day 50.

It would seem that there are officially some changes afoot with the 15mg Remeron/mirtazapine experiment. Nothing to be concerned about (unless TSF's recent 80-day disappearance is in any way related to a similar "efficacy reduction", since he was one of the inspirations for my choice of medication, ha), just making some notes here in case any other insomniacs are following the breadcrumb trail (and for my own breadcrumb-following, here's that dosage thread I keep losing).

About a week ago (so around Day 42 or so) I came down with some kind of flu, one of those that you seem to feel deep in your bones as well as in your forehead and sinuses, and the aching in my legs started to wake me up at night. Plus I couldn't breathe out of my nose so I was snoring/wheezing and probably waking myself up via that awesomeness as well.

During the second night of that, being awake at 3am or whatever, I suddenly had a feeling I hadn't had in, well, weeks: I felt like "myself". It was like something snapped back into place that had been knocked loose, or, yeah, maybe I felt "switched on" or something. Almost immediately I felt like my empathy circuits were fully functioning again, which has its definite pros and cons, but I think this is the main component of whatever difference there was/is.

And since then, I haven't slept through the night. I'm pretty sure it's not because a week ago I suddenly decided that the meds weren't working any more and so now it was time to go back to being miserable between 2am and 5am; I'm not actually very miserable and I'm not being consumed with horribly anxious compulsions...I'm just awake.

I think a huge part of not being miserable about it is that 1) my mornings are thankfully, luxuriantly, completely (and purposely) obligation-free at the moment and 2) it truly helps immeasurably to know that if I absolutely need to sleep, there are options that seem to work infallibly thus far as long as I continue to seriously restrict their use (I'm talking about 0.5mg lorazepam, 15mg oxazepam or 7.5mg Ambien), and by restricting their use I mean using them once a week at most.

So the next decision is either reducing or increasing Remeron dosage by 7.5mg (so either back down to 7.5mg or up to 22.5mg). I know this doesn't appear to make any sense, but calculating a relevant dosage is complicated by Remeron's dual function as sleep aid and antidepressant: it seems that the sedative and antihistamine effects are more prominent at lower dosages, and as you get closer to 30mg the antihistamine backs off and the antidepressant effects kick in, which can also facilitate sleep. I'm imagining/idealizing the difference as either being brained by a truncheon (a la the past six weeks) or drifting off to "healthy, natural sleep" (ahem).

Of course, as all experienced ducks know, increasing one's dosage of something/anything most likely brings one closer to that something's eventual lack of literal or conceptual efficacy. So the next bit of concrete planning involves either 1) do nothing and wait and see what happens if I eliminate alcohol completely for a while. Or, 2) a doctor visit on Monday to see which direction she'll suggest, though I think I already know. And I guess I'll agree in advance: maybe it's better to push forward a little more before retreating. If I do indeed feel more "like myself" right now, I feel like a very stable, pretty rational and semi-peaceful version of myself, which I would say is no small improvement.

+++