u/Leib9898

I've been struggling with insomnia that seems strongly connected to hyperarousal. My sleep problems tend to become much worse when I'm emotionally stimulated – and not necessarily because of negative stress or anxiety. Positive excitement, anticipation, changes in routine, important events, and especially romantic feelings can put my nervous system into an extremely alert state.

When that happens, I can feel physically tired and desperately want to sleep, but my brain/body just doesn't seem to switch into sleep mode. I may fall asleep very late and wake up relatively early, often getting around 5 hours of sleep or less. The next day I feel exhausted and unrefreshed.

My psychiatrist prescribed mirtazapine mainly to help with this combination of hyperarousal and insomnia.

I started mirtazapine on July 29.

Initially I took ¼ of a 30 mg tablet (7.5 mg). It definitely had an effect on me: I felt calmer and more relaxed, and it reduced that feeling of being "wired." It also increased my appetite.

However, the actual improvement in sleep has been disappointing. Since starting on July 29, I can probably count only about two nights when I felt I slept really well. Most nights I still fall asleep very late and sleep around 5 hours, sometimes less.

I also experienced dizziness/heaviness during the day.

On August 16 I increased the dose to 15 mg (½ tablet) according to my psychiatrist's instructions.

The 15 mg dose definitely relaxes me. I can actually feel the calming effect. But so far, it still doesn't make me fall asleep easily. I can lie there for hours despite feeling physically relaxed. For example, one night I didn't fall asleep until around 2:30 a.m. and woke up at 7:30 a.m.

What concerns me most now is the daytime heaviness and cognitive fog. Before mirtazapine, poor sleep already made me tired during the day. Now it sometimes feels like I have both the exhaustion from insufficient sleep and the sedation/heaviness from the medication.

I'm noticing reduced concentration and mental sharpness, and I feel like my life is somewhat "on hold" because there are so many things I want and need to do, but I'm too tired and unfocused to do them properly.

My psychiatrist wants me to stay on 15 mg for three weeks before reporting back. I've only recently increased to 15 mg, so I know it's early. I'm planning to give this dose a few more nights and see whether anything starts changing.

I'm curious about other people's experiences, especially those who took mirtazapine primarily for insomnia/hyperarousal rather than depression:

• Did the sleep benefit improve after being on 15 mg for a while?
• Did the daytime heaviness/brain fog eventually disappear?
• Did it calm you without actually helping you fall asleep at first?
• If mirtazapine relaxed you but didn't improve your sleep enough, what did your doctor eventually do – change the dose, switch medications, or add something else?

I'd especially love to hear from people whose insomnia is triggered by emotional arousal, anticipation or excitement, rather than only negative anxiety.