time to move on!
@desertshores can you tell me what quetiapine pharma co and size tablets you are buying? Just the 50mg tablets, or something larger and cutting them into pieces? I see they are available up to 300mg. How did you arrive at the 50mg dose? Trial and error? Thanks much!
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The only reason I tried doxepin is because it has a slightly better safety profile for long-term use.
My daughter has been using 100 mg tablets for many years with no obvious ill effects.
She gave me a few to try. The 100 mg tablets were a little too strong for me. I think the 300 mg tablets would be way too much for most people. 50 mg is the dose I use, and it seems just right for me. Too high of a dose is too much of a good thing.
The pills are very cheap from India. I would order the 50 mg tablets.
These are the ones I ordered, and they work quite well.
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jjrap1, Yes the next-day sleepiness effect is the big problem with Doxepin. Otherwise, it would be a winner for me.
You noted quetiapine. I ordered some a couple of weeks ago.
Lots of sleep products, both OTC and prescription have been failures (for me) in the past, but maybe quetiapine will work. Or, maybe it will work for you.
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Thanks @desertshores for suggesting this. I tried last night 25mg (cut 100mg into four) and it was the first night in three years that I slept for 8.5 hours straight. REM was over 2 hours (24%) and it has never been over 12% before. Deep sleep was always good about 30% and so was last night. Surprisingly I feel more sluggish this morning (with 8.5 hours sleep) than when I’d usually get only five hours sleep but I’m sure I’ll start feeling better as day goes on.
Edit: Two nights in a row of 8.5 hour of uninterrupted sleep (first time in three years) thanks to Quetiapine 25mg.
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Curious how you compare the potential downside of quetiapine vs ambien?
Ambien works really well for my husband, but I’m always looking for healthier alternatives for him. When I google quetiapine, it appears it’s also no free lunch.
I am assuming you all are choosing this over ambien for a better health profile, but I wanted to double check.
Virtually every sleep aid has its downsides. Ambien is never recommended for long-term use. doxepin would be the safest bet long-term, but unfortunately, it doesn’t work for everybody, nor does quetiapine.
The main downsides of quetiapine are long-term weight gain and metabolic effects, and some people experience low blood pressure at night, which can cause dizziness.
"Quetiapine 50–100 mg: think “metabolic + orthostatic + antipsychotic-class risks.
Ambien 5–10 mg (or CR): think “falls/delirium + complex sleep behaviors + dependence risks.”
Personally, n=1. I have not experienced these side effects, even after taking quetiapine for ~2 years. My current BMI is 21, and as an old person, I have virtually no appetite, so if quetiapine caused a little weight gain, it wouldn’t matter to me; that would be okay.
Things that quetiapine is supposed to affect (mine are okay):
Williams et al., 2010 (Pharmacotherapy) – “low-dose quetiapine” and weight gain
Retrospective study; showed progressive weight gain over time: about +5.56 lb at 6 months and +10.58 lb at 12 months compared with baseline (both statistically significant at 6 and 12 months)
Conclusion: Despite limited generalizability, these findings suggest that, even at low doses, quetiapine has an impact on metabolism. Further research is needed to clarify its role in metabolic dysregulation. This study was registered in the international database of prospectively registered systematic reviews
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BTW: you mentioned doxepin at 3mg. I have not tried that small of a dose. The most often recommended dose that I see is doxepin 6 mg. I use 10 mg because the doxepin I ordered is in 10mg capsules, so I have been taking 10 with good results.
Your best bet might be Lemborexant 10 mg because it is considered safer than the quetiapine.
Quetiapine unfortunately not recommended long-term.
I asked about the two protocols I most often use.
Here is a composite analysis from ChatGPT 5 and Perplexity Pro: Side-by-side comparison (your options vs lemborexant)
| Option | Sleep profile (your experience) | Biggest long-term safety issues at 85 | “Morning clean” odds |
|---|---|---|---|
| #1 Trazodone 50 + quetiapine 50 | Best duration (~8h) but you’re drowsy ~2h | Falls/orthostasis, plus quetiapine-specific concerns (metabolic effects, QT risk, delirium/cognitive risk in older adults) when used off-label for insomnia | Lowest (you already see hangover) |
| #2 Gabapentin 300 + doxepin 6 | ~7h, restful, clean wake | Mainly balance/ataxia/falls (gabapentin), plus additive sedation with other depressants; low-dose doxepin is generally a favorable sleep-maintenance agent in older adults | High (you report this) |
| Lemborexant 10 mg | Good for sleep onset + sleep maintenance; shown vs placebo and even vs zolpidem on some objective measures | Somnolence + fall risk (dose-related; especially ≥65), next-day impairment risk if not allowing a full night; unusual sleep-related phenomena (paralysis/hallucinations) | Moderate at 10 mg; better at 5 mg in ≥65 per labeling |
Detailed Comparison: Lemborexant 10 mg vs. Current Protocol
| Feature | Lemborexant 10 mg (Proposed) | Gabapentin 300 mg + Doxepin (Current) |
|---|---|---|
| How it clears | Liver (CYP3A4 enzymes) | Kidneys (Filtration) |
| Your Ability to Clear | Slower (Liver blood flow ↓ with age) | Excellent (eGFR 78 is high for age) |
| Half-Life | 17–19 Hours | ~6–7 Hours |
| Morning Status | ~40-50% of drug still in system | < 10% of drug still in system |
| Geriatric Dose | Too High (Rec. max is 5 mg) | Optimal (Well within safety limits) |
| Fall Risk | Moderate (due to residual drowsiness) | Low (if waking is clean) |
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thanks for the info.
Actually must have been someone else, never tried doxepin. I have only tried (so far) melatonin at various doses and worked initially but seems to have lost the efficacy after a while. Then I tried DSIP which didn’t think it helped much, maybe helped with REM but my main problem is I can only sleep 3-5 hours then I wake up and can’t fall asleep again. and recently I tried Quetiapine 25mg which did an excellent job keeping me asleep for 8.5 hours straight but felt close to horrible the next day the whole day, but after taking 4.5mg of LDN the sluggishness and grogginess seemed to dissipate quite a bit.
Last night I tried an even smaller dose of Quetiapine (about 12.5mg) which it did an excellent job in keeping me asleep for 8.25h straight and the negative effects were way less that of 25mg, maybe 25% as bad, which seemed very manageable. Perhaps I’ll keep experimenting and try to find the least amount in mg that helps keep me asleep. Tonight, I will try even a smaller amount and see how it goes. I’m hoping that a micro/miniscule dose of say 5mg will do enough good and clearly the side effect at such minimal doses have to be near zero. If that works, I’ll consider the sleeping issue solved.
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Currently gabapentin 300 mg + doxepin 10 mg is my all-time favorite except for Ambien, which is not for long-term use. For some reason the gabapentin-doxepin combo leaves me refreshed and feeling good in the morning. For me it is as clean a wake-up as Ambien.
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