Positives

• Patient reviews on Drugs.com show mirtazapine averages 7.1/10 across 531 reviews for off-label insomnia use, with 59% reporting positive experience; some patients describe getting a full 8 hours and feeling like “a new person simply because my body was getting rest” Drugs.com.
  
  
• Patients on Mayo Clinic Connect describe mirtazapine helping them fall asleep faster and stay asleep longer, often when other sleep aids had failed Mayo Clinic Connect.
  
  

Negatives

• A documented case report describes a patient with post-COVID sleep disturbance who fell asleep on mirtazapine but developed severe agitation and uncontrolled nervousness, ultimately requiring discontinuation PMC.
  
  
• 19% of Drugs.com insomnia reviewers report a negative experience, most commonly weight gain (often 10-20 lbs over months), excessive next-day grogginess, and increased appetite Drugs.com.
  
  

Hurdles & Side Effects

• Patients commonly report sedation, weight gain (especially at 30-45 mg doses), increased appetite, dry mouth, and metabolic effects worth discussing with prescribing clinician, particularly for those with overlapping dysautonomia or metabolic concerns WebMD.
  
  
• Mirtazapine generic is widely available at $10-30/month with most insurances covering it; specialists often recommend starting at 7.5-15 mg at bedtime since lower doses are more sedating than higher ones Drugs.com.