I worked my way up to 40 mg. I started at 10 mg and initially experienced some dizziness, but that quickly passed. I've been on 40 mg for about 2 years. If I'm having a hard time falling asleep I will sometimes take an additional 10mg. Other than the initial dizziness, I haven't really experienced any side effects. If your are experiencing AM fatigue, you might want to try taking it earlier in the evening.

I had a hard time falling asleep at under 40mg. I already take it 3 hours before bedtime, but I could still pry myself from the pillow in the AM. The most bothersome is the jitteriness (anxiety) at 50mg and the shakiness (tremors). It's really embarrassing to have a sales clerk help me dig the change out of my hand. I wonder if they think I was on a bender the night before. LOL. Being in public makes me worry that I WILL have the shakes, too. The shakiness is worse in my non-dominant left hand, but the shakes still can be bothersome even at home (try holding a glass of water). When I see my Neuro next month I'll probably ask to give the Amitriptyline a try.

Did I mention that when it's hot & humid the sweat also pours out from under my baseball cap? That's still something I can deal with, though. I had lesser tremors before I quit smoking 6 years ago (Chantix). The PN came just over 2 years ago.