@Finni thanks. I just woke up a while ago after nodding off in my recliner. The same miserable symptoms were back. I’ve been awake a while and those symptoms have gone away.That tells me  something very negative is happening in my sleep. I think the mirtazapine/doxepin poison combo may be affecting my respiration, my breathing. A while back Sminismoni offered that my respiratory drive might being affected. I asked Horowitz about this when I saw him via zoom. He said no, that wasn’t the case. But I’m not so sure about that. I’m supposed to do a home sleep study this week which will hopefully tell me something. If that’s what’s going on that would put me in a very difficult position to be in. 

Here’s hoping that you’re just having a horrendous withdrawal and having “toxic sleep” 🙏 

odds are, that’s what’s going on 

 

I’m so glad you’re having the sleep study so you can know for sure 

S

 

 

Edited March 22Mar 22 by Nemina

 

3 hours ago, Pokey449 said:

. I just woke up a while ago after nodding off in my recliner. The same miserable symptoms were back. I’ve been awake a while and those symptoms have gone away.That tells me  something very negative is happening in my sleep. I think the mirtazapine/doxepin poison combo may be affecting my respiration, my breathing.

 

 I am so sorry for your terrible suffering, @Pokey449. It’s good that you have a health check soon. ❤️‍🩹🥺
 

Feeling bad after waking up, waking up with a shock or trembling does not necessarily mean that you have an additional problem on top of withdrawal. Many of us wake up like that, when it happens after dosing off during the day it’s called “toxic nap”. I even had this years ago when suffering from trauma. Now in WD I have it again. It has to do with a vulnerable or hurt CNS, I think. And with cortisol or adrenaline. I have seen @gardengirl2, @Richie , @Raymondand others write about it. @Finnihas just mentioned that, too. Maybe you guys have an explanation?

 

 I really hope for better nights for you. @Pokey449, you are in my prayers 

Edited March 22Mar 22 by Nemina

 @Nemina I hope you are correct in what I’m experiencing is just part of WD. But I’m concerned it’s more problematic than that. The reason I say that is as follows. 
Im on 2 poisons. Mirtazapine & doxepin. I should have never allowed that to happen, but neither should have my psych provider. I have a history of sleep apnea & AFib. Doxepin as I have learned is not a good mix with those 2 conditions and it’s recommended it not be taken by people with those conditions. My psych provider should have caught that. I should have caught that. My  research has indicated doxepin can suppress respiratory drive in higher doses. Thankfully I’m not on a high dose, but still???   As well doxepin is more sedating in lower doses as is mirtazapine & I’m on both. I’m a CPAP patient due to my apnea & my cpap therapy has been getting slowly worse or less effective. My nightly AHI, which is a measure of how many apneas (obstructed breathing) I have per hour has been going up. In addition my pulse oxygen levels have been lower than my historical usual. Often below 95. 
I truly hope I’m just suffering broken sleep due to WD as you suggest. But If the doxepin is suppressing my respiration I’m not sure that can be fixed short of oxygen therapy at night while I sleep while still tapering. Either way  I need to figure this out.  Being glued to my recliner out of sheer exhaustion is no way to live. And being scared I might not wake up some morning isn’t either. 
 

Any thoughts/advice @Chippy

8 hours ago, Pokey449 said:

 @Nemina I hope you are correct in what I’m experiencing is just part of WD. But I’m concerned it’s more problematic than that. The reason I say that is as follows. 
Im on 2 poisons. Mirtazapine & doxepin. I should have never allowed that to happen, but neither should have my psych provider. I have a history of sleep apnea & AFib. Doxepin as I have learned is not a good mix with those 2 conditions and it’s recommended it not be taken by people with those conditions. My psych provider should have caught that. I should have caught that. My  research has indicated doxepin can suppress respiratory drive in higher doses. Thankfully I’m not on a high dose, but still???   As well doxepin is more sedating in lower doses as is mirtazapine & I’m on both. I’m a CPAP patient due to my apnea & my cpap therapy has been getting slowly worse or less effective. My nightly AHI, which is a measure of how many apneas (obstructed breathing) I have per hour has been going up. In addition my pulse oxygen levels have been lower than my historical usual. Often below 95. 
I truly hope I’m just suffering broken sleep due to WD as you suggest. But If the doxepin is suppressing my respiration I’m not sure that can be fixed short of oxygen therapy at night while I sleep while still tapering. Either way  I need to figure this out.  Being glued to my recliner out of sheer exhaustion is no way to live. And being scared I might not wake up some morning isn’t either. 
 

Any thoughts/advice @Chippy

Hey mate. I’m sorry you’re having such a hard time. It all looks like wd to me. I know you worry about these other factors. Obviously we aren’t doctors here and can only give you our opinion. If you’re concerned about other factors you’d need to run them by your doctor for their thoughts. 

@Chippy I think I’m losing my mind. It was time to take my morning meds.  I typically take my BP med, my blood thinner and my 8 am dose of doxepin in the morning   I took my 8 am dose of doxepin as usual. But I’ve got a lot on my mind this morning and I was totally thinking about all I had to do. And without thinking, being totally side tracked,  I mindlessly took a dose of mirtazapine which I ONLY TAKR at bedtime. I don’t know how or why this happened???🙄😱 I immediately knew I F’ed up!!!  
I have been feeling like I’ve been slowly getting a little better with my long hold and now I may have totally messed it up but I hope not. There’s nothing I can do about it.i took it.  I assume I still need to take my dose of mirtazapine as usual at bedtime????????? Hoping a single dose screwup won’t throw me way off track???? It’s taken so long just to get a little better 😢

Pokey

 

 

1 hour ago, Pokey449 said:

@Chippy I think I’m losing my mind. It was time to take my morning meds.  I typically take my BP med, my blood thinner and my 8 am dose of doxepin in the morning   I took my 8 am dose of doxepin as usual. But I’ve got a lot on my mind this morning and I was totally thinking about all I had to do. And without thinking, being totally side tracked,  I mindlessly took a dose of mirtazapine which I ONLY TAKR at bedtime. I don’t know how or why this happened???🙄😱 I immediately knew I F’ed up!!!  
I have been feeling like I’ve been slowly getting a little better with my long hold and now I may have totally messed it up but I hope not. There’s nothing I can do about it.i took it.  I assume I still need to take my dose of mirtazapine as usual at bedtime????????? Hoping a single dose screwup won’t throw me way off track???? It’s taken so long just to get a little better 😢

Pokey

 

 

So what did you do exactly? I’m not following?

 

Can you write what you took today and at what times?

I took my doxepin taper dose, my  BP med & my blood thinner at 8:00am as usual. 
But I mindlessly flaked out by accident & took 7,5mg of mirtazapine at 8:00am as well. I normally take it at 10pm 

Got you. I’d skip tonight’s Mirtazapine dose, you don’t want to double dose yourself and take your next dose as normal tomorrow evening mate. 
 

What’s done is done. Try not to worry about it. These things happen. 

That seems logical to me. Mirtazapine has a 20-40 hr 1/2 life. seems my mistake shouldn't booger me up to much. thankfully it was the mirt I made the mistake with, not my tapering dose of doxepin.

I think I was finally starting to stabilize. I was gradually sleeping longer and better. Feeling more rested, being engaged more in daily living. Thinking “I got this, it’s going to be ok”. Then yesterday happened. 
I use a weekly pill box to help keep track of my daily meds. I also use alarms on my iPhone to remind me when to take my meds. I take my doxepin doses at 8am & 2pm and my mirtazapine at 10pm. 
Yesterday when my 8am alarm went off on my iPhone I went to my pill box and noted it was empty. I took the last pill in it the night before, mirtazapine at 10pm. It was time to refill it for another week. So  yesterday morning I went to the medicine cabinet in the bathroom where all my meds were stored to refill the pill box. 
The first medication prescription I grabbed to refill the pill box with was the mirtazapine. Then what I did next makes no sense to me. In fact it scares me why & his it happened……..I opened the mirtazapine pill bottle & immediately took a tablet of mirtazapine rather than refilling the weekly pill box. I don’t know why or how I came to do that. I never take mirtazapine in the morning. I was supposed to be refilling my pill box only then. It was like my thinking completely shut off, that I was out of control of myself & someone or something else took control of me. Very bizarre & Scary!!!

So I didnt take my mirtazapine at my usual time last night as I didn’t want to double dose myself. Needless to say my sleep was the pits last night. Hopefully things will settle down pretty quickly. But I remain perplexed and worried about what could have caused me to do what I did. 
 

 

2 minutes ago, Pokey449 said:

Needless to say my sleep was the pits last night. Hopefully things will settle down pretty quickly. But I remain perplexed and worried about what could have caused me to do what I did. 

The human mind is amazing. I do silly things all the time and surprise myself daily. Try to not do things like that again. Brain loves stability as you know but these things happen. My Dad used to say ‘now let that be a lesson to yer!’ ie silly move but just don’t do it again. 

What’s a reasonable starting dose of magnesium glycinste? I have 180mg caps. Take  it in the morning or bedtime?!

17 minutes ago, Pokey449 said:

What’s a reasonable starting dose of magnesium glycinste? I have 180mg caps. Take  it in the morning or bedtime?!

Id start 25-50mg mate and just ease it up if you don’t react badly. I’m not sure I’d add anything myself whilst you are feeling so unstable particularly after your dose mistake. It might be ok. I’m always cautious. Particularly as you wouldn't know if it was the magnesium that caused the problem or the dose error or just the general lack of stability. It’s totally your call though mate. 

Ok. Think I’ll wait until I’ve settled back down again, if I was in fact settling down as I thought, or it was just a fluke. I’ll research dosage some more in the meantime. What I’ve found so far says for sleep 300-400mg a couple hours before bedtime but I guess that’s for “normal” folks. Those of us here don’t have normal nervous systems. 

3 minutes ago, Pokey449 said:

What I’ve found so far says for sleep 300-400mg a couple hours before bedtime but I guess that’s for “normal” folks. Those of us here don’t have normal nervous systems. 

No we don’t. When you start. Start small and increase gradually if you don’t react/think it helps. 

13 hours ago, Pokey449 said:

I guess that’s for “normal” folks. Those of us here don’t have normal nervous systems. 

I had to laugh at that, Pokey. Got dat right. 🤪

 Morning Chippy et al. I got 6+ hours of sleep last night but I’m not feeling that great nor in a good place. In fact I think I am, metaphorically speaking, between a rock and a hard spot. 
I continue to wake up in the night & early morning in great discomfort. Symptoms include whole body pain, stiffness, headache, groggy headed, unsteadiness when I get up. Decreased O2 per pulse oximeter, air starved feeling. These symptoms occur even when I’m on CPAP and to a much greater degree when I’m off CPAP. My CPAP numbers for the night have been getting gradually worse. 
I believe the doxepin, perhaps in combination with the mirtazapine is affecting my respiration. Horowitz said no, this would not happen. But all the AI generated info I can find says doxepin should NOT be given to people with a history of sleep apnea. I don’t know why in the hell my psych doc didn’t catch this. He knew I was a cpap patient. 
Im pretty sure the above symptoms are not WD symptoms because once I get up and get moving the symptoms go away pretty quickly. WD sxs wouldn’t do that I don’t think. 
If I was on any other drug causing this I’d simply stop the drug and see/hope the symptoms improve. But of course I can’t just stop the doxepin. Doxepin & mirtazapine are not routinely given together so by default there’s potentially very negative interactions & affects that doctors have no clue of. I’m caught in a catch 22. I can’t just stop the doxepin but think there’s the likelihood that my health, maybe even my life is in danger being on it. And the doxepin only gets more sedating the lower the dose  🤔🤨

 

 

 

1 hour ago, Pokey449 said:

 Morning Chippy et al. I got 6+ hours of sleep last night but I’m not feeling that great nor in a good place. In fact I think I am, metaphorically speaking, between a rock and a hard spot. 
I continue to wake up in the night & early morning in great discomfort. Symptoms include whole body pain, stiffness, headache, groggy headed, unsteadiness when I get up. Decreased O2 per pulse oximeter, air starved feeling. These symptoms occur even when I’m on CPAP and to a much greater degree when I’m off CPAP. My CPAP numbers for the night have been getting gradually worse. 
I believe the doxepin, perhaps in combination with the mirtazapine is affecting my respiration. Horowitz said no, this would not happen. But all the AI generated info I can find says doxepin should NOT be given to people with a history of sleep apnea. I don’t know why in the hell my psych doc didn’t catch this. He knew I was a cpap patient. 
Im pretty sure the above symptoms are not WD symptoms because once I get up and get moving the symptoms go away pretty quickly. WD sxs wouldn’t do that I don’t think. 
If I was on any other drug causing this I’d simply stop the drug and see/hope the symptoms improve. But of course I can’t just stop the doxepin. Doxepin & mirtazapine are not routinely given together so by default there’s potentially very negative interactions & affects that doctors have no clue of. I’m caught in a catch 22. I can’t just stop the doxepin but think there’s the likelihood that my health, maybe even my life is in danger being on it. And the doxepin only gets more sedating the lower the dose  🤔🤨

 

 

 

Hey mate. Glad you got 6 hours sleep. Good news. 
 

Dont forget you took your dose at the wrong time so you are kinda starting this whole stabilisation journey over again having disrupted things further in the process. You noticed things were settling a bit according to what you wrote a couple of days ago. I think given some more time without changes things will start to settle for you. 

Hi @Chippy  Another s****y night in multiple ways. Im exhausted. I won’t whine on about my symptoms other than to say I still think there’s more to what’s going  than just WD alone.  I fear my life is at risk. But I hope I’m wrong and that you’re right that things will settle down soon as you predict. 

Just now, Pokey449 said:

Hi @Chippy  Another s****y night in multiple ways. Im exhausted. I won’t whine on about my symptoms other than to say I still think there’s more to what’s going  than just WD alone.  I fear my life is at risk. But I hope I’m wrong and that you’re right that things will settle down soon as you predict. 

I hope things do too. Might take a while but I think they will. You were showing such positive signs before the mis dose 

4 minutes ago, Pokey449 said:

Hi @Chippy  Another s****y night in multiple ways. Im exhausted. I won’t whine on about my symptoms other than to say I still think there’s more to what’s going  than just WD alone.  I fear my life is at risk. But I hope I’m wrong and that you’re right that things will settle down soon as you predict. 

When is your sleep study?

Hi @Finni  I’ve got the sleep study kit here now and can do it any night. I’ve been hoping for one decent night of sleep before doing the study as I expect the night I do the study will be a crappy night of sleep. I have to do it of course without CPAP which that alone will likely result in a poor nights sleep. But I got to get it done so I have enough time to get the report so I can share it with my ENT doctor who may do a surgical procedure that will supposedly open my airway enough so that I can toss the cpap machine. 
But I think the doxepin is suppressing my respiratory drive, that is, it’s affecting how my brain tells me to breathe. But this past Monday night I slept really well and woke rested for a change. So that contradicts my theory. That was the day before I messed up and took my mirtazapine dose in the morning instead of my usual time at bedtime.  Chippy thinks i discombobulated myself again & thinks I will smooth out in time. I hope he’s right as I’m getting pretty tired of not getting a reasonable nights sleep almost on a daily basis v

Well I got 7 hours of sleep last night but not without issues. Once again I woke up about 4am, 6ish and 8am. The first time was with my CPAP mask still on and I awoke congested, couldn't breathe well  and took it off. I was in mild pain and discomfort when I awoke then. The next 2x I was very uncomfortable. When I awoke at 8 I was in extreme discomfort. Whole body pain, stiffness, headache, very groggy like I was coming out of anesthesia, felt unwell, unsteady on my feet.........after I was up a while, had a coffee/breakfast I started feeling OK......I really think the mirtazapine/doxepin combo is affecting my respiratory drive, my breathing which is scary and I dont know what if anything can be done.......maybe its just due to not being stable yet which I hope