Have you tried alternating patch days? I've done that when the Emsam was too activating I'm bipolar so it can cause mania if not cautious). I've also cut patches to get a custom dose. When I was really manic last year we did 3 mg every other day (I wore the same patch 2 days I think; can't remember for sure) and that was cut down from 9 mg patches. Then I cut them diagonally to get 4.5 mg patches for another long time. When I got depressed I went up to 12 and since I get my patches through patient assistance and can't change the dose easily I was cutting a patch and making 12 mg. That worked until I was IP and they had to use the 9 mg patches (my hospital doesn't stock Emsam so I provide my own).

Despite some struggles with sleep (I take 1200 mg of gabapentin and 350 mg of clozaril plus 2 mg of klonopin at bedtime but that's more my bipolar then Emsam) I've been on it nearly 7 years and love it. It's been one of the few ADs that ever did anything for me. It just takes some creative dosing.