Help! Insomnia - 20 mg Amitriptyline stopped working

[Frankbutchersfangs]

Dear all,
Posting here for the traffic...not an AIBU..

Anyone got any suggestions/advice? Since September 2020 I have had intermittent insomnia. In the September of 2020, I had three whole nights where I just could not get to sleep at all very suddenly. After those three nights I was able to sleep. Then it re-occurred but it wasn't getting to sleep that was the problem, it was waking up and then going into a very light/unrefreshing sleep that was the problem.

This carried on until August 2021 when I went to the doctor to have my FSH levels tested (I'm 44 now) and the GP said my FSH levels were normal (so not perimenopausal/menopausal) and suggested a prescription of Amitripytline 10 mg. 10 mg only worked for about two weeks, then I upped it to 20 mg which has worked up until the last month; so have been on the 20 mg dose a year. Now I am back to where I was in 2021. I am loathed to increase to 30 mg as I feel as though when do you stop? Do you carry on increasing and increasing the dose until you're on a very high dose just to get to sleep?

I am certain it is my age, being 44 and being the sort of person that prior to my 40s could sleep at the drop of a hat. I am not anxious/depressed - my home life/work life is happy and steady. But my body just does not seem to want to give me a full night's sleep. I need my sleep because I am studying for a degree in my spare time and lack of sleep means I don't take in the information very well.

Has anyone got any experience of taking Amitriptyline for sleep related issues? Did you have to up your dosage? If I knew that I could up my dose to 30 mg and it would keep insomnia at bay for a good number of years I would do so. But what I don't want is to up the dose and then have to keep upping it and upping it.

If anyone has got any suggestions I would be really grateful. I take all the usual sleep hygeine methods already (e.g. cut out caffeine, sugar, not eating late, avoiding electronic devices and exercise every day). I have read about Melatonin on here but it has mixed reviews. Help, anyone?

I couldn’t sleep on less than 100mg. You need to up your dosage.

At 44 l could sleep on 50 mg. After menopause l couldn’t sleep on less than 100mg and sometimes struggled on that.

Thanks for your reply. It's scary to think that we have to keep upping and upping the dose. When will it ever end? When do people just come out of this stage and naturally start sleeping again? Or is this it for the rest of our lives, relying on sleeping aids just to get a good restful sleep!!

Well l never sleep without some sort of medical intervention.

l didn’t have to keep upping and upping though. 100mg was generally fine. I never slept in 20 or 30 though.

I recently got Zopiclone with is like a benzodiazepine. I would avoid anti-depressants for their other effects and stick with a benzo or non-benzo. It really, really helped! One of them I was out like a light no matter what.

And since it's only intermittent it would probably work for a good while.
I got 14 tablets. It helped through a period and I no longer use them. But would keep them on hand for bouts of insomnia if I expected to get it again.

You could also try Piriton which knocks many out, including myself.

You could also go for a strong valarian which could help.

Yes Amatriplin wears off after a while what dies your doctor say?
Best to discuss it with them.

I didn’t find it wore off.

I have been prescribed it for neck pain and take 10mg of it at night and it helps me to sleep.
I do find it stops working after a while and I am reluctant to increase the dose so I tend to stop it for a few weeks then go back on it and it seems to be ok again.

Interesting replies, thank you. Has anyone tried Melatonin and found that this works? I am willing to try anything at this point. Also, if you have tried Melatonin, what dose is best and where do I buy it from?

Really AITCW? Did you not even sleep very well when you were younger?
Do you have any side effects from the higher dose of Amitriptyline?

I had four months of insomnia last year. I went on Amitryptiline as was having bad migraines. Even with 20mg I didn't sleep. I added 600mg N-acetyl cysteine before bed and straight away started sleeping again. I'm up to 30mg ami now and still take the NAC before bed and am asleep in minutes/ seconds most nights. I only struggle if mid cycle for a couple or nights or if really stressed about something e.g. an argument with DH. You can get the NAC on amazon. This is the article I read about it which made me try it.
schoolafm.com/ws_clinical_know/insomnia-relief-for-night-time-racing-mind/

Hey @User963 thanks for your reply. Did you find that you quickly got used to 20 mg and needed to increase to 30 mg quite quickly? I will look up the N-acetyl cysteine, thank you for the suggestion.

@Frankbutchersfangs no I slept fine with the 20mg Ami and NAC for months. I only increased to 30 as it wasn't helping my migraines. It still doesn't really but I'm not sure about increasing it further as hard enough to wake up with 30mg as it was.

What I meant was that whatever was causing my insomnia (which I think was physical rather than mental) seemed to be cured by the NAC. When I had the insomnia none of the drowsy medications like antihistamines or amitriptyline helped with the sleep. Once the NAC shifted my brain glutamate/GABA pathway back to normal drowsy medications started working again.
It probably depends on the cause of your insomnia though. Mine was covid related I think.

I found the Amitriptyline wore off, too. Unfortunately, upping the dose beyond 50mg just makes me really dopey - it doesn't help me to sleep properly at all.

Can't comment on the actual drug but sounds like your body has built up tolerance. I have this with dioxizosin for ptsd sleep issues. I have to come off it for a week and deal with the Insomnia/sweats then start a lower dose again and build back up to 16mg (I can take up to 32mg but my body can't cope the next day and I feel like a zombie). So essentially I get a few weeks OK sleep and a week of hell but it works for me.

If I could have zopiclone every night that would be great!!