@Chippy @Nemina @Sminismoni @Journey  Thanks for all your kind words and understanding that being alone with all this is not a good thing. It is a very lonely experience, I think even when loved ones are close by it’s lonely but even more so when you are literally all by yourself. I will consider your alls advice

That said I think I’ve reached stability with my current dose, but all is not well. @Sminismoni a while back you offered that the doxepin on top of the mirtazapine might be suppressing my respiration. I shared that with Dr. H and he negated that saying no that wasn’t happening. I think that is incorrect. I think, in fact I’m pretty sure that’s exactly what’s happening to me at this point. At a minimum it’s making my sleep apnea worse. 
When I use my CPAP I’ve been waking up more frequently in recent weeks not feeling well, have a slight headache, very groggy and aching all over and needing to take some deep breaths. If I take my cpap off and fail to put it back on I  fall asleep only to suddenly wake up later with sob, worse headache, dry mouth, very groggy and an elevated heart rate. My apnea has gotten worse. If I fall back to sleep w/o my Cpap I awaken again later with the same sxs. I don’t feel overly sedated upon awakening, only very uncomfortable due to the above sxs. I often feel what I describe as “toxic”. Im pretty sure Dr H was wrong  & that  the drugs are affecting my respiration/apnea 
Why I say I think I’ve reached stability is as soon as I get up, move around, have breakfast I feel better and all the other WD symptoms I was having seem to be mostly absent now. My primary problem now is as described above. 
I don’t know what to do about this. I can’t just stop the doxepin but it’s making my respiration (apnea) worse. And doxepin becomes more sedating as you go lower in dose. I’m caught between a rock & a hard spot. 

@Pokey449 I think that currently, and perhaps in the longer term it might be helpful to change nothing. IF my theory is correct, that these drugs are suppressing respiration, the lower you go the worse you will be. Whereas if you hold and wait, there is a chance your body and brain will adapt. It is similar to training to climb the Himalayas. You spend time at increasing altitudes, so your body can produce more red blood cells to compensate for the lower oxygen in the air. Bodies can and do adapt to extreme physiological challenges over time, and generate a new set point. So you will more than likely reach stability with time and may decide never to risk tapering off more. It is important to remember that despite these extreme symptoms night after night, you haven't died yet. The best predictor of future behaviour is past behaviour (a saying we have in psychiatry). So if you've survived the last 100 nights of this, there is a good chance you will still be alive in another 100 nights. Hang in there.

@Sminismoni during my last session with Horowitz I told him that given my age and the challenge & misery of getting off this garbage I felt that once I get to 25mg  ( I’m currently at 29.6mg) I’d stop and stay there for life. Doxepin comes in a 25mg cap. 29.6mg is an awkward dose to manage the rest of my life and not that far away from getting to 25mg. Horowitz thought that was a reasonable thing to do. He did suggest that after reaching & stabilizing at 25mg that I then reduce the Mirtazapine to 3.75(1/2 tablet) and remain there as well. 
What’s your take on this protocol?? 
 

@Pokey449

 

I think @Sminismoni has a good point. I’m not sold that what you are experiencing isn’t still wd tbh. But either way I think holding your dose and letting yourself stabilise is a really good idea. 
 

One good night isn’t stability. Or even two. It can take some time to see stability and you’ll likely experience windows and wave during this period. 
 

When you properly stabilise then perhaps continuing to taper to those whole doses maybe a good idea for convenience. Part of me wonders if just staying put isn’t the worse idea tbh. I know it’s an awkward dose. But the price of stability….

13 minutes ago, Chippy said:

Part of me wonders if just staying put isn’t the worse idea tbh. I know it’s an awkward dose.

@Chippy I’m not clear on what you are saying for sure ?? 

4 minutes ago, Pokey449 said:

@Chippy I’m not clear on what you are saying for sure ?? 

I’m saying I wonder if keeping this dose as is for the foreseeable isn’t the worse idea. 

@Chippy I’m sorry if I’m being extra dense this morning 🫩 I’ll blame the damned drugs. 
Sounds like tapering to 25mg wouu Ild be the BETTER idea than staying @ 29.6mg forever??
But, I need to be good & stable, right, before I reduce the dose again?? 

59 minutes ago, Pokey449 said:

@Chippy I’m sorry if I’m being extra dense this morning 🫩 I’ll blame the damned drugs. 
Sounds like tapering to 25mg wouu Ild be the BETTER idea than staying @ 29.6mg forever??
But, I need to be good & stable, right, before I reduce the dose again?? 

No don’t be sorry. Logistically tapering down would make sense. I’m just wondering if you wouldn’t be better off keeping the dose the same to not rock the boat. 
 

Either way I think that’s a problem for the future. I’d not touch your dose for some time yet. I’d settle into forgetting about it and just take each day as it comes. I think if you hold here you might be surprised how much better you’ll get in time. 

Maybe I’m being hyperbolic but I think the doxepin in my body is going to kill me. I had another terrible night last night. According to my nightly CPAP

report I got 5hours of restless sleep. But I awoke about 3 feeling absolutely s***y!!

I kept trying to fall back asleep but would awaken each time suddenly with a gasp & feeling creepy crawly & restless. I had weird points of pain in my left arm wondering if it was heart related or just arthritis??  A dark foreboding cast it’s spell over me. I spent the next 4 hours like that and finally got up at 7.

Although getting up I feel better than I did in bed Im very tired and exhausted. I’ve held my current dose for 45 days. I’ve been zigging & zagging in and out of a wave. Bad days, better days. Sxs that ying & yang.  Maybe it’s just my anxiety talking but I truly think the doxepin is having a serious impact on my health, I’m starting to worry it may even be life threatening. 

16 minutes ago, Pokey449 said:

Maybe it’s just my anxiety talking but I truly think the doxepin is having a serious impact on my health, I’m starting to worry it may even be life threatening. 

This is your anxiety talking Pokey. Your brain is trying to solve this like a Rubiks cube, desperate to prevent the worst case scenario it can think of. Next time you spiral, try visualising a Rubiks cube (I know you're old enough to know what they are!) and use this image as a cue to remind you it's your brain just trying to solve a puzzle. And remember, you have had dozens of nights like this and did not die. If it was truly that life threatening, you would already be gone. Instead, it just happens again and again, and yet you live to tell the tale every time. 

@Sminismoni Thanks for the Rubik’s cube suggestion. I guess logic would say you’re right, if it was going to kill me it would have likely done so by now, but still I wonder. 
The thing is I often have the thought it would be a blessing if it did kill. I’m worn out with the physical/mental misery of it all and the dark hold it has on my life. This is not living. 

6 minutes ago, Pokey449 said:

The thing is I often have the thought it would be a blessing if it did kill. I’m worn out with the physical/mental misery of it all and the dark hold it has on my life. This is not living. 

Im sorry Pokey mate, I know this is a hard path to walk. You are doing it so well, real trooper.

@Nemina  Thanks for the video. It was helpful to me knowing my situation could be a hell of a lot worse. That ladies situation sounded pretty bad and she survived. I would have liked a bit of a more scientific explanation of how/why they think her Akathisia disappeared. I find it hard to believe it was simply because she moved. But miracles do happen. Thanks again 

Last night was really terrible. I’m confident I have more going on than “simple” WD alone. What’s happening  I think is a complicated interaction of cause & affect. One thing affecting another which in turn affects something else if that makes any sense. But It’s hard to sort out what’s causing what.

Im tapering doxepin which tapering as we know can cause a host of sxs, side affects & complications. I think the doxepin is suppressing my respiration at night during sleep. I’m waking SOB often. This may be occurring because I have diagnosed sleep apnea & the doxepin could be making my apnea worse. My CPAP therapy at night has become increasingly more difficult and less effective. Last night my apnea count was the highest it’s ever been while on CPAP. My night time pain has increased as well which may be because of & makes all the above worse. And I’m having weird pains in my left arm. It may be due to a left shoulder issue I know about  but I’m worried it’s due to my heart. Depressed respiration/oxygen is not good for one’s heart, or everything else for that matter. The left arm pains go away after I get up. 
In short I’m waking multiple x at night feeling terrible with some really scary & exhausting signs & symptoms which lessen or completely go away during the day, except for the awful fatigue.
My nights seem to be getting worse. I dont know how much longer my body & mind can take it. I’m scared. 

 

 

 

 

4 hours ago, Pokey449 said:

Last night was really terrible. I’m confident I have more going on than “simple” WD alone. What’s happening  I think is a complicated interaction of cause & affect. One thing affecting another which in turn affects something else if that makes any sense. But It’s hard to sort out what’s causing what.

Im tapering doxepin which tapering as we know can cause a host of sxs, side affects & complications. I think the doxepin is suppressing my respiration at night during sleep. I’m waking SOB often. This may be occurring because I have diagnosed sleep apnea & the doxepin could be making my apnea worse. My CPAP therapy at night has become increasingly more difficult and less effective. Last night my apnea count was the highest it’s ever been while on CPAP. My night time pain has increased as well which may be because of & makes all the above worse. And I’m having weird pains in my left arm. It may be due to a left shoulder issue I know about  but I’m worried it’s due to my heart. Depressed respiration/oxygen is not good for one’s heart, or everything else for that matter. The left arm pains go away after I get up. 
In short I’m waking multiple x at night feeling terrible with some really scary & exhausting signs & symptoms which lessen or completely go away during the day, except for the awful fatigue.
My nights seem to be getting worse. I dont know how much longer my body & mind can take it. I’m scared. 
 

I’m so sorry pokey. Please make sure you get yourself checked out if you think you have other issues going on won’t you?

 

Obviously we are not medical professionals and can only share our thoughts with you on the wd tapering process here. I very much suspect most of what you are going through is the ups and downs of stabilising, some of your worry may be your health anxiety. But of course there could be other things too so please be safe and get checked if you need to. 
 

I’m hoping you have a better night tonight mate. 

Hi @Chippy  Yeh I’m going to share some of what’s going on with my cardiologist and my sleep doc. I’m especially concerned about what I think may be cardiac symptoms. Im

just exhausted and feel really crummy. Worn down & feel ill. I’m doing another sleep study (long story) tonight at home. Can’t use my cpap for that so I  expect another crappy night. 

4 minutes ago, Pokey449 said:

Hi @Chippy  Yeh I’m going to share some of what’s going on with my cardiologist and my sleep doc. I’m especially concerned about what I think may be cardiac symptoms. Im

just exhausted and feel really crummy. Worn down & feel ill. I’m doing another sleep study (long story) tonight at home. Can’t use my cpap for that so I  expect another crappy night. 

Think this is a good idea mate. Better to be safe. It’s probably the wd but rule other things out 

On 3/14/2026 at 7:19 AM, Pokey449 said:

@namastejen1  I’d love it if I could get back to playing my horn. Music is poetry, is an active form of meditation for me. I use to play in a trio & quartet which I loved and arranged some of the music for both groups. I love arranging the music too. It’s a creative process.  I’ve not been able to put together such a group here thus far. Maybe when & if I ever feeling better. Some days I fear I’ll be like this the rest of my life. I got to get more active again. This “couch surfing” is not good for one’s health. I feel fat, tired & out of shape. It sucks. Wishing you well @namastejen1
 

Hey Pokey, thank you for sharing such a lovely message. I can see how much music means to you and I’m sorry that you are at quite the crossroads with it because of the Rx. I know you’ll feel better at some point-we all will. We are destined to succeed and help each other out. That’s my firm belief.
I have not been on here for quite a while and may find it hard to catch up with everything, but I do hope you’re feeling better despite the sleep apnea issues. I see others have been helping you with suggestions for wd thought. All spot on.

I have been couch surfing quite a bit when not feeling well recently. But for a while, I get the feeling you expressed of tired, out of shape, and for me kind of flabby since I used to work out quite a bit, and with the tapering it’s been hard to do. It really zaps your energy when we’re trying to wake the brain up again as we’re coming down off of these different drugs.  I’m hoping though that you can stabilize where you’re at and then make adjustments later. I might have to stay at 0.39mg a little longer than I’d like but I have to see how I am at the end of 35 days supply-that’s the Rx amount the compounding pharmacy makes for me.

Be well, my friend. I’ll be praying for you.

Edited April 14Apr 14 by namastejen1

@Chippy I did a repeat home sleep study last night. I didn’t have faith in the one I did 2 weeks ago.  I’m pretty sure what I’m experiencing now is worsened sleep apnea symptoms due to the doxepin. In doing some reading I’ve learned that doxepin should not be prescribed to anyone with sleep apnea. Nor a history of AFib either. I check the boxes on both of those. My psych provider was aware of this when he prescribed the stuff. Just proves you can’t trust doctors to know what’s best for you. 
If my sleep study comes back showing increased apnea I think I’ll be a candidate for a simple surgical procedure that improves apnea w/o the need for CPAP.  I’m on CPAP now but it’s not going well. 
The sxs I’m experiencing at night are classical apnea sxs. They evaporate after I get up in the morning. I don’t think WD sxs would do that would they?? 

5 minutes ago, Pokey449 said:

If my sleep study comes back showing increased apnea I think I’ll be a candidate for a simple surgical procedure that improves apnea w/o the need for CPAP.  I’m on CPAP now but it’s not going well. 

Be interesting to see the result Pokey. Having surgery can be  not so good for your nervous system, but if you must, then you should do that. If it helps in the long run....

 

5 minutes ago, Pokey449 said:

I don’t think WD sxs would do that would they?? 

Hard to say, they sound classic wd to me, but if you think they are sleep apnea symptoms too, then yes of course they could be. As I said we aren't doctors. Added medical issues, certainly complicates things, makes it harder to understand what is happening.

 

Best to see what the study says and go from there I think.

Well yet another terrible nights sleep. I’m waking up SoB and my body feeling like what I think is hypoxic. It just feels weird and it takes some deep breathing and time to feel normal again. I really do think that the doxepin/mirtazapine combo is affecting my respiration and my heart. Sometimes when I check with an Oximeter my HR is down to 50. O2 is in an acceptable range but I often see sudden drops, such as going from 98 to 93 in a flash. I did another home sleep study Monday night. Hopefully it will shed some light on what’s happening. But whatever is happening it ain’t healthy.

23 minutes ago, Pokey449 said:

Well yet another terrible nights sleep. I’m waking up SoB and my body feeling like what I think is hypoxic. It just feels weird and it takes some deep breathing and time to feel normal again. I really do think that the doxepin/mirtazapine combo is affecting my respiration and my heart. Sometimes when I check with an Oximeter my HR is down to 50. O2 is in an acceptable range but I often see sudden drops, such as going from 98 to 93 in a flash. I did another home sleep study Monday night. Hopefully it will shed some light on what’s happening. But whatever is happening it ain’t healthy.

Sorry you had a tough night again. Really hope the sleep study can shed some light Pokey.

On 4/12/2026 at 5:15 PM, Pokey449 said:

@Nemina  Thanks for the video. It was helpful to me knowing my situation could be a hell of a lot worse. That ladies situation sounded pretty bad and she survived. I would have liked a bit of a more scientific explanation of how/why they think her Akathisia disappeared. I find it hard to believe it was simply because she moved. But miracles do happen. Thanks again 

Dear @Pokey449 I understand.

Personally, I believe that love is very very healing. I also seriously believe that it makes a difference when we send one another love, peace and strength on this site. It does something to the people involved.

And being around loved ones can also be very healing. (Even though admittedly, living a partnership during withdrawal is not an easy thing.)

I believe that God is love and that God/love is the strongest force in the universe. My very personal belief is that Jesus Christ is the clearest revelation we have of the character of God and all he did and said can also be boiled down to the conclusion that God is love.

Maybe that’s why this woman got suddenly better when she was around her loved ones. And That’s why I personally would think that moving nearer to your children and having your wife around more could be a good and healing move for you.

I hope you had a better night and send you love, peace and strength!

Hi @Nemina thanks for your kind encouraging words. I have no doubt being close to loved ones provides a healing component to one’s life. My being here alone, especially when I get up in agony in the dark of night is both a painful & very lonely. Loneliness certainly does not aid healing. Love does. I’ll be honest and say I can’t feel the presence of GOD in such times. He and I had a falling out quite a few years ago. But I’ll admit that’s on me, not God.But I do often wonder about mending that relationship 😢

The challenge to moving closer to my loved ones is mostly an issue of energy. Energy that I don’t have most days. I’ve made 4 big moves in my life and doing so is stressful & requires lots of energy. But I’ve told myself if I do move this time I’m just going to hire a moving company and tell them to come in and pack it all. But still it will be disruptive & exhausting. We’ll see.

I am coming to the conclusion that my respiration & my CPAP therapy is being negatively affected by the doxepin in my body. And there's not a damned thing I can do about it. I cant just stop taking it like I would if it was some other drug. I go to bed feeling OK, I think I'm in a window now. I go to sleep just fine. But I awaken later in the night feeling pretty rotten. Hard to describe the sxs: whole body pain & stiffness, thick groggy headed feeling, often with a headache, somewhat woozy. Feels like my breathing just isn't right despite my SPO2 saying 94-98% upon awakening. HR is normal. I get up, am unsteady, stiff and exhausted on my feet only to start to feel better after I'm up moving and have some breakfast. I don't know how to change what's happening. I figure its either going to get better on its own or I'm not going to wake up some morning.