When do you recommend a patient with rosacea use mirvaso?

I have used Mirvaso before and had horrible rebound flushing. However, I am having more and more severe facial flushing that is almost constant. I have heard that if you get rebound, you should just reapply the mirvaso. However, I have also heard that mirvaso loses efficacy over time, and eventually it has to be applied every couple hours to get the same effect. Sometimes it even stops working altogether. This seems like a vicious cycle to me, but I am desperate at this point. Please advise.