Tag Archives: insomnia

the mania/insomnia symbiosis

I am no stranger to insomnia. I’ve experienced the overactive brain induced insomnia, the straight up fear and adrenaline based kind (airplanes are notorious for producing that for me), even insomnia formed by a series of horrible nightmares and my body and mind developing a fear of sleeping.

Typically, though, the type of insomnia that tends to really sneak up on me (and especially in the summer) is the kind where I’ve missed my sleep window and can’t reclaim it.

My energy level is very rarely a straight line, it is more often a series of peaks and valleys, and their intensity seems to be associated with my mood swings, diet, and anxiety or excitement, among other things. I have found that for my situation, going to sleep in the evening at the first sign of tiredness has typically been the only way for me to ensure I get to sleep. The problem is that this energy trough might occur at 6 pm (right after I’ve eaten dinner) and the best case scenario would put me in a position to wake up the next morning at 6 am. Once that energy lull passes, I can find myself wide awake again -thus unable to sleep.

I’ve always needed a lot of sleep. More than most people. 12 hours tends to leave me in the best emotional position the next morning, but 10 hours can be manageable.

Missing my sleep window because of anxiety or outside forces (loud neighbors, hot apartment, unfavorable reactions to medications, etc.) might mean I only get 7 hours, sometimes less. That might be sustainable for a day or two, but the longer I go without sleep, the more symptoms of mania I begin to acquire. The more symptoms of mania (even hypomania) I acquire, the less likely I am to be able to sleep the next night.

This fuel might be racing thoughts, or a huge spike in energy, or euphoria (where feeling good seems to counteract the idea of sleeping) among others. Regardless, these traits begin to mix with an increasing fog that sets in from insomnia. My actions start to feel like they matter less, since the fog distorts any of the negative consequences that might be on the horizon… leading to impulsive and relatively irrational decision making. That poor decision making might include missing my next sleep window, when one (rarely, with hypo/mania) occurs.

Keeping my mood under control begins to feel less important, as my sudden frequent crying spells also begin to alternate with fits of hysterical laughter can’t contain… and though there is an audience at the grocery store as I have a laughing fit so severe I am crying and sitting on the floor, it just makes me laugh harder because their concerned faces look increasingly hilarious to me.

Insomnia makes me feel like I am doing a better job of managing my mood swings even though I have had several outside opinions that this idea is not true. While I definitely become more reactive and my swings can land in rapid succession (as they do normally for me, many in a day) my perspective on this situation varies largely from an outside opinion. An outsider might argue I am more difficult to manage (since my brain seems too tiered to bother with trying to negate my impulses triggered by mood swings… well, and the fact that I begin to express everything that crosses my mind, even to strangers) but the euphoria I experience makes me feel that I am doing a great job of taking care of myself, and the fog that has come from not sleeping makes every moment that isn’t the present seem long gone. Out of sight, out of mind.

Ultimately, I find that insomnia may not be the primary trigger of mania on all of the occasions that I experience it, but it does typically perpetuate manic and hypomanic symptoms for me in a symbiotic way.

The less I sleep, the more manic I become.

The more manic I become, the less I sleep.

 

Advertisements

Attempting Hormonal Therapy with Mixed Emotional Results

I know I have been somewhat MIA the last couple weeks, but here is a quick rundown of my current situation and how things have been faring.

It looks like some (if not all) of the GI problems I have been having since trying Seroquel (all of which are still present even after almost six months of stopping it) are potentially due to a hormonal problem triggered by the drug. After having an endoscopy (having a camera put down my throat to inspect my stomach) and a colonoscopy (same thing, only in reverse… and with significantly less dignity) the result was that the doctors could find no reasonable cause for the intense amount of pain and other odd symptoms I have been having.

After everyone scratched their heads for a while I did some of my own detective work and I went to see a gynecologist. She recommended hormones. I started taking them two weeks ago… and the result was pretty much exactly what I expected – the same sort of response I have had to pretty much every drug (even the flu shot) the last couple years.

A bad reaction.

You see, not only do I experience a treatment resistant, very sensitive, easily triggered version of bipolar disorder (type 1), most medications I have tried (even something as simple as a nasal spray) have triggered big problems for me either by making my emotional state completely deteriorate and triggering a big bipolar episode, or by triggering significant side effects (which generally just go on to trigger more bipolar episodes).

So on day 5 of hormone treatment when I began crying uncontrollably for an entire day I pretty much knew it was the end of that road, but I kept taking the drugs for two more days (just to be sure it wasn’t my own rapid cycling). Nope, by day seven I had become completely engulfed in suicidality and promptly called the gynecologist’s office to inform them and stop taking the new hormones.

Stopping the hormones suddenly was also a problem. Within two days I was no longer in the throes of depression, but instead I became manic and couldn’t sleep for three days.

I had another appointment with the gynecologist yesterday to try and figure out what to do next. She recommended another form of hormonal therapy (with significantly fewer hormones) which I started last night. Personally, I don’t expect this to end up any different than the last round, but I am willing to give this treatment option a shot because my only other option is surgery… which, frankly, scares the bajeezus out of me a little bit.

Like my continuously evolving trial of medications to potentially treat my bipolar symptoms, after hearing about my experiences the doctor concluded that I am very brave for being willing to try hormones again. It is my belief, however, that bravery and desperation can often look a lot alike from the outside looking in…

At any rate, that would be what I have currently been up to. I am sure the mania was also partially fueled by the fact that it has been summer-time weather (sunshine in the 60’s) in Seattle last week, the total opposite of what normally goes down here in January. It seems weather like this could make for an entirely different kind of winter than I am normally used to (30+ days of rain in a row potentially ending in a depressive hospitalization). Mania has its pitfalls, but honestly there are times (like the winter) where it just feels nice to have a little variety.

I expect I will know pretty soon if I will be able to tolerate this new drug, ironically enough it has the potential to alleviate my lactose-intolerance that started when taking Seroquel, however the pills themselves contain lactose so taking it so far has not been a fun ride. Really, just the fact that I have found a doctor who has found evidence of a diagnosable problem after six months of doctors being unable to give me any kind of answers has been encouraging, even if the treatment options do turn out to be somewhat torturous.

In my life, a little hope can go a long way.

One Good (Manic) Turn Deserves Another

The last thing my (ex) therapist said to me (jokingly) was,

“…and I never got to see you manic!”

In my depressed state I shrugged and replied,

“it is rare these days… euphoric mania, anyway. It hardly ever happens anymore, frankly I can’t even remember the last time it did.”

Little did I know, within a week I’d be hunkered over my chest of drawers urgently rearranging my shirts because, well, is it better for them to be grouped by print or by sleeve length?? And, no, no, no, the underwear needs to be arranged in descending order of favoritism and then by color!

As much as I would like to say I saw this swing coming, I would be lying to you. Generally I would say I have a tendency to become manic in October, however I find that when I say that ahead of time it never actually occurs.

This time around I think I would like to blame the aggressive head cold that has been going around for my lack of catching the warning signs. Normally euphoric mania comes on largely in a physical way for me first, but I can’t say I felt any kind of awesomeness, electric humming, or skin-crawliness that I normally experience until much later on. This time around (because of the cold) I felt sinus pressure, ringing ears, a sore throat that lingered on much longer than I anticipated, and initially much more lethargy than I normally would when mania strikes. By the time I started to realize things were getting out of control it was a bit too late to divert it.

Of course, in hindsight I can say, “ahhhhhh, ok,” to the series of odd and rather impulsive actions that led up to my frantic laundry situation and subsequent hours of laying in bed awake, chest pounding, having rapid conversations in my own head. One would think I might have had a clue when the series of somewhat depressing situations I’ve found myself in lately became increasingly hysterically funny to me, or when I stopped each of five consecutive movies I was trying to watch halfway through because I no longer felt interested (and then the only movie that did hold my attention was The Silence of the Lambs), or when I cut all of the instances of the number “2” out of a cosmo magazine to see which one was “the best,” or when I spontaneously maxed out my credit card buying tickets to see The Who. I was even having trouble writing, many of my sentences were coming out backwards.

Contrary to popular belief, these are not things I normally do. I’m the kind of girl that usually just likes to wad her shirts up in a ball and shove them in the drawer, or look at the prices and fluid ounces of every bottle of shampoo in the store to make sure I am getting the absolute best deal before buying one. I know I usually claim I don’t do the “spending” thing with mania, but apparently this was an exception. (Boy, I hope I’m not inadvertently picking that habit up!)

To be fair, I think normally these are things my boyfriend would probably notice, however he was out of town for work all last week.

The episode seems to have peaked Saturday night and then turned to the dark side, leaving me experiencing four swings of “crazy girlfriend” type, hostile-agitated-mixed chunks appearing between mildly euphoric moments throughout the day.

I’ve been having trouble getting my thoughts together long enough to complete anything I’ve been trying to write, but I have a few ideas that I hope to get down soon. Thankfully I have been lucky not to experience any psychosis in the last week (knock on wood), however the sort of hostile, “I hate you” mood swings I’ve been having haven’t exactly been a walk in the park either.

I have my intake appointment with my new psychiatric clinic on Friday (hooray!) and though they are usually somewhat grueling, I will be happy to have someone around to help me untangle the big ball of emotional spaghetti in my brain again.

More Rest, More… Butter?

Very quick update.

Please do not be offended if I do not answer your calls, texts, or emails in the next few days. Between the physical illness I’ve been having and intense insomnia I have stumbled into a place of extreme irritability, confusion, delusion, and paranoia.

Yesterday I shampooed my hair three times because I couldn’t figure out which bottle was which. I also snapped at my poor old granny on the phone, which is why I am instigating a period of Sarah-radio-silence until I can talk like a civilized human being to people again. Or, at least, civilized-ish.

On the upside, after some really fun biopsies of my stomach lining I do not have celiac disease (thanks doc!), I have finally slept four hours in a row (thanks benadryl!), I’ve been enjoying a John Cusack movie marathon, and I ate 1/8 teaspoon of butter this morning on an otherwise very dry bagel (weee!). This is huge progress (especially since I spent a big chunk of time earlier this week doing more vomiting) and I hope it means I will soon be able to stop putting olive oil and salt on my noodles and eating with my eyes closed pretending it is butter.

Once I get better at the not-hating-everyone bit I should hopefully be on my way to recovery on all fronts (well, that and once intestinal infection is ruled out). Usually the emotional instability part takes a bit longer to catch up, but who knows… maybe if I drink enough smoothies I’ll start to feel peppier.

Wrapping Up the Seroquel Journey

Things with seroquel have gone from bad to worse to emergency status.

After lowering my dosage from 50 mg to 25 mg a couple weeks ago my GI issues seemed to get slightly better. The intense pain I was having subsided, and I was no longer running to the bathroom every thirty minutes. I took this as a sign that the bulk of the abdominal issues I’ve been having have been triggered by (and if not, largely fueled by) the seroquel.

I wanted to give the remaining 25 mg of seroquel time to let the side effects from reducing my dosage subside so I could see if 25 mg would still be causing me problems. After three weeks the nausea I was having in the evening started to grow. I found myself needing to pop a tums every hour, and then every thirty minutes, and then every ten minutes. I used pepto bismol and pepcid and drank ginger ale, and by the time I could see where things were heading, I tried to make an appointment with my GI doctor. That appointment still hasn’t happened yet, it takes place later this week.

Soooooo the only thing I could do was to contact my psychiatrist and express (quite urgently) that I needed to be taken off the seroquel completely. He consented, but by that time it was too late.

The nausea became completely overpowering, and I became so dizzy I couldn’t look at the television screen or even the screen on my phone without vomiting. My stomach pain (like the nausea and dizziness) grew exponentially and last Thursday I quickly found myself in a situation where it had been 24 hours since I could keep water or food of any kind down.

My doctor had given me some anti-nausea medication that wasn’t working. By the time I got to the ER they shot me full of two more kinds that didn’t help. The third helped, but made me dizzy until I became nauseated again. Well that, and it gave me hallucinations.

By Thursday night I had only been able to eat about 600 calories total over the previous three days. I’d had three hours of sleep (because the nausea was so intense). And even though I’d stopped taking the seroquel the day before (after shit started hitting the fan so I knew this wasn’t a product of withdrawal) things continued to escalate for another 24 hours.

The reason I went to the ER was because after going so long without water (and subsequently becoming dehydrated) I knew I would need some fluids or I would run the risk of experiencing lithium toxicity again. That and I needed something to help with the nausea because I wanted desperately to sleep.

Two sacks of fluid via IV and (I think) three types of anti-nausea medication later (frankly I can’t remember a lot after the hallucinations took place) I asked them to let me leave. The staff seemed in no hurry to find “the cause” of my intense pain and nausea/vomiting and I wasn’t concerned about that because I largely believe it to be the seroquel. I also have that appointment later this week with my GI doctor anyway who knows my history and seems like a pretty smart lady, so all I wanted was something to help me make it through the week to the appointment.

Though I had expressed my theory about the seroquel, there were several other theories going around. Maybe an ulcer was to blame, or pancreatitis (which it isn’t, the test came back negative later), or any other number of things.

The concoction of medicines they injected me with in the ER allowed me to sleep for the first time in several nights, and while on Friday I was sill experiencing pain and extreme fatigue my nausea was improving. I also managed to eat half a bowl of soup, and a few crackers without incident.

By Saturday my appetite was slowly returning. I felt hungry for the first time in over six weeks (as the seroquel had suppressed my appetite over that entire time) and my energy and alertness were beginning to return. Though I was still having stomach pain and nausea, they were largely only taking place after eating and in the evening again.

On Sunday I felt relatively normal, despite only being able to eat very small amounts and being fairly dizzy upon walking around. The pain was still present, but again, mostly after eating and in the evening when my stomach is the most full.

I have been avoiding all foods that don’t mix well with ulcers (dairy, caffeine, pretty much everything I was avoiding before this anyway when my symptoms were getting worse) just in case an ulcer is playing some kind of role in this situation.

At this point just the fact that my symptoms have been improving like this (and within 48 hours of stopping the seroquel) I feel certain that if that medication wasn’t causing the bulk of the issues, it was at least feeding the fire. My issues seem to be receding now instead of ramping up, so either way I feel like I’m on top.

Goodbye Summer, Hello Relief!

As a child, summer was always a time to celebrate. After all, there was no school, no homework, and (if I was lucky) no real responsibility in sight. Unfortunately as an adult, my feelings about summer have changed dramatically.

The funny thing is, I know that in winter I’m complaining about Seattle winter. Dark days, the constant drizzle, and experiencing days, weeks, and even months sometimes without seeing that big yellow orb in the sky.

But now, as an adult, I am finding summer to be equally as challenging. While I admit it feels quite odd to feel so depressed when the sun is shining, the issue I have is with temperature.

Living in a cold corner of the country, we get excited when things warm up at the beginning of summer to about 65 degrees. By 70-75 degrees, people are sporting bikinis. The typical home in the Pacific Northwest however has not been built for true heat, so when things start getting into the 80’s and even the not-so-lucky 90’s there is a distinct lack of air conditioning that makes these temperatures more livable in other parts of America.

With that in mind, that is part of the reason I have been somewhat absent in the blogosphere through the middle part of this week. In addition to the knuckle-dragging depression I’ve been having, my medications (which seem to constantly warn me not to get “too hot”) make it even more difficult for me to cool down. Once I get warm, I can’t seem to cool off again very easily.

In the end, there is only so much time I can spend in a cold shower, or hanging out in an air conditioned grocery store before people start getting concerned. Even with windows opened strategically and every fan we own pointed right at me I was still averaging a body temperature of 100-101 degrees, and while the internet seemed happy to suggest I “sip a cool drink” I really wasn’t kidding anyone… the heat this week left me miserable.

Usually I can tolerate a pretty significant amount of misery before becoming agitated, but after three nights of waking up every thirty minutes due to the heat I was overjoyed to see some big, grey, poofy clouds this morning. I’m hoping a little cool air can help with my irritability and give me a chance to take a nap because frankly… I’m exhausted and I am well approaching the snapping point. I can’t really imagine how this lack of sleep has not triggered mania this week, maybe that is a sign of the tight grip depression has on me at this point? I don’t know.

I know in four or five months I’ll be eating my own words and I will be desperate for a little sunshine, but at this point, at the close of summer, I feel happy to hand over the keys of summer in exchange for the cold, grey, relatively stable weather of the rainy season.

Fixation Without Representation

As I went through my belongings in preparation of moving the last two weeks I found a letter that confirmed my suspicion. It was something of an intervention letter from my best friend in high school expressing her concern (and rightly so) for my apparent fixation and total inability to focus on the present -one of the symptoms that contributed greatly to my subsequent (first) psychiatric hospitalization.

The irony was that as I read the letter, I was experiencing a mixed/depressive episode (something my psychiatrist has nicknamed the “three quarters” episode comprised of three quarters depression and one quarter mania) with very similar symptoms as that first big episode.

I can’t claim to be an expert on the human brain or the human heart, or even to know much about which of my symptoms “lend themselves” to which diagnoses… what I can say is that in the realm of what I experience, fixation has been a big problem for me and has greatly contributed to some of the most torturous episodes I’ve ever experienced.

So bipolar, OCD, anxiety… it all feels irrelevant. When my mind and my emotions are one train on one track it seems futile to try to categorize the details. All I know is that the train is headed one way; toward self annihilation.

The fixation issue seems to come about most often when I find myself under a particular amount of scrutiny or rejection. While there are times someone might say,

“You’re being irrational and fixating on things,”

I can usually gladly follow the logic around how the person arrived at that conclusion. Being able to understand where that person is coming from, I can say, “why yes, I am doing those things. Thank you.”

The trouble starts when I am being insulted (and perhaps finding out about it later) or people seem to be going out of their way to attack me (or manipulate me) and I can’t find the logic in it.

An example I can throw out is from the first time this really took place, when my ex-boyfriend was stringing me along while dating another girl. His actions and words did not match whatsoever, and all I wanted, all I longed for, was to understand why.

My mind begins to obsess over every little detail. Every contradictory or accusational thing that has been said echoes over, and over, and over again in my mind, and the only course of action I can seem to take is to argue and plea my case against them.

This month I received some extremely bizarre (and untrue) accusations about myself that left me in the same position. Why would my ex-therapist (among others) act so nice to my face, and then write such bizarre accusations about me in her files? Why would the people I am trusting (the situation involved several others I’m not at liberty to disclose at this point) go out of their way to screw with me? How does attacking someone having a decidedly hard time help anyone?

The voices of all of these people banded together in my mind and took turns bashing me. Every second of every day it was all I could think about, and it was all I could do to argue with each voice, to try to contradict it, to try to stand up for myself… knowing my efforts were truly fruitless and that the voices wouldn’t listen, and even if they did, the relinquishment of their manipulation would only take place in my head (and not in real life).

This is a big part of the reason I couldn’t blog about anything. Every time I tried to write a blog post, I could only get one or two sentences in before the pleading would spill out of my head through my fingers into the computer. I was desperate to focus on something, anything else, but this was one situation where writing only fed the beast. I tried at one point just to write a personal piece about what I was thinking, the arguments, and what was happening. I stepped away from the computer seven hours later and still felt I had barely touched the tip of the iceberg.

Through all of this obsessing, I was angry. I was depressed. I couldn’t sleep because it was all I could think about. In a matter of days I was whittled down to a sharp point, extremely reactive to everyone and everything around me.

If the topic of suicidality in our culture is taboo, the topic of homicidality is taboo to the 10th degree. I realize this, but honestly the issue of homicidality is also one that will send me straight to the hospital much more quickly than most lingering thoughts of suicide will. It is something I have to deal with, and in these sorts of situations (mixed episode, feeling like my back is up against the wall, feeling like I am being attacked from all angles -including from within my own head) I become extremely concerned for the safety of the people around me. When I have spent all of my energy talking back to these angry, accusational voices… I don’t have much energy left to funnel toward self-control.

In a sense, I got lucky. Having that “three quarters” episode meant that I only really spent 1/4 of my time in raging attack mode, and these outrageously angry moments came at me in waves book-ended by the other 3/4 of my time in severe, suicidal depression. If those rage waves would have been any closer together (or longer in duration) I would have opted for hospitalization without question. As it was, I was on the fence… and only because I was supposed to move in a matter of days.

Personally, I think the sort of rapid cycling I experience makes hospitalization a difficult prospect because my mood can change several times just in the time it takes for the intake procedures. At the same time, when it cycles and I am in an impatient unit I quickly get the boot, which doesn’t help because it can quickly cycle back into a dangerous place (within minutes, hours) of being discharged. I’ve experienced a lot of frustration around this phenomenon and because of this it isn’t unusual for me to feel more upset upon leaving than I did when I checked in.

Through all of this, my psychiatrist has really been one person I feel that I can trust. He suggested I go home and wait it out, and I spent the vast majority of my time confined to the apartment until the rage waves subsided and switched exclusively to depression (minus the insomnia).

The end result felt a little counter-intuitive, because what ultimately seemed to help me move past the fixation (and I say that but it still comes and goes) was not talking about it. Not writing about it.

I mean, I tried those things at first (talking about it and writing about it) because those are two things that have always helped me feel a sense of relief in the past about things that were making me anxious. What I experienced this time around though was that talking about the situation with my therapist (for example) only led to his voice contributing to the ones in my head. Every time I was talking about it, I was thinking about the situation more and more, which left me stuck in that “thought loop”.

Writing was equally as fruitless. I tried as hard as I could to outline an argument for myself, to make sense of the pieces I had, and it only left me with new questions to fixate upon. Every word was like a dagger, and seeing them all clumped together gave them more momentum.

Apart from my medical support team, I only told three people what actually happened. I avoided everyone else (for fear they would ask about my current state) until I felt comfortable allowing one or two people to try to draw me into their world of the present. Funny anecdotes about their jobs, or their cats, or whatever. Tiny tidbits to focus on besides me.

Those tidbits made up a gateway, and the moment I fell through the other side was the first shower I took in the new apartment. I was messing with the shower-head spray mechanism and accidentally turned the spray into a high-powered water gun that hit me in the chest and almost knocked me over. The sheer impact and surprise of the situation made me laugh out loud uncontrollably (imagining myself and Kramer with his industrial power shower head)… and for the first time in weeks I breathed a sigh of relief.

Ultimately I’m still not ready to talk about the incident that triggered this whole fiasco (I don’t want to re-start the fixating thought-loop), and though I’ve had a day or two where I’ve been able to come up for air, I’ve noticed some of the mixed symptoms returning in the last 24 hours. Luckily I have an appointment with my psychiatrist this afternoon and an entire blank canvas of an apartment full of possibilities.