Tag Archives: sleep

5 Exercises for Falling Asleep

Falling asleep can be tough, even after attempts to remove all distractions. Sometimes I find myself too worried or anxious to fall asleep, other times it is like my mind just wont shut off.

Obviously living with bipolar disorder complicates things for me when it comes to sleep. In depressive phases I might feel like I can sleep for days, but there are times when I feel exhausted but can’t seem to fall asleep. Other times manic energy or a racing heartbeat makes it difficult to physically relax, not to mention hypomanic or manic flights of ideas that leave me constantly grabbing for a pen while I’m lying awake.

In these situations there are definitely times where I feel compelled to use a sleep aid and any number of attempts on my part to try to slow myself down to sleep seem to fail, however I can also have a difficult time falling asleep when I haven’t been bouncing up and down manically in my living room for 12 hours.

There have definitely been periods where I was prescribed sleep aids to take on a regular basis, and what I found was that it really screwed up my ability to fall asleep if I stopped taking them for any reason. The inevitable insomnia that followed triggered mania for me, and finding myself caught between being able to sleep but also having unwanted side effects or damaging my own ability to sleep wasn’t a fun place to end up.

These days I make the best effort I can to fall asleep before turning to a sleep aid, and over the past few years I have gathered a few exercises (some physical, some mental; all done while laying in bed) that have helped in my sleepy success.

Of course, there are many things that can be done to help increase our success rate for falling asleep like limiting screen time, increasing physical relaxation, and creating a routine around our sleep schedules. I find every little bit helps, and while it isn’t my intention to directly address these (or other) external strategies in this post it should be said that taking some time to bolster a healthy sleep routine can definitely get the ball rolling, and you may find that doing so may be all it takes to help you fall asleep.

These exercises are free, relatively easy, and can be done by anyone, not just folks with bipolar disorder, or anxiety, or depression. While I am not suggesting this can “cure” anything (and there are serious situations that require medical expertise) these five exercises have helped me become more successful at falling asleep naturally when I have been dealing with sore or stiff muscles, racing thoughts/flight of ideas, constant worry or obsessive thinking, physical symptoms of panic while in bed, and helped me relax when I generally just felt too alert to sleep. Some nights it takes a little extra energy to push myself into sleep past some of the physical side effects of my medications as well, and in those situations this list is my first line of defense.

1. Pointed Toe Exercise

This first exercise was especially helpful for me when I worked retail and spent several hours a day on my feet, but I used it just the other day when I had the flu and my legs were aching, keeping me from falling asleep and it was just as effective.

  • First I lie on my back and try to position my upper body to be as relaxed as possible.
  • Next I point my right toe down at the foot of the bed and then point it back toward myself. I repeat the pointed toe with the right foot ten times, and then do the same exercise with my left foot ten times.
  • Next I point both toes toward the foot of the bed at the same time, alternating between the pointed toe and toes pointed back up at me. I do this a total of ten times.
  • Finally (and this part is the most fun) I alternate which foot is pointed. If my right toe is pointed at the foot of the bed, my left foot is pointed up toward me, then they switch positions. Left foot pointed at the foot of the bed, right foot pointed up at me, kind of like using a paddleboat. I do this until each foot has been pointed at the foot of the bed ten times.
Usually by this time my muscles are stretched and much more relaxed, and my brain (that has been focusing on counting) is yawning and telling me, “dude, counting is boring. I’m going to sleep.” Sometimes I don’t even make it through the whole exercise before I am ready to fall asleep!
2. Clench & Relax
This is another exercise that is good for a tight/clenched/sore body, but the physical relaxation can be helpful anytime, really. I’ve seen several variations of this exercise but generally the idea is the same; systematically move through the body tightening and releasing different muscles as you go.
  • For this I lay on my back, and it doesn’t really matter how relaxed I am when I start (because end game relaxation is kind of the point here).
  • Starting with my feet, I flex my muscles in my feet and hold them rigid and count to five, taking a deep breath in as I count. When I breathe out I let go of the clenched muscles.
  • I continue up my body continuing this pattern with each area, flexing calves, hamstrings, hips, stomach, chest, shoulders, biceps, lower arms, hands, and then my neck. Finally I flex my face (I just scrunch it so the muscles are tight) and release.
One tip to maximize relaxation on this is to keep all areas of the body that have already been addressed as still as possible to maintain the relaxation. It can be eerie to feel like parts of my body have melted away to relaxation as I progress with the exercise, and that is part of the fun for me.
3. Fake it ’till You Make It
When I was a child I hated taking naps, so I devised a plan to lay perfectly still and pretend I was asleep to trick my mother into thinking I was napping. I remember laying on a couch at my grandma’s and considering what someone looks for to tell if a person is sleeping, and I tried to address every aspect I could think of. Wouldn’t you know it? I ended up falling asleep! I use this technique when I just generally feel too alert to sleep overall, as it covers some mental and physical strategies.
  • First I consider, “How do sleeping people lay?” and position myself in whatever is most comfortable for me that would recreate a deep slumber.
  • When people sleep they often appear or feel heavy and loose, not rigid, so I focus on making my body as heavy and loose as possible. I unclench my hands, sink into pillows, and let my shoulders sink downward.
  • The real trick, I find, is considering how sleeping people breathe. The breaths often aren’t too deep or too quick, but instead they are slow and moderately shallow. Focusing on trying to reproduce this kind of breathing is something that often uses all of my attention (which doesn’t make room for many other thoughts).
With this exercise I like to imagine what would happen if someone I knew came in the room and found me there. Would they think I was asleep? Typically, when the answer is yes, real sleep is right on the heels of my faux sleep.
4. Continental U.S. Map
I find this exercise the most useful if obsessive thoughts or constant worrying is getting in the way of falling asleep. Sometimes even if my regular thoughts are simply being too persistent I can use this to fall asleep as well. This exercise can be done in any position, all it takes is closing one’s eyes.
  • First I imagine there is a white line against the black background I see with my eyes closed.
  • Next I follow the line with my eyes as it creates an outline of the continental United States (moving clockwise). I allow my eyes to move as the line dips and curves around the great lakes and rises up over Maine, etc.
  • Depending on how persistent the thoughts are I might circle the country two or three times before going back to trying to sleep. If the obsessive or persistent thoughts happen again, I do the exercise again.

I know this exercise might sound ridiculously simple, but it has been super helpful for me. Weird, right?

5. Conjuring Observations

Ok, this one might be a little trickier but it is my favorite. I find it to be sort of emotionally soothing, beyond just helping me relax enough to sleep, and it is usually my first choice when I am experiencing physical feelings of panic in bed while trying to sleep.

  • This exercise requires me to unfocus my eyes. The best way I can describe it is that I close my eyes and first focus on an imaginary point (like the line in the US map in exercise 4), and then relax my eyes as though I am looking at a distant landscape of a mountain beyond tiny point. It can be helpful to make the distant thing I am looking at someplace familiar, a wooded trail I know, a beach I grew up by, or a room from my childhood.
  • Once my eyes are unfocused and I am looking at this “distant place” I occupy my mind by conjuring items or landmarks that I once observed of these places. Sort of like taking a big empty space and filling it with elements that I can remember. They can be as specific or general as I want. For example:
    • What were the location and types of trees in our old orchard?
    • What machines were at the arcade at the local drive in movie theater?
    • What was the floorplan of my childhood friend’s house?
    • What items could be found on the counter in my childhood home?
  • For this to be a nice experience and soothing (like soothing enough to make me fall asleep), there are some rules I employ, like:
    • I only choose places with positive or neutral associations. That doesn’t mean some places (like my beach) were never associated with anything negative, only that I have reached the point where I no longer feel a negative association with that location.
    • The details should be difficult enough to remember that it requires my entire focus (so it can’t be wandering around distracting me).
    • I never populate these spaces with living creatures, human or otherwise. I want to treat these spaces as tools and don’t want to lay around reliving memories that might produce an unexpected emotional response that might hinder my ability to sleep, not help it.

 

So what do these exercises have in common? It seems that each of them involves creating a relaxed atmosphere (physically or mentally) and occupying my mind in a challenging, but still relatively mundane task (like keeping track of how many times I’ve counted to ten). For me this is a combination that has made a recipe for success when it comes to coaxing myself to sleep.

Keep in mind that yes, like I mentioned, there are definitely still times I can’t calm my manic energy enough, or rebound from a midnight panic attack into a state of sleep, but I have been finding that with practice those moments seem to be getting farther apart. While I can’t guarantee these will work for you just because they work for me, I hope that considering what we are imagining or thinking, or how we are feeling right before bed is just as important for falling asleep as, say, having the right pillow.

There are numerous tips and tricks out there to help turn those sleepless nights into sleep-filled ones, and I encourage anyone and everyone who has had trouble falling asleep to do a little research and keep some tricks up their sleeve! There has certainly been no contest for me, more stable sleep is a constant requirement for a more stable emotional life and regaining the power to help myself fall asleep without the use of a sleep aid (at least, most of the time) has been paramount in helping me regain a feeling of control and peace in my life as well.

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Big Change Bringing Optimism; 10 Years in Seattle

Today is my ten year anniversary of the day I moved to Seattle to go to art school.

The funny thing is that moving here was never something I aspired to, in fact I thought the city was dirty and full of all kinds of sad and frightening things. Frankly, I really just think I got lucky when my depressive stint in a cold house in the middle of the woods on an island was interrupted by a phone call from the school with an open invitation to come down.

I already had been to college once and dropped out after a mixed/manic episode and I was already familiar with the burden of student loans. Still, the offer was too tempting to resist, and swapping the dark and quiet island for loud, bright city streets also meant swapping my depression for hypomania.

The sudden shift in my emotional state taught me a few things, even though it was something I really didn’t understand at the time. Learning that the excitement and insomnia that came with being in new places made me feel quite spectacular, and that my depression could temporarily be outrun led to a lot of attempts to shift gears and outrun that depression in later years. Unfortunately no matter where I ran, it always managed to catch up with me.

The biggest thing I remember about this day ten years ago was laying in bed awake trying to sleep while the streetlight poured in and the fire station only three blocks away emitted what seemed to be a constant siren. It felt like the epitome of the opposite of where I had come from and it took several sleepless days for me to become tired enough to sleep through it.

This change, though not one I expected, coming to me with all its sense of newness and opportunity, produced a two year period of almost uninterrupted hypomania (with the exceptions of a few mixed and manic nights), something I have not experienced since. While I’ve learned that trying to outrun depression is something that acts as a temporary fix for a more permanent problem I face, knowing that opportunities for growth are something that can help me rise above it (even just temporarily) has been wildly invaluable.

And the city? A big portion of the original area downtown where I moved has been gentrified, and the run-down convenience stores and bars have been replaced with shiny new condos and rustic taprooms. A lot of the homeless population has moved on to other parts of the city, replaced by people who work in technology often having more money than they know what to do with. Sometimes it is strange to me to think of the way the neighborhood used to be with fondness and find myself feeling like the distrust I have for this shiny new version trumps any negative feelings I had about the dirtiness and sadness of the way things used to be. At least before I felt like the city was being real and honest, instead of trying to hide the unfortunate business of homelessness and those of us who still live from paycheck to paycheck.

The reality is that the city I moved to ten years ago has become an entirely different city, and while I feel lucky to have lived there in a time where it was a place I really did feel at home, it has changed as much as I have.

At any rate, there is a dream of the next place, wherever it is. I don’t know how long it will be before fate comes knocking and I find myself terrified by how dark and quiet it is while I am trying to sleep.

In the meantime, thank you Seattle for 10 years.

Concluding Hormonal Treatment; Pushing the Bipolar Button

My second jaunt down Hormone Road this week ended relatively the same as the first (two-three weeks ago). By day six I was experiencing so much anhedonia I couldn’t eat or sleep. I had become completely engulfed in a tidal wave of pointlessness and self harm fantasies, so much so I could be seen walking up and down the street in the rain like a zombie, frowning for no real apparent reason.

Honestly, I pretty much expected this (since it already happened once two weeks ago) but I was holding on to some faint hope that I might be able to avoid surgery for the odd and still somewhat unknown abdominal problems I have developed. I’ve never had surgery (well, just a wisdom tooth extraction), and never even stitches, so the idea of anyone slicing me open (even a little slice) makes me exceedingly nervous.

Despite my inability to talk with the nurse over the phone in a polite or straightforward manner I am pretty proud of myself. She suggested I see the surgeon the same day I was calling to let her know about my reaction to the hormones, but somewhere in the back of my mind a little voice reminded me that I couldn’t figure out how to use the shower the day before (the same shower I have been using for the last six moths). If I couldn’t figure out how to make hot water come out of a tap (with only two options, left and right) it might not be the best idea for me to talk with a surgeon and make important decisions about the most invasive procedure I will have ever had up to this point. I told her it would be better to meet with him next week, and I am glad I did because it would be another 24 hours before I could smile for the first time in days.

One thing I have found relatively interesting from this whole hormonal excursion is that the first round (on a higher dosage of hormones; desogen) triggered an extremely agitated mixed state where I was depressed, but also very aggressive (not unlike my experiences triggered by corticosteroids). The second round (lower dosage, microgestin) provided a straight-up triggering of intense hopeless depression. Even after I stopped taking the drug (after waking up completely depressed) the depression worsened for 48 hours before the symptoms began to recede.

As usual, I feel compelled to point out that my body (for whatever reason) has become extremely sensitive to pretty much any and all medications I’ve tried, usually with some very poor results. Though it is probably not typical for people to have these sorts of reactions to hormones, it irks me somewhat that most bloggers and internet articles have now taken the stance that hormones never cause mood issues. Of course, this was also the stance of the first nurse who ever gave me hormonal birth control (when I was 18) -which promptly landed me in a psychiatric facility because of a sudden intense mixed episode.

Do hormones cause people to have mood problems? Maybe not most people, but I believe that anyone making broad sweeping generalizations about how safe and effective a treatment is (hormones never cause mood problems, vitamin supplements never cause side effects) are usually trying to sell you something. The truth is that even though hormones might not cause mood problems in most people, nobody ever mentioned them potentially triggering episodes for people who already have abnormally behaving moods.

Frankly, going into this second round of hormones I guessed (with probably 90% certainty) that I would not be able to tolerate them. This guess was not based on anything I read on the internet, but based on my own experience with hormonal treatments I previously encountered (prior hospitalizations, prior depression triggered by hormones, etc.). Having tried a multitude of medications in the past few years (and finding myself reacting to them in unusual ways) has taught me that the best thing anyone can do when starting a new kind of treatment is pay attention. Get to know what is typical for you; a typical headache, a typical bipolar episode, even your typical aches and pains. Without knowing how my body and mind normally act, it becomes incredibly confusing and maddening trying to discern side effects from the normal mood cycles I experience.

And most of all? Don’t forget about your doctor. If something is feeling off, or if I feel much more miserable more quickly than I normally would (like this week)… that’s when it is time to say something. I know that I tend to get incredibly anxious about contacting my doctors after starting a new treatment because I don’t want to appear to be a hypochondriac, but working with people I trust has meant that they also trust my judgment, and I know they want the best for me.

As frightening as surgery sounds to me, after 7-8 months of extreme pain I am ready for this issue to be addressed… and if hormones are not going to be the way to do that, I am ready to take whatever steps I need to in order to improve this situation. Though I can rule out episodes triggered by hormonal therapies at this point, the pain I have been experiencing is significant enough to trigger episodes as well. In the end, all of the healthcare I have been seeking is ultimately tied to improving my mental health as well, less pain -> less stress/distress -> more sleep -> more stable mood. I am hoping that if I can get my body to a relatively happy place, my mind might follow suit.

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.

Taking a Vacation from Mental Illness

As someone who lives openly with bipolar disorder, I take pride in being able to share my experiences as well as educate others about mental illness. Unfortunately, being unemployed (and this blog being the primary source of my attention lately) I had been starting to feel very two-dimensional.

After all, it seemed like all I ever did was talk about mental health, write about mental health, and think about mental health. I admit, I started to wonder if I was even capable of carrying on a normal conversation (particularly with strangers or people around my age) without talking about this (now, several years in, slightly tired) topic.

A week ago I was lucky enough to find myself beginning a journey to go on vacation to Florida. Being sick and tired of my normal, anxiety-driven controlling behavior I decided that for this vacation I would do something different. I would relinquish control of all the activities involved to others and simply be “along for the ride”.

For someone like me that is difficult, at best. Still, I was determined to spend this vacation worrying as little as possible, something that became tricky when I hit a bit of a road block.

I was in Florida at a friend’s house attending a barbeque. I had also been awake for 36 hours because of the way my flights had worked (and my inability to sleep on an airplane due to general discomfort and terror) and there was that moment that I always dread, the one where I meet someone new and they are about to ask me what I do for a living. I had just finished answering the lead in, “where are you from?” question when the woman I was talking to said, “oh, that’s nice,” and walked away.

This was like a get-out-of-jail-free-card. She didn’t care what I did (or didn’t) do. I went to bed with a smile on my face, not just because I hadn’t slept in thirty-something hours, but because nobody had cornered me into telling them my life story.

It felt so good being able to focus on other people’s lives and stories that I felt relieved when, three days later, the issue of my mental health still hadn’t come up. I was lucky that no big melt-downs had occurred on my end (thus not requiring me to explain myself) and though I was concerned for a minute that I was hiding in some way, the truth was that the big draw was not constantly feeling the need to explain (or defend) myself.

In addition to how much time I spend thinking about myself and mental health in general, it can be hard in my daily life to see people tip-toeing around my needs, or taking time out of their lives to take care of me. As much connecting as I have done with the mental health community, I have kind of drifted away from everyone else… leaving me feeling estranged from what it means to be simply human, no more, no less.

In the last several years I have a hard time thinking of any milestones where my own mental health wasn’t an issue, so being able to take a vacation from the constant worry and explanations that surround my own mental illness was an extremely significant experience for me. Basically, going to Florida was, for me, like being able to step out of my own head and focus on the world around me again. I really must say, it was magnificent. 

Hypomanics Just Want to Have Fun

I’ve been hypomanic, but I didn’t realize to what extent exactly. Yes, there has been hilarious dancing, yes I have been walking up to strangers on the street and talking to them, and yes, my anxiety around spending money has been lifted and I casually bought a pair of shorts.

When I got into my therapist’s office yesterday (our relationship renewed by medicaid’s promise to give me 33 free sessions) I said,

“Well, I’ve been having trouble sleeping and I’ve been running all over the city for two days straight, but things don’t seem too intense.”

I shrugged and wrote off my symptoms. After all, I wasn’t experiencing any agitation (or even racing thoughts), and things hadn’t reached the point of mania (where people couldn’t understand what I was saying anymore) so things seemed fine.

After about fifteen minutes of talking and filling out some paperwork my therapist looked at me and said,

“I realize this may be coming out of left field, but you’re speaking rapidly, using much more exaggerated hand gestures than usual, and your volume is just short of yelling.”

I was shocked, not that she said that to me… but that I hadn’t any idea that I was doing any of these things.

To be fair, two years ago I couldn’t pinpoint manic symptoms in myself short of starting a fight with a pharmacist or believing I was a werewolf. It seems so much easier to pinpoint symptoms of depression or mixed episodes, because they feel unpleasant. How difficult is it to notice I am experiencing something or doing something that feels great?

When it comes to hypomania, I can recognize insomnia, or a lack of hunger, or high waves of energy, even giddiness and elation. Less straightforward is the part where this becomes funneled through me and introduces itself to other people’s lives.

I don’t really know how to pinpoint symptoms like rapid speech and exaggerated hand gestures, short of someone pointing them out to me. Even then, my therapist asked if he pointing these things out made me want to change my behavior. At the time, sitting there, I said no.

As much as I am afraid of coming off wild and intensely, I know this period also lends itself to a certain hilarity that I can’t embrace quite the same way at other times. It becomes easier to tell jokes, easier to laugh at jokes, and easier to take conversational risks.

I know this can ball itself up and transform into mania (or even a mixed state) but it seems as though the acting excitedly itself isn’t an issue. Just because I am paying close attention, monitoring my sleep and eating to try to keep things wrangled in doesn’t mean I can’t have a little fun.

And after a little depression, don’t we all deserve a little fun?

Sick and Sore

Well, this week has been a sick one. I picked up some kind of flu that made me sleep for 14 hours at a time and flung my mood into a wobbly space where I was tearful 24/7 (as I predicted might happen here).

I wanted to give some explanation as to why the writing has been sparse. Though I’m feeling better, it seems like my brain (and mood) haven’t quite recovered, making it hard to do things like draw conclusions, focus, or not hold weird prejudices against people for no apparent reason.

In any case, stay tuned.