Not In Kansas Anymore...

Click your heels, and see if home is where you hang your hat, or somewhere else inside yourself as this simple, postmodern girl takes on L.A.

Tuesday, July 14, 2009

So. I went to see Master P, and basically? I have fucked myself. I should explain.

I have never been a big person on the sleep schedule thing.

First of all, I'm a hopeless night person, and all prior attempts to change the have failed miserably. I even went through a sleep study once ( they said I had "depressive sleep patterns"-- and all it really means is, "Your REM cycle starts later than most peoples', which is indicative of a brain that is prone towards depression." Though I wasn't on meds at the time or in the middle of a depressive episode, even *I* knew how accurate yet just plain ol' inconclusive that was. Not surprisingly, my response was, "That's the best you can come up with?"). Later, ( when I was being properly treated for depression with medication)and still up at night/shunning sunlight as a regular rule, I asked my psychiatrist what I could do. He said barring some sort of attempt on his part to medicate me into a Michael Jackson-like coma, there was nothing he could really do to make me go to sleep earlier and wake up earlier,since I was likely just wired that way. I've checked with other doctors along my little journey through Modern American Psychiatry, and the consesus was the same: I might as well get used to being how I was.
In recent years, especially with the move to a different time zone, I have become increasingly vampire-like. Even when I had jobs, and schedules, it was always this struggle to deal with the sleep hygeine ( yes, that's what they call it) issues. Working for Big Bookseller was probably the easiest since my schedule was very flexible, and most of the time I worked 5 to midnight (and it was against the rules to schedule someone in any earlier than 11ish the next day if they did that). Still, being the finely-tuned wackjob that I am, it would take me forever to wind down from work, and then get into bed.

Of course, I didn't do much to help this little prediliction into any sort of copable lifestyle. I had terrible insomnia in college as well as the tendency towards night activity and DID try to do the "sleep maintainence" thing ( go to bed at the same time, don't watch tv or read in bed, try not to nap during the day, etc.), on the recommendation of my GP and miserably failed ( which inspired the sleep study, where they prescribed NOTHING but more of the same. WTF? I hope my insurance company enjoyed taking the $3600 hit....). In retrospect, that may have been due to lack of medication, but I lost my faith in ANY kind of sleep maintainence. So, once on medication, I took the irresponsible liberty of knowing that instead of being an insomniac, I WOULD sleep, and decided to give in to my nocturnal nature as much as I liked.

That, my friends, was a mistake. However, I didn't think so, since I was sleeping okay, and not doing too terribly with the schedule ( so, I'd sleep til 2pm after going to bed at 4am. So what? I didn't have any place to be.). THEN I met MC, which only confirmed my lifestyle even more.

MC, as I've already stated, has ADD and when he's being a responsible person, takes Adderall for it. Adderall, by the way, is a stimulant. And even though he works, he works from noon to 8, and then the rest of the night is his. He stays up really late, and he would stay up really late to talk to me. Like untill the sun came up late. Me, being already like "SO?" would stay up with him, almost falling asleep into the phone. Unlike MC, though, I didn't have Adderall to pick me up at 11am to get me to work. So, there became a habit ingrained of staying up late with him and then sleeping til the middle of the day. I did realize this, of course, and occasionally asked for nights "off " to sleep properly. Still, the habit was already in place and I didn't see anything wrong with it because it wasn't out of control. Yet.

Of course, like I've already documented, everything --including my heart--soon went into the toilet.

See, when we were breaking up and I was flipping out all the time on the verge of a breakdown, the only time I felt semi-normal was after I took my nightly medications. Why? Because they're sedating, and I was so anxious during the day, I could barely function. Needless to say I was greatly relieved of my taxing symptoms at night. So, I would stay up. Higher than a kite, but I would be okay for awhile and have some space in my head that wasn't consumed with worrying and crying about our failing relationship. I would do my dishes and my laundry and watch tv, and then collapse around 6am.
I would do my best, really level best, to sleep as much as possible during that time. First, I knew I wasn't doing well, and I knew my mind needed the rest. Second, I really DIDN'T want to get up and face the inevitable onslaught of crying and panicking my already imbalanced brain was sending me into, nor did I want to face the reality of what was happening. So I would sleep a full 12 hours, thinking I was doing myself a favor, waking up at 6pm, and after attempting to eat, I'd go inovoluntarily into spin-mode again, take my meds at the usual time ( 11:30pm every night!) and stay up. Lather, rinse, repeat.

After we split, and I felt less anxious, I got really depressed. I didn't want to be up during the day. I didn't want to be feeling anything. Lather, rinse, repeat. And this, kids, is how you create a clusterfuck for your brain. Master P explained it not in quite those terms, but close enough.

Basic brain function, for everyone, works because we when we sleep, our brain goes through a complex process of cycles and regeneration, for lack of a better word. Our eyes, even though they are closed, respond to light and natural rhythms of the sun to give our brain signals about sleep.

It's been shown in studies all over the world ( there was this really cool one where they put this woman in a room with NO outside light, no clocks, no outside stimuli to give her mind a clue as to what time it was. She kept a pretty average schedule: ate and worked and interacted with people, otherwise. However, because the researchers had deprived her of a sense of time, her sleep became really screwball. By the time she was done with the study, she had lost all ability to sleep normally for reasonable (8-10 hours a stretch) time. Yes, they helped her correct it before she left!). Even if you're a "morning " or "night" person, it is still determined by the rhythms your brain receives from exposure to light. Yes, you can train yourself to sleep during the day if you work third shift. However, everything else will go with it- your body chemistry, your appetite for food, sex and anything else will become habituated to THAT schedule alone. You won't be able to jump in and out of it and not see some problems.

For folks like me, with a chemical imbalance and a brain that doesn't work so good, screwing around with your sleep is like playing Russian Roulette: pretty soon you're going to trigger an episode, like it or not. Brains like mine, with a mood disorder can't handle a great deal of change in cycles and functioning without sort of freaking out ( and its even worse with other, more complicated diseases. I have bipolar friends for whom travelling in and out of different time zones is a trigger). That's because some of same chemicals that govern sleep ( seratonin, norepinephrine) also govern mood.

Fun, huh? Well, wait, there's more:

In depressives ( like me), the most typical form of the florid disease period has the person feeling like ultra-shit when they first wake up in the morning, and eventually feeling a bit better as the day progresses. That's because seratonin and norepineprhine abate significantly before waking, and it takes some time to roil back up to snuff enough to actually, you know, not cry through a meal. ( That's how I knew what Master P was saying made perfect sense, as if I needed more than the MD to back it up: I swear to you, never go to a mental hospital at breakfast. You will see more crying and eating- or attempting to eat- than you will be able to take!). In people with atypical depression, you see the opposite, which is, as the sun goes down, they feel worse and worse.

Atypical depression is one of the hardest things to treat, by the way. ( For a literary reference, see William Styron's Darkness Visible, about his own atypical depressive episode. Bleak. ) Doctors hate it, because it really goes against what the "normal" brain function is supposed to do, and it makes things really hairy, as you might surmise after having read all this.

But back to me ( of course, it all comes back to me). This past weekend I attempted, just out of good sense, to try and get back on a semi-normal schedule. I kept in mind my natural orientation of being a "night" person, and all the things I knew I was supposed to do ( sleep hygiene-wise). I took my meds at the same time I always do, and was aware that yes, for a few days, my little experiment in actually sleeping through the night was going to suck with a capital "S". I was going to have to force myself awake during the day and lay there not sleeping at night for a few days of misery.

So I did. And I discovered two awful developments.

One, after a few days, it didn't work. At all. I kept on schedule and I still laid there. Relaxed and calm, but mind completely awake. I would get up on schedule and be really out of it. And this persisted past an amount of time it would normally take to get oneself back on track. Even coming home from Paris was easier, and they're 9 hours ahead of my time zone; I was back to sleeping at night and awake during the day after 36 hours. But not this time.

Two, even though I kept the proper schedule, each night I would have a horrible period at about 8pm where despair would completely overtake me. I slipped into crying and obsessing and all that rot after a full day of feeling at least semi-okay. This would last up untill it was time to take my meds again.

WTF? That's when I called the doctor.

His summary was that I had been screwing around with my sleep for so many months ( since about February, when I met MC), and really pulling some inevitable 3rd shift living on myself so intensely that my body finally shifted. My faux-atypical depressive symptoms were now in place: because my body thinks it's morning at 8pm, the seratonin and norepinephrine abates THEN instead of when it should, so I sink down. Then, because I'm already there ( with low neurotransmitters for sleep), the meds aren't helping me sleep anymore AT ALL like they used to.

And he stated, for the record, that when this sort of thing happens, there's no use in treating the depression til the sleep is corrected, since the same chemicals are involved. If he threw a bunch of stimulating anti-depressants at me, it would fuck my sleep further. So, basically, I have to suck it up, suffer the mood problems for awhile longer and go through the hoops of fixing my sleep first, which involves a major change in my sleep med doses, a rigorous schedule and a possible addition to the pharmacopia I already take. JUST to get me to sleep correctly. YAY. ( I should mention here I HATE adding in new drugs. I think piling meds upon meds is just....complicating a situation that is already complicated. Because if something goes wrong, you don't know what to point to, and their interaction with each other is rarely well-researched or documented as a problem point. Not to mention your LIVER is sitting there processing all this STUFF, trying to keep up. Psych patients have three main issues, always: liver problems, kidney problems and metabolism problems, all because of the tax the drugs take on their bodies. I'm not saying it means STOP, I'm saying it means BE MINDFUL. But I digress....)

Nice move, Jessica. You indeed fucked yourself.


On the upside, at least I have a doctor who understands what the hell is going on and what to do. Right now, I'm ideally supposed to be sleeping from 2am ( med dose at 11:30! When he asked me if I was taking my meds at the same time, I said, "Of course. I want to give you SOMETHING to work with, for crying out loud!" He said, "Oh, thanks. Well, at least we have that!" and cracked up laughing) and up at noon. For a night person, that's pretty decent, gives me plenty of sun exposure, plenty of night time to jack around, and plenty of sleep time ( 10 hours). I'm taking enough Klonopin to knock me out even if I resist, and have permission to up the dose to TWICE as much. If that doesnt work, I have permission to add some other drug ( Lunesta! With the "Happy Sleepy Butterfly" commercials!) til I pass out cold.

As for waking up, therein lies a secondary challenge: oh, any ol' psychiatrist can get you to sleep. It's getting you to wake up and be functional again that's always a fun trick to try and pull. He said, "I can give you Provigil ....or some other stimulant....but that will have your anxiety sticking you to the ceiling". I said, "No, let's not do the Elvis scenario, okay? I'll do caffiene and see what happens."

And here we are at Day Two: Day One (last night) I slept from 2am to 7pm the next day. I don't know if my body needed that much sleep, or if I'm overmedicated. I plan on forcing myself awake tomorrow at noon if it kills me. My body needs to learn. Jessica has FINALLY learned, and now the spirit is finally willing. I need the flesh to follow in order to get back on the road to getting well.

And with that, good friends, goodnight.