Bipolar 2 From Inside and Out

Posts tagged ‘insomnia’

To Sleep, Perchance to Sleep

Sleep is tricky when you’re bipolar. Depression equals too much; mania, not enough. There seems to be no Goldilocks zone.

I’ve been bouncing back and forth between oversleeping and not sleeping enough. Some nights, I lie awake until 3:00. Other nights, I go to sleep at midnight, but wake at 3:00, unable to get back to sleep. No matter which pattern starts the day, I invariably fall asleep while talking to my husband or watching TV, not even aware that I’m doing so. (We call these “kitten naps” instead of “cat naps” because my husband says I look like a kitten falling asleep, my head getting lower and lower until I fall on my face and am more or less sound asleep.)

I don’t know for sure what is causing my broken sleeping patterns, but I have a few suspects.

Meds. My psychiatrist has prescribed me a sleeping pill. It used to be a script for 30 at a time, so I could take one every night. Now I only get 15 per refill, so I can, technically, take them only every other night. The problem is that I don’t know on any given night which sort of night it will be: One when I fall asleep naturally and wake up in the middle of the night, or one when I can’t fall asleep and take kitten naps all day.

If I could predict, I could take a sleeping pill on the nights when I can’t get to sleep at all. But taking one after I’ve been asleep for a few hours doesn’t seem like a good solution, especially since I can’t take one every night.

My not-very-good solution has been to put one sleeping pill into every other day’s section of my pill caddy, never knowing which sort of night I will have. The sleeping pills don’t appear to have any effect at all on these odd sleep patterns, however.

Stress. Stress is another likely culprit. Things have been coming down hard and heavy lately. My husband has cataract surgery tomorrow morning, and that same afternoon I have Wound Care Clinic for a lesion on my heel. Dan needs me to drive him home from the surgery and both to and from the next day for his follow-up. I have an appointment that afternoon with Dr. G., my p-doc, so at least we can have a chat about my sleeping patterns and my meds.

Schedules. I work at home, but Dan has a regular job. I say regular, but I only mean 40 hours per week. How those 40 hours are divided up is crazy. Some days he goes in at 10:00 or 11:00 and gets home at a reasonable hour to have dinner together. Other days he works from 1:30 to 10:00, which means we’re both dead tired when he gets home. These schedules are not conducive to any kind of relaxing time together. When we’re awake at the same time, we usually have to talk about household business matters rather than anything we could bond over. Our meal schedules are irregular too, which can’t be helping my circadian rhythm. His days off are Monday and Tuesday, which is why all our appointments and errands are clustered there.

Pain. That lesion on my heel is a result of edema and a blister that burst. Right now it is the size of a quarter and looks like raw meat. I am told that it used to look worse and be bigger. Either way, it hurts when I have to walk on it, which is every day. I can only take Tylenol for it. I do have some stronger pain pills, but I can’t take them because I’ll have to drive Dan home from his surgery, and the drug takes five or six days to clear my system.

What to Do?

Dan’s work schedule is a given. There’s nothing to be done about it. The medical problems won’t back off for a while, as Dan has another eye that also needs to be operated on, with all the pre-surg and post-surg stuff lasting until just before Thanksgiving. My wound is healing, but very slowly, as I have to walk on that heel or use a wheelchair, so Wound Care Clinic will also continue for I don’t know how long. And who knows whether Dr. G can do anything for my screwed-up sleep patterns?

All I can figure is to keep going as we are until something lets up. We’ll manage somehow. We always do, together.

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mental health

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Mania, Overthinking, and Costa Rica

I’ve had a bad spell of overthinking lately. It’s related to a bad hypomanic episode that I had lately. I had it in my head that my husband and I needed to move to Costa Rica. Of that I was sure. (Why Costa Rica? Of that I wasn’t sure.) What I couldn’t decide was whether we needed to go to Costa Rica for a week or two to scope out arrangements before we took the proverbial plunge.

At first, I had been exploring whether there was any real estate for rent at a reasonable price in or near the town of Grecia, which I had somehow fixated on. (Why Grecia? Again, not a clue. That’s about the last thing I’d need to decide and arrange for if we were to move.) I was researching the cost of living, the health care system, and the cuisine. I was practicing in my head the Spanish that remained from my high school days, supplemented by “essential phrases” that were listed online. I looked up what papers were needed and how long you could stay on a temporary visa. I checked on whether we could bring our cat.

It kept me awake at night. After I take my nighttime meds, I usually read for about a half hour before I shut down my brain and try to sleep at night. But I had no such luck. The arrangements, the language, and the travel all occupied my thoughts. I would give up on sleeping, try reading for another half hour. Then the cycle would start all over. For the first time in a long time, I need sleeping pills—the 10 mg. ones. Even then, sleep didn’t come easy.

My husband pointed out that maybe it would be better if we went to Costa Rica for a week or two to see how we liked it before we made the move. Instantly, my mania switched in a different direction. I began working with a travel consultant on what cities or attractions (in addition to Grecia) we might like to see. Anticipating a chunk of money coming in (another manic fantasy), I researched flights, even selecting flight times and layovers as well as costs. I selected dates, then revised them based on seasonal prices. Again, I couldn’t sleep for running over the arrangements in my head.

At last the mania and the planning eased off. The fantasy funding fell through, as I should have realized it would. Along with it, my mania retreated and my overthinking stopped—at least for the time being. My overthinking backed off too, at least on the subject of Costa Rica. Now, what I have to overthink is my writing assignments, which seem to have multiplied while I wasn’t looking. I’ll make money, but not enough to get me to Costa Rica.

At any rate, I’m happy to say that I’m back to where I was before the mania and the overthinking—back to sleeping without sleeping pills, anyway. Now all I have to overthink, besides the writing, is our upcoming trip to Florida, which provides plenty of fodder. I’ve prearranged everything I can think of, but I’m sure there’s something that I’ve forgotten or that is completely out of my control. And I hate that feeling. It leads to other things that are out of control, like thinking and mania.

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mental health

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Why Can’t I Sleep? Why Can’t I Wake Up?

Image by fizkes

Often in the past, I went to bed at my usual time but woke up at 4:45 a.m. and couldn’t get back to sleep, no matter what. It was like I had a hamster on a wheel inside my brain.

Other nights I would go to bed early and couldn’t get to sleep for hours. I tried reading, but sometimes I read till 2:00 a.m. with no sleep in sight. (I know you’re not supposed to read when you want to get to sleep because it activates your brain, but it’s been my nighttime habit for decades. When I find that I am reading the same paragraph twice, I know it’s time to knock off and fire up the CPAP machine.)

Then again there are days when I feel the need to nap in the early afternoon. I try to resist, but if I give in, there are no refreshing catnaps for me. I’m down for two and a half hours typically. Then the whole sleep-wake cycle gets off course.

And when I’m in the middle of a depressive episode, I’ve been known to stay awake all night, obsessing and catastrophizing. There are also days I can’t get out of bed in the morning, or all day in some cases, though I don’t usually sleep well after them.

What is it with all the sleep disturbances? Well, I have bipolar 2, so that may have something to do with it. An article published by the National Institutes of Health (NIH) says, “Sleep disturbance is a core symptom of bipolar disorder. The diagnostic criteria indicate that during manic episodes there may be a reduced need for sleep and during episodes of depression, insomnia or hypersomnia can be experienced nearly every day.” They also note that insomnia and hypersomnia are early warning signs, or “prodromes,” of a bipolar episode occurring. In fact, sleep disturbance is the number one prodrome for mania, and is recognized by approximately 80% of those suffering from it as an indication of an impending episode.

Webmd discusses a number of ways that bipolar disorder is associated with poor sleep: either insomnia or hypersomnia (over-sleeping); decreased need for sleep; a circadian rhythm sleep disorder; REM sleep abnormalities which can affect dreaming; and co-ocurring sleep apnea (around a third of people with bipolar also have sleep apnea, which is associated with excessive daytime sleepiness and fatigue). Bipolar meds have also been known to affect sleep-wake patterns, as well as co-occurring substance abuse disorders.

What are the consequences? Sleep deprivation has demonstrated detrimental effects on cognitive functioning, particularly in teens and young adults. This has been observed in performing psychomotor vigilance tasks, working memory tasks, and cognitive processing tasks. No wonder a series of sleepless nights can result in a foggy or fuzzy-headed feeling!

Unfortunately, the advice given for how to counter the effects of sleep disturbance in bipolar disorder is almost indistinguishable from the advice given to the general population, such as incrementally moving bedtime and waking time until the desired period of sleep is reached; and not using electronics such as computers, cellphones, and TVs near bedtime. Some preventives that have worked with bipolar patients have included bright light therapy in the morning and the use at bedtime of supplements containing the naturally occurring hormone melatonin that the body releases in response to darkness.

My own experiences with sleep deprivation and bipolar disorder have been a mixed bag. For many years before I was diagnosed, I was subject to the difficulties caused by shift work, either third or second shift. (When I was on second shift, we sometimes extended our sleepless periods by playing cards or midnight miniature golf after the shift was over.) Third-shift work made me too tired to drive safely, especially if I was also working first shift the next day, which sometimes happened. My husband pitched in and picked me up on those days. My friends knew never to call me before noon.

For a while I took a prescribed sleep aid, but sometime during the last year realized that as my sleep-wake cycle was regulating to a more “normal” pattern, and that the sleep I got without the meds was more refreshing and conducive to clear thought in the morning. So I quit taking it, with the approval of my psychiatrist. Even though I work at home and make my own hours, my work schedule has become predictable as well. Now I wake around 6:00 or 7:00 a.m., check my emails and timeline, have some breakfast and start my work (when I have some). I break for lunch, then resume work in the early afternoon. (And pray I don’t get any more work that day, as sometimes happens.)

As for getting to sleep, it’s usually not a problem (except when it is). Any more, I take my nighttime meds, read for about 30 minutes, and drift off to sleep normally. I usually only need a nap if extra work requires that I stay up late in the evening or get up very early in the morning.

So, does “Sleep, that knits up the ravelled sleave of care,” as Shakespeare described it, exist for people with bipolar disorder? I’d say, not for everyone, but when it does, it’s always welcome. We all have our various sorts of “ravelled sleaves” that need tending to.

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mental health

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The One Pill I’m Embarrassed About Taking

I know that there are lots of people – and not just the bipolar ones – who don’t like taking medication and especially don’t like needing to take them. It’s a reminder of their illness, I guess, or a dependence on a chemical answer when we’ve been told for so long, “Just say no to drugs” and indoctrinated by DARE. The only thing they leave out is that some drugs are good for you – the prescribed ones that allow you to live and function.

I don’t mind my psychotropic medications. In fact, in many ways I love them. They are the things that keep me relatively stable, on a mostly even keel, and make sure that none of my mood swings lasts more than a couple of days. I loathe pill shaming and consider it just one more kind of stigma that attaches to mental illness (and other chronic illnesses).

But there is one medication I take every day that gives me pause. It is my sleeping pill. My psychiatrist prescribes them and I take one every night, along with my other nighttime pills. In about 20 minutes to an hour, I’m asleep, and I stay asleep usually until 8:00 a.m. or so. It means I get about eight or nine hours of uninterrupted sleep per night.

I do need that sleep. I’m not one of those people who can function on four or five hours of sleep, the way tech geniuses and high-powered execs claim they can. If I don’t get my eight hours – and sometimes even if I do – I take naps during the day. Not just naps: mega-naps. My brain and body sneer at 20-minute catnaps. If I’m going to sleep, they say, it must be an hour at a minimum. Two is even better.

It’s not like I want to go back to the days before the sleeping pills, either. I do still remember the long nights of fear and sorrow, the fits of crying, the panicky sensation of not being able to breathe. The endless mental replay of every stupid thing I’ve ever done. The anticipation of the disasters the next day would bring. The hopelessness and the helplessness and the loneliness. The feeling that I was the only being awake, maybe in the world. If a single little pill can save me from all that, I should be glad to take it.

Why, then, does it bother me?

Perhaps it’s because it doesn’t feel necessary in the way my psychotropics do. They are prescribed for my bipolar condition and somehow make the difference in how my neurotransmitters operate. The sleeping pill feels like a different category of drugs.

Or perhaps it is because sleeping pills are often a drug of abuse and even suicide. My psychiatrist trusts me with them, though, and has for years. Plus, my anti-anxiety med is also often abused and I feel no guilt about taking that.

Maybe it’s because a sleeping pill feels in some way like a luxury. I don’t think it does anything specific for my bipolar disorder – except that sleepless nights are certainly associated with depression and my middle-of-the-night anxiety as well.

I hate to think it, but maybe the pill-shamers have gotten to me. I take such a cocktail of assorted psychotropics that it’s perhaps natural I should ask myself every now and then if I’m overmedicated (my doctor doesn’t seem to think so) and whether I could do without any of the drugs. The sleeping pill is the only one that might be in that category.

But no. I don’t want to go back to the nights of distress, despair, and devastation. I don’t want to wake my husband up as I gasp for breath and need him to stroke my hair until I fall asleep. And I surely don’t want to go through those bad feelings all alone in the night while he works the third shift.

All in all, I think the sleeping pill is a good thing for me and that I shouldn’t try to give it up. I just wish I didn’t feel so ambivalent about it.

 

 

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mental health

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The Lighter Side of Insomnia

I’ve had insomnia. Lots. January seems to be an especially bad time of year for me. A sleeping pill reduced the frequency, but nothing banishes it completely – the obsessive thoughts, the catastrophizing, the worrying, the worrying about how worried I am. We’ve all been there at 3:00 a.m., trying to will ourselves to sleep.

What could possibly be light-hearted about that?

Just this: An actual x-ray of my insomniac self:

T-shirt by Headline Shirts. Photo by me.

Indeed, my friend Leslie and I, both afflicted with insomnia, recognized this as our mutual problem. We began to end our late-night commiseration with the sign-off, “Death to Hamsters!”

Our mutual friend, the incomparable, incorrigible Tom Smith, heard of this and ran with it. Here is the result, for your amusement.

Imagine, if you will, this performed as a sing-along with a hundred people joining in on the chorus. It may not put you to sleep, but at least it puts insomnia in some kind of loony perspective.

At least it does for me.

Notes:

No hamsters were harmed in the making of this blog post. A rubber duck may have been squeezed, but it had nothing to squawk about. So if you’re with PETA, chill already.

Lyrics to Hamster Brain available here: http://www.tomsmithonline.com/lyrics/hamster_brain.htm.

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mental health, Uncategorized

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