It is 4 am. I awoke this morning before 1 am. After trying numerous times to get back to sleep, I gave up and am starting my day. I return to my blog. . .
In 2002, on December 29th, my twenty fifth wedding anniversary, I ended up in the emergency room as a result of a major gastro-intestinal event. During the course of the examination the doctor remarked "Has anyone ever told you that you have a heart murmer." "No." "You better get that checked out."
Turns out I had a mitral valve prolapse, and was scheduled for surgery that spring. I did my research and discovered that the surgery was being performed with a surgical robot, and found a doctor that was willing to do it that way. I ended up being the first surgery in Spokane using this technique. I checked into the hospital early Wednesday morning. The surgery lasted a long time and it was late in the evening that I began to awake. However, because the whole surgery was performed though a series of 1/2 inch incisions the recovery was almost instantaneous. By morning I was walking around the floor. I was discharged from the hospital on Friday. My doctor asked that I remain in Spokane over the weekend. On Saturday the kids came to visit and we spent the day walking around Riverside Park and riding a four person bicycle car. When I got home to Sandpoint on Monday, I had a funeral for a young child who had died while I was in the hospital, and I resumed a full work schedule. Open heart surgery had been a piece of cake.
It is amazing to me that I could undergo heart surgery on Wednesday, be riding a bike on Saturday, and back to work on Monday. And yet after nearly two decades of treatment, I still cannot sleep.
"I can knock you out." my doctor said. The problem is to find a medication that will enable a healthy sleep cycle, and that is sustainable. At one point, fearing that I had become dependent on alcohol for sleep (I had) I asked my doctor for an alternative. I was prescribed a sleep medication. When I went to the pharmacy to have the prescription filled, the pharmacist took me aside to emphasize that I should only take the medication once every three days or so. If I took it everyday, I would become habituated to it and it would no longer work (at least without increasing the dose beyond what was appropriate). Furthermore, there was a risk of addiction. Not to mention that it also carried a risk of liver damage.
So I was faced with two choices. I could take the medication that was habituating, addictive, and caused liver damage, or, I could drink alcohol which is habituating, addictive, and causes liver damage. I began taking the medication one night, and drinking two nights, which at least reduced my alcohol consumption by 1/3. When my wife would complain about my alcohol consumption I would be quick to point out that my choice was not whether or not to use drugs to sleep -- it was simply a choice of which drugs to use.
After undergoing treatment for chemical dependency, my doctor has been very committed to prescribing only medications that are non-addictive. This has severely limited the choices. Basically, almost all of the sleep medications are potentially addictive and so we've been using other drugs such as anti-depressants that have a side effect of making one drowsy. This has had the effect of enabling me to go to sleep. Staying asleep is the problem. We changed meds this last week to see if we could find a more effective treatment. It is worse.
Less than a week after open heart surgery I was going full speed.
Two decades of treatment for insomnia has been ineffective.
Something just doesn't seem right about that.
The hardest thing about this whole experience is fighting off the urge the think that a full night's sleep is only a couple of drinks away. The last time I tried that I nearly entered into "eternal rest" which is an entirely different problem than waking up too early. . .
Tuesday, July 21, 2015
Wednesday, July 8, 2015
Dissed Ability
At one and the same time I am extremely grateful that I have disability insurance and can be sustained by that safety net as I cope with my Bipolar diagnosis, AND am extremely resentful that I am considered disabled at all. The most aggravating part of being on disability is to be asked the evaluative questions by my insurance company. Can you dress yourself? Can you care for your own personal hygiene. Can you assist with routine household chores? (Truth be told, I've never done well with that last one even when I was at my best. Just ask my wife!)
My experience has been that I have been more disabled since diagnosis and treatment than I was prior to treatment, when I was still maintaining a full work schedule, though admittedly, it was getting more difficult. But before we proceed, a bit of background on Bipolar II symptoms. First of all, someone who is Bipolar will experience recurring bouts with depression alternating with periods of "hypo-mania", or an elevated mood, but one that is not a full blown manic episode. Symptoms of hypo-mania are:
I went on disability because of a deep depression. Stress at work was also producing within me "partial complex seizures", where my right arm would shake uncontrollably. This was particularly pronounced in Church, where I could not sit through a worship service, let alone lead one, without experiencing the seizures. I was also diagnosed with PTSD at that time, which I preferred to call "Post Traumatic Church Disorder".
My experience has been that I have been more disabled since diagnosis and treatment than I was prior to treatment, when I was still maintaining a full work schedule, though admittedly, it was getting more difficult. But before we proceed, a bit of background on Bipolar II symptoms. First of all, someone who is Bipolar will experience recurring bouts with depression alternating with periods of "hypo-mania", or an elevated mood, but one that is not a full blown manic episode. Symptoms of hypo-mania are:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility (e.g., attention too easily drawn to unimportant or irrelevant external stimuli)
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
- Excessive involvement in pleasurable activities that have a high potentional for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indescretions, or foolish business investments)
I went on disability because of a deep depression. Stress at work was also producing within me "partial complex seizures", where my right arm would shake uncontrollably. This was particularly pronounced in Church, where I could not sit through a worship service, let alone lead one, without experiencing the seizures. I was also diagnosed with PTSD at that time, which I preferred to call "Post Traumatic Church Disorder".
As I mentioned above, my decision to not return to the ministry, but rather establish a woodworking business, triggered a hypo-manic episode. That proved to be relatively short lived, however. Once we had the CNC Router up and running, a simple complaint about the noise by a neighbor (we were operating it with the garage door open) sent me into a tailspin into a deep depression. My productivity went way down. And since that time, I have struggled to maintain a full work schedule.
It's this vulnerability to external triggers that keeps me on disability. My medical team is absolutely convinced that parish ministry is toxic for me, now. Too many triggers. And there is no way to predict whether a trigger, such as a simple negative comment from a parishioner, will send me into a deep depression that has previously left me feeling borderline suicidal or ignite the engines for another hypo-manic phase.
I am fortunate that our Church has a good and generous disability program. What I have come to appreciate is that there are two distinct advantages to having that in place. First of all, and most obviously, it provides a safety net for me. Through the disability program the Church has cared for me and my family and we have not suffered as a consequence of my being Bipolar. But, I also realize now that the disability program also protects the Church from becoming a victim of my disease. As I mentioned in a previous post, one of my most pronounced hypo-manic episodes ended up costing the Church millions of dollars. Yes, that is no exaggeration. Hopefully, one day, that will be recoverable. Perhaps the greatest risk associated with a bipolar pastor would be if a hypo-manic episode manifested itself in "sexual indiscretions". The potential damage of that would be irreversible.
And so, for my sake and for the sake of the Church, I've accepted the safety net. I just wish I didn't have to answer questions about whether I can dress myself.
Monday, July 6, 2015
Sleep,or Not.
Sleep has been a constant problem, since my adolescence. The irregularities concerning sleep have varied over time, but the lack of a consistent, healthy sleep pattern has remained constant. A good night's sleep, illusive as it may be, is the end that has justified many means.
Early one in my life, transitions were the problem. When awake, I could stay awake late into the night or even for days at a time without a noticeable problem. But once asleep, I had a hard time waking. During adolescence, when sleep problems first manifested themselves, I began by staying up late. I became a Johny Carson fan and never missed an episode. At the conclusion of the show, I would stack six or seven albums on my record player and attempt to sleep with the music providing the 'white noise' in the background. By morning, I was finally in a deep sleep and could not wake up without difficulty. My father rigged up an alarm bell in the ceiling above my bed that they could activate from upstairs, and leave ringing until I got out of bed and went upstairs to turn it off.
During college and my years in seminary, I dealt with my sleep disorder by studying late into the night. I found that I was most alert after 10 pm, and completed most of my work between 10 and 2 am. One semester in college I purposely arranged my schedule with late afternoon classes and evening classes so that I could stay up till 2 or 3 in the morning, and then sleep past noon. Even then, waking was extremely problematic. I found myself dependent on roommates, or later, my wife to wake me up as devices such as alarm clocks could easily be ignored or turned off. The irregular sleep pattern was difficult on relationships, whether a roommate or my wife, simply because some people actually wanted to be undisturbed by my 'alternative' schedule.
After I got married, in an attempt to regulate the sleep pattern I found that an excessive amount of walking late in the evening helped me get to sleep. I would typically leave the house about 9 pm and walk until I was so exhausted that I could fall asleep. This might involve 2 or 3 hours of walking, I suppose 8 to 10 miles of pavement pounding. I became notorious in the communities in which I lived and well known by the police departments, who on many occasions had been called to investigate who this person was walking about the neighborhoods late at night. There were times when I wondered about my safety as I walked late at night. Then I realized that I was the one everyone was frightened by. I wore my knees out in the process.
When I was first diagnosed with depression, I was put on Ativan, and anti-anxiety drug that also helps sleep. Of all the remedies, Ativan, or lorazapam, was the most effective. With it I could fall asleep on schedule and sleep for 8 hours or so. After about four years, I decided that my depression had passed and that I could go off all medications, including the Ativan. What I didn't realize was that the Ativan was addictive and worked on the same receptors in the brain as alcohol. Upon quitting the Ativan, I immediately replaced it with alcohol, and found that a couple of "Scotch doubles" (my definition of a "double" varied greatly over time, and I would get really irritated at what a restaurant or bar considered a double). Alcohol worked for me as well as the Ativan had, though my dependence on it brought a whole lot of other problems that would have to be addressed later.
When I went through chemical dependency treatment for the alcohol, my psychiatrist informed me that both alcohol & Ativan (which I had resumed taking prior to that time) were now off limits. My "bottom" that had led me into treatment had involved taking Ativan and alcohol simultaneously, which is not to be recommended. I nearly died that night.
Since then, my anti-depressant medications and the mood stabilizer all have a sedative side effect, though non-addictive. And I have been prescribed trazodone to specificallly aid the insomnia. One of the impacts that this has had on me is that now, going to sleep is no longer the problem. I struggle to stay awake until bedtime, which has moved up from midnight or later to 8:30 pm. But then I wake. I begin waking up as early as 10:30 or 11, but more frequently at 1 to 2 am. I am typically, after a half hour or so awake, able to get back to sleep for an additional hour or so, but then by 3 or 4 am I can no longer sleep. I have subsequently been diagnosed with sleep apnea, requiring the use of a CPAP, but that has not changed the basic sleep pattern. During the day I find myself overwhelmed with drowsiness, which is a problem in that my work as a woodworker involves using tools that are dangerous to operate while drowsy. Occasionally, I can take a nap and actually feel rested afterward, but normally that is not effective.
It seems such a simple thing. A night's sleep. But a solution to my insomnia has been the most illusive issue I've dealt with since adolescence. And to this day, the greatest threat to both my remaining on medications and my sobriety is this simple desire -- to have a full night's sleep.
Early one in my life, transitions were the problem. When awake, I could stay awake late into the night or even for days at a time without a noticeable problem. But once asleep, I had a hard time waking. During adolescence, when sleep problems first manifested themselves, I began by staying up late. I became a Johny Carson fan and never missed an episode. At the conclusion of the show, I would stack six or seven albums on my record player and attempt to sleep with the music providing the 'white noise' in the background. By morning, I was finally in a deep sleep and could not wake up without difficulty. My father rigged up an alarm bell in the ceiling above my bed that they could activate from upstairs, and leave ringing until I got out of bed and went upstairs to turn it off.
During college and my years in seminary, I dealt with my sleep disorder by studying late into the night. I found that I was most alert after 10 pm, and completed most of my work between 10 and 2 am. One semester in college I purposely arranged my schedule with late afternoon classes and evening classes so that I could stay up till 2 or 3 in the morning, and then sleep past noon. Even then, waking was extremely problematic. I found myself dependent on roommates, or later, my wife to wake me up as devices such as alarm clocks could easily be ignored or turned off. The irregular sleep pattern was difficult on relationships, whether a roommate or my wife, simply because some people actually wanted to be undisturbed by my 'alternative' schedule.
After I got married, in an attempt to regulate the sleep pattern I found that an excessive amount of walking late in the evening helped me get to sleep. I would typically leave the house about 9 pm and walk until I was so exhausted that I could fall asleep. This might involve 2 or 3 hours of walking, I suppose 8 to 10 miles of pavement pounding. I became notorious in the communities in which I lived and well known by the police departments, who on many occasions had been called to investigate who this person was walking about the neighborhoods late at night. There were times when I wondered about my safety as I walked late at night. Then I realized that I was the one everyone was frightened by. I wore my knees out in the process.
When I was first diagnosed with depression, I was put on Ativan, and anti-anxiety drug that also helps sleep. Of all the remedies, Ativan, or lorazapam, was the most effective. With it I could fall asleep on schedule and sleep for 8 hours or so. After about four years, I decided that my depression had passed and that I could go off all medications, including the Ativan. What I didn't realize was that the Ativan was addictive and worked on the same receptors in the brain as alcohol. Upon quitting the Ativan, I immediately replaced it with alcohol, and found that a couple of "Scotch doubles" (my definition of a "double" varied greatly over time, and I would get really irritated at what a restaurant or bar considered a double). Alcohol worked for me as well as the Ativan had, though my dependence on it brought a whole lot of other problems that would have to be addressed later.
When I went through chemical dependency treatment for the alcohol, my psychiatrist informed me that both alcohol & Ativan (which I had resumed taking prior to that time) were now off limits. My "bottom" that had led me into treatment had involved taking Ativan and alcohol simultaneously, which is not to be recommended. I nearly died that night.
Since then, my anti-depressant medications and the mood stabilizer all have a sedative side effect, though non-addictive. And I have been prescribed trazodone to specificallly aid the insomnia. One of the impacts that this has had on me is that now, going to sleep is no longer the problem. I struggle to stay awake until bedtime, which has moved up from midnight or later to 8:30 pm. But then I wake. I begin waking up as early as 10:30 or 11, but more frequently at 1 to 2 am. I am typically, after a half hour or so awake, able to get back to sleep for an additional hour or so, but then by 3 or 4 am I can no longer sleep. I have subsequently been diagnosed with sleep apnea, requiring the use of a CPAP, but that has not changed the basic sleep pattern. During the day I find myself overwhelmed with drowsiness, which is a problem in that my work as a woodworker involves using tools that are dangerous to operate while drowsy. Occasionally, I can take a nap and actually feel rested afterward, but normally that is not effective.
It seems such a simple thing. A night's sleep. But a solution to my insomnia has been the most illusive issue I've dealt with since adolescence. And to this day, the greatest threat to both my remaining on medications and my sobriety is this simple desire -- to have a full night's sleep.
Subscribe to:
Posts (Atom)