To Sleep, Perchance to Dream

So I’m probably preaching to the choir, but I have had sleep problems forever. When I was little, I slept so deeply, I wet the bed till I was inappropriately old to be doing it. (Thank goodness that passed.) Then, I became a horribly difficult sleeper – everything woke me. With the depression, I would be able to sleep 18 hours one week, and then only 3 the next week. Besides, depressive sleep is a different kind of sleep – it’s deep and hard, but it’s sad and painful.

I try to sleep. My eyes are closed and I am in bed. But falling asleep requires drugs (of which I have tried an assortment – let me tell you about those side effects!) and then I have difficulty staying asleep. Sometimes I close my eyes telling myself, “ok, we are going to relax and get some rest, girl” and I open my eyes and 5 hours have passed. So that means I wasn’t really asleep for those 5 hours. A lot of times, I’m basically directing my dream – almost like I’m above it, directing a play. When I do fall asleep, I have anxiety nightmares (where for some reason someone is always yelling at me and won’t let me explain – yeah, you have to ask Freud about that…) and I wake myself up yelling or continuing the conversation. Funny thing about that is that I’m aware I’m awake but I still feel the need to finish the thought. I crack myself up. Sometimes, I get up to use the bathroom, and in the 20 seconds it takes me to get back to bed, start worrying about the day ahead and if I’ll be tired when I wake up and if I’m actually sleeping. Needless to say, sleep has become the enemy.

And no one can say I don’t try. I have an eye patch and noise machine. I only sit in my bed when it is nighttime. I do not nap. I only drink one cup of coffee at 8:30am every day, otherwise, no other caffeine. I wake up at the same time every day and “go to sleep” every time at night. I stop looking at computers and phones about 30 minutes before I go to sleep. I try to read, listen to classical music, sometimes if the meds have kicked in, I have the patience for a mindfulness exercise. The one error I make is that I sometimes eat too late and that makes it difficult some nights to lie down. But that is a whole other issue all on its own.

Evidently there is this new form of sleep therapy called CBTI and it’s what it sounds like: Cognitive Behavioral Therapy for Insomnia. (Check out the program and procedures.) They try about half the things I already do, and something I think is cool called “sleep restriction” which sounds awful but effective. Given my doctor would really like to get me off my sleeping meds, and the impact my lack of sleep has on my mood and my day, she really thinks this might be helpful.

Of course, my insurance doesn’t cover it. So now I have to decide whether it is worth the money to pay out of pocket. Does anyone else find therapy and programs really difficult to value? How do I know what’s too much for a program or a treatment? I mean, there’s no real comparison tools. Plus, with mental health, if it works, it seems like it was worth all the money in the world. And when it doesn’t, even $25 seems like a horrid waste that could have gone to buying some groceries.

I just remember that I used to love sleep. I loved that really deep, dead to the world sleep, where your body just felt like a rock. I remember as a child, I also liked dreams. They just felt so real even though they were so odd. Now my dreams feel so real that I carry their emotional impact around with me all day – and I don’t have good dreams anymore, I have terror dreams, which I believe are called night terrors or nightmares.

I’m not a morning or a night person, and without sleep, I’m not really a midday person either. I don’t know what I’m going to do. I just know I’m tired and the idea of blissful sleep is such a distant idea, it feels like merely a dream I used to have.

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Self-Medicating: How Can Something So Right, Be So Wrong?

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Mental illness or not, we all do it. No, I’m not talking about masturbation – I’m talking about self-medicating.

Life is a stressful, complicated, big blob of fear, anxiety, and failure, wrapped in a bomb with an unknown time limit before explosion and death. It’s no wonder people need a way to relax.

For some, they go the way of meditation, aromatherapy, yoga, acupuncture, natural and prescribed medications, exercise, and healthy eating – and I am in no way knocking these things. In fact, I have tried, and am doing, the majority of them. But sometimes, it’s not enough. And especially if you working with the complexity of life and a mental illness, it can be too much to balance with breathing exercises and a downward dog. Besides, medications are expensive and as I mentioned in my last post, take time, are unreliable, and have major side effects.

So we try to self-medicate first. For me, it started with food. I could stuff myself with food and just before I thought I would throw up, stuff myself some more. Then, by the time I got to high school and was constantly trying to lose weight, it became anorexia – trying to see how little I could eat to see how much control I could gain. But there was also alcohol and drugs. And it’s not like someone was asking me if I was okay because everyone was doing it, it never impacted my grades, I never got busted, drank and drove, or made those mistakes that some Beliebers do.

In college, I would outdrink the guys next to me and then make out with a few – trying my best to convince myself I wasn’t the ugly, worthless piece of shit I knew I was. It never quite did the trick and since I was too much of a control freak to sleep around, I started to wonder how I was going to find my release.

Somewhere around sophomore year, I found cutting, or as some call it “self-mutilation.” It was the best of times; it was the worst of times. It was the point I realized I needed therapy but it was also when I finally found a self-medication that did what I needed. I’ve tried to explain cutting to many, and I’ve learned from others that like most things, it’s different depending on the person. But I can tell you what it gave me, and why to this day I still miss it. But more on that later.

I know people self-medicate in different ways that take them on much more intense addictive paths. These paths exacerbate their psychosis, and can lead to, for example, homelessness, violence, and abusive relationships. While I know that prescription medications are not a cure-all (I’ve been “unlucky in love” with most of mine,) I think the difference is that self-medication is a short-term fix while medication and therapy seek to find a long-term solution. And given how exhausting this process is, I think the latter is what we’re truly looking for on this journey.

Medication: A Complicated Balance

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It’s ironic that the next topic I wanted to discuss on this blog was medication, because the reason why I couldn’t sit down to type about it was because of my … medication. It’s a tricky thing – medication is intended to help you get back to your life; to quiet the demons so you are strong enough to get out of bed, get out of the house, try to have some sort of consistency or “life.” But it’s a balance because feeling better is a complicated mix, with some severe side effects that are both psychological and physiological.

I have been on prescription medication since college. With each medication came its’ own set of side effects including: dry mouth, akinesia, stomachaches, weight gain, (a pro-depressant if you ask me,) headaches, light-headedness, dizziness, sluggishness, wanting to rip my skin off, insomnia – pick an uncomfortable side effect, and I’ve had it. And sometimes you have to decide if the side effect is worth the effect you are receiving psychologically from the medication. This is a personal, complicated, and often difficult process (both in starting new meds and withdrawing from old).

Four months ago, I went on a medication and within two months, had gained 30 pounds without change in diet or exercise. At that point, I didn’t care if it made me feel like someone in an anti-depressant commercial, it wasn’t worth it. Getting off that medication was difficult with headaches, sluggishness, and stomachaches, (in other words – withdrawal,) and the weight still hasn’t come off. Two weeks ago, I went on another medication and developed akinesia. It was like having 18 cups of coffee on 2 hours of sleep. I couldn’t stop moving but every time I took a step, I wanted to lay down wherever I was – in the street, at the gym. I was spelling words incorrectly, having a hard time doing anything for more than 15 minutes, and having massive panic attacks. So yeah, I decided after two weeks that all that the negatives outweighed the positives on that one.

The medication I am still on makes it difficult to fall and stay asleep. So, I take medications to help decrease anxiety (both mentally and physically) and medication to not only help me fall asleep but ideally stay asleep. I know – you all of a sudden go from no meds to having five because the one you are taking needs four to compensate for the first one. But at the same time, I can see the positive changes psychologically the first medication is making and it makes the other four worth it. At this point in time, even with the sleep aggravation, it’s an aggravation worth dealing with because the benefits of this medication do outweigh the annoying disadvantages. And besides, if I’m taking one pill, what’s another four. :)

A large problem for people with bipolar or schizophrenia (or any other mental illness for that matter,) is that they go off their meds. They decide to either self-medicate or go cold turkey because they don’t like the side effects. On meds, they don’t feel like themselves – they’re cloudy, unable to concentrate, and feel like their creativity is suppressed. I cannot tell anyone what they should or should not do because making these sacrifices/decisions are personal. I will say that sometimes we either think we don’t need medications when we feel better, even though it’s the meds we are taking that are making us feel that way, or we don’t want to feel the side effects so we give up. Unfortunately, given the power of mental illness, I think sometimes we just have to honestly weigh how bad the side effects are in relation to the impact and effect the medication is having on our overall mental health and well-being.

Another reason I’m often tempted to go off meds is because I miss how I “normally” feel. Sometimes you are depressed or sick for so long, that being like that starts to feel like the norm. I’ve been feeling different since I was eight and with the meds, I sometimes feel like I’m faking this version of myself and that version lacks the sensitivity, passion, and creativity I used to have in handfuls with my depression. In fact, when I take medication and start to make plans and build up life, I feel this deep sadness. At first I thought it was the depression creeping back in but I think sometimes I’m mourning the loss of my sadness and mood swings.

It is in those extremes, I feel most “alive.” I am more impulsive, more creative, and less passive. I yell at people instead of being polite; I hate myself without the guilt of those around me telling me I shouldn’t; I hurt myself and no one can stop me, and in a way, it makes me feel powerful, in control, and “normal.” Life may not feel dulled like when on medication, but I realize the feelings I have that are “full,” are dark, foreboding, and negative. When I’m having a hypomanic episode, I feel effective and efficient, but tottering on a string, about to slip and fall into a large hole of deep, intense depression. And I realize that in the end, it’s all about about the long-game and every day survival.

I know, at least for me, I also don’t just take these medications for myself. I take them for my family and friends. Because without them, I know eventually I’ll become suicidal (shit, sometimes even with them,) so I have to keep trying. After all, I don’t want to hurt my mom who tries so hard to help, or my friends who have stood by me for so long. I don’t want my sister to have to explain to her children what happened to their aunt. Even if I can’t fully do it for myself because at the moment all I can see is that this dry mouth is really impacting making any conversation and my jaw hurts from chewing so much gum, I have seen the possibility in others of what my life could look like, and I recognize it just takes time – even though I detest that idea, no matter how true it is.

I mentioned that I’ve been on medications for over 10 years. And that’s because sometimes medications stop working. Or they re-diagnose you. Or your lifestyle changes and a side effect is no longer viable. (I can imagine for some sex drive might become a game-changer. Sadly, not for me at this time.) I can’t think of a metaphor for how frustrating and disheartening this process is. It also has personally given me trust issues – what if I go on something and it works and I build my life up and then it just stops working and everything comes crashing down. Then, after all that, you want me to try it again? Patience is a bitch.

But every so often, I’ve found myself in a good place with medication and so I know it’s possible. And while faith is not a strong part of who I am, I can’t seem to get rid of the hope that one day I’ll find something that works and won’t quit on me. And so, at least for now, I won’t quit on myself.