Sleep Study

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I've been having trouble sleeping for years. I'm 42 now and my insomnia started when I was about 14. The diagnosis of bipolar disorder at 19 explained my sleeplessness at the time. About 10 years ago, I started having sleep problems again. I had gained a lot of weight because of bipolar medications, and my psychiatrist suspected that I had sleep apnea. He referred me to a sleep specialist and I had a sleep study. It was determined that I had mild sleep apnea (too mild to treat) and I was told that I would get better sleep if I slept on my side, so that is what I did.

This past summer, I started to suspect that my sleep apnea had gotten worse. I was waking up about 6 or 7 times each night, that I remembered, and I didn't feel rested. Part of the problem was that I was taking lithium, and it was causing extreme thirst, which was compelling me to drink huge amounts of water, and I was in the bathroom all day and all night. I was so thirsty that I would drink more water each time I woke up at night. Whether because of my extreme thirst, or suspected sleep apnea, I wasn't getting good sleep, so I asked my general practitioner to refer me to a sleep specialist, and I let my psychiatrist know about it. My psychiatrist was very interested in learning the results of my sleep study.

My sleep study in October was disastrous. I got out of bed 7 times to go to the bathroom and drank 6 cups of water throughout the night. I only slept for 1 hour, although it seemed like I didn't sleep at all. During that hour, I stopped breathing 16 times because of sleep apnea. That qualifies as moderate sleep apnea and is considered serious enough to treat. I went back for another sleep study in November, and this time I wore a CPAP, a device that blows a gentle stream of air into the nose during sleep to keep the airway open so that you can breathe properly. I slept 7.5 hours and was getting at least 90% oxygen all night, which is in the healthy range of oxygen. It was determined that I would get my own CPAP, and I did.

In December, I met with a respiratory therapist and was fitted with a mask and learned how to use and care for the CPAP. At first, I was given a full face mask. After three weeks of sleeping with it, I decided that it was too uncomfortable, so I went back for another mask. This time I got nasal pillows and they are proving to be much more comfortable.

I was not really excited about using the CPAP at first, but now, at the end of January, I feel so much healthier and more energetic since I've been using it, that I believe it is worth the expense and awkwardness. Also, it is thought that if you have sleep apnea and bipolar disorder, using a CPAP can lessen your experiences of both mania and depression. As an added bonus, I even look better. My eyes look much more rested and my skin looks radiant. Now, in addition to considering it necessary for good mental and physical health, I consider it to be a beauty treatment, and that makes me feel more excited about wearing it.

Unfortunately, many people with bipolar disorder gain weight from the medications, and that causes other health problems, like sleep apnea. There is a possibility that if I lose weight, I will be able to sleep well without the CPAP. Getting to my ideal weight is my next quest. When you get good sleep, you have fewer stress hormones in your body, so it is easier to lose weight.

Since I've been using the CPAP, I've lost 23 pounds. This is probably also the result of a medication change. When my psychiatrist learned, from the sleep study, that I was waking up and drinking water all night, she substituted Trileptal for lithium. I've been asking psychiatrists to take me off of lithium for years, but this was the straw that finally broke the camel's back. I'm also taking Lamictal and Saphris to control my bipolar disorder and I'm doing very well. I'm stable and alert and feeling much more optimistic about the future than I've felt in years.

Stress

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Tonight, while attending my biweekly support group, one of two support groups I attend, everyone spoke of stress more than usual. We all experience relationship stress, work stress, and the stress of having bipolar disorder itself. It's stressful to think about whether or not to disclose the illness to friends, families, and coworkers, and the mania and sleeplessness that occur at times with the illness, along with the with the seemingly endless depressions, are stressful states to be in.

At many times in my life, stress has sent me over the edge into mania and depression, and has caused me to be hospitalized more times than I can remember. As people with bipolar disorder, it is essential that we try to get a handle on our stress levels. For me, medication, diet, exercise, meditation, lifestyle changes, and therapy, have helped me to manage my stress. When stress seems to be getting out of control, I know I need to do something about it. If I can't handle the stress on my own, it's definitely time to call both my psychiatrist and my therapist. Spending time in a serious state of stress often leads to unpleasant outcomes for me: mania and depression. Hospitalization always seems like a huge setback, plus it's time consuming, often at the worst times, and expensive.

The biggest lifestyle change I've made is going on disability. At the time I went on disability, I was mired in a serious depression that I spiraled into after becoming so inert that I couldn't continue to teach. I had chosen to become a special education teacher because I thought that, as a person who had experienced many years of stability, I was ready to handle the stress, and my diagnosis of bipolar disorder would give me the insight and compassion to help students who were struggling with learning and behavior disorders. I did a good job for almost five years. In fact, I earned several awards and a lot of positive feedback from students, parents, and my principal. But the stress eventually got to me and I became almost immobile and was no longer able to gather the energy to teach. In fact, waking up was hard, as was attending to daily tasks such cooking and cleaning, and even getting dressed. I got to the point where I was barely able to care for myself, and I applied for, and was granted disability.

The period before I went on disability was the lowest part of my life. After I received disability, a lot of the stress I had felt was removed. Ironically, I saw disability as a time to focus on my health. I gradually regained my mental and physical strength. For anyone who has experienced long periods of depression, it's obvious that it's physically unhealthy. Too much time spent in bed or sitting causes muscular weakness, and many people who are depressed don't eat enough, or eat the wrong foods, and the poor nutrition causes a deterioration in health.

After a year on disability, I was able to begin working at a part time job, and now I've been working part time for slightly over three years. I'm feeling much better about myself, and people are beginning to wonder why I'm still on disability. The answer is stress. It has been a breaking point for me in the past and I need enough experience with my stable self to prevent stress from harming me again. I feel that I need a longer period of stability behind me before I go off of disability. My therapist and psychiatrist have shared their opinions that I am not ready to go off of disability yet, if at all.

Although I've been on disability for several years, and have reduced my stress, I've still become manic and have had to be hospitalized twice in the past three years. And I've experienced one serious depression where I was unable to work as many hours as usual for a couple of months. I'm hoping that my medication changes and lifestyle changes will continue to work, and I'll improve in my ability to handle stress to the point where I'll be able to handle the stress of working full time. I want nothing more than to deal with my bipolar disorder in a healthy way and to live the most productive life that I possibly can.

Picking up the Pieces

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For me, the hardest part of recovering from a depression or a mania is the time after the episode, when I know I'm doing better, and able to move forward, but also realize how far behind I am in things like cleaning, going through my mail, and paying bills - the routine things that are important but go out the window when I'm not in my right mind.

My mania started in March, and was followed by a depression that started in June and ended in July - thanks to a medication change my psychiatrist made. So, I've been feeling better since July. August was a month of recovery. I started going out with friends again, started my exercise routine back up, started cooking more often, and made great strides in organizing and cleaning my apartment - my cleaning routine is always the last routine to recover after a serious mood episode. So now it's September and I'm pretty much back on track. I finally feel that I have recovered seven months after my symptoms of mania first began. That's a very large chunk of time!

It's hard for friends and family to understand the recovery that needs to take place after a mood episode. It seems like once I start acting normal again, everyone assumes that I'm back on track, but that's far from the reality because I always have a lot of catching up to do.

The process of surviving mood episodes and then picking up the pieces is exhausting. It's why I take my medication, try to stick to my routines, keep regular appointments with my psychiatrist and therapist, attend support group meetings, and aim for stability. It's disappointing when I have to pick up the pieces again, but at least I have enough experience with it to know what to expect and also see it as a good incentive to stick to my treatment plan.

Financial Assistance

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I had a good, unexpected thing happen this week. I am on SSDI (Social Security Disability), and I work part time. My finances are tight, but I have enough money to pay my monthly bills. However, it's hard to save money, and I've had to ask my parents for help with things such as unexpected dental and medical bills and car repairs.

My father encouraged me to apply for food stamps and I got them. I really didn't think I would. I don't think of myself as that poor. The state worker, who determined that I qualified for food stamps, also told me that I may qualify for help with my Medicare premium, and housing assistance, so now I'm in the process of applying for those programs.

If you're on SSDI , or are just living on a low income, I would encourage you to go to the agencies in your state that help with food, medical treatment, housing, etc., and apply for the various programs. You might get some benefits that could help you live more comfortably, and maybe save a little money each month.

I've been on SSDI for four years, and nobody told me that I might qualify for this type of help. When I first received SSDI, I may have been embarrassed to write about this, but after living on a very restrictive budget for the past four years, I am not ashamed. I will accept the help. I am grateful for it.

The Right Dose

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"All substances are poisons: there is none which is not a poison. The right dose differentiates a poison and a remedy." Paracelsus (1493-1541)

I was depressed for the month between my last appointment with my psychiatrist and my most recent one. I didn't reach the lowest depths of depression, but it was interfering with my daily activities. I was the happiest when I was at work, but I wasn't socializing as much as usual, and I was having trouble unpacking after closing a storage space I had rented when my boyfriend (now my ex-boyfriend) moved in with me.

When I was describing my depression to my psychiatrist, I didn't use the word depression, I told her that I thought I had a more realistic view of life after switching out Seroquel for Saphris in my bipolar cocktail. I am now taking Saphris, lithium, Lamictal, and temazepam as needed. There were problems I hadn't noticed, when I was taking Seroquel, that were worrying me, but I thought I would be able to keep moving forward.

About a week later, I called my psychiatrist and asked for another appointment. I told her that I don't like to use the word depression because it is the last state I like to be in, but I was worried that Saphris was causing me to be depressed, and I wanted to quit taking it. I had quit taking it many months before, because I felt like it had caused depression.

My psychiatrist said that she thinks Saphris is probably the best antipsychotic for me because it is less likely to cause weight gain than other atypical antipsychotics. She said, "I was probably blocking too much dopamine," and changed my dose from 5 mg., morning and night, to 5mg. at night only. I was skeptical that this change would help, but it did.

I felt good the next day and have felt good ever since. I really wanted to quit taking Saphris, but during the discussion with my psychiatrist, about the dose, I was reminded of the quote above, something I was exposed to in a college biology class, and it gave me the will to try a new dose. I'm really glad I did. Maybe Saphris will turn out to be the wonder drug for me that it has been for some others. I'm going to keep giving it a try.

Mood Transitions

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I was manic in March and April, and then I was hospitalized. When I got out of the hospital, I had been stabilized enough to travel from Connecticut, where I was visiting my sister, to Kentucky, the state I call home.

Now it's early July and, looking back, I realize that I was hypomanic until a few weeks ago even though I was no longer in a crisis situation. I really don't enjoy being manic because my increasingly erratic behavior eventually becomes frightening to myself and others. I also don't like hypomania because it is a step toward both mania and depression for me, but sometimes it's hard to identify. In our society, we are rewarded for high energy and productivity, so sometimes what may seem positive can really be negative.

I was very active after I got out of the hospital, which seemed good since I'm trying to lose weight. It didn't take much to motivate myself to exercise and the things that usually seem hard, like waking up early in the morning, seemed effortless. I broke up with my boyfriend when I was manic, for good reasons, but it didn't really phase me until a few weeks ago, when I closed the storage unit I had opened when we moved in together, and brought everything back home. I felt a sadness and a loss of control as I unpacked and tried to decide where to put everything. I knew that I shouldn't miss him, but I did. At least I missed his companionship.

It struck me that I'm single and may possibly be for the rest of my life. I began to worry about living independently and taking care of myself. Ever since my diagnosis at the age of nineteen, organization, especially of my living space, has proven to be challenging for me. I'm trying to solve this problem by paring down my possessions to the bare minimum. The process of sorting through everything stirs up many memories and mixed feelings and living in a mess, although it is temporary, is disconcerting.

Anxiety had nearly immobilized me for the past few weeks. A couple of good friends helped me realize that my world wasn't ending, I was just overwhelmed. They assured me that I could take care of myself and helped to distract me from my fears by encouraging me to have fun and think about other things. I'm very fortunate to have supportive friends. They have both been through trying times, but have not experienced mental illness. Their insight helped me to understand how a "normal" person would think and pull themselves out of my situation. I quit the negative thinking and started to feel much better.

A few days after I started to feel better, I had an appointment with my therapist and told her about all of the mood changes and the anxiety I had experienced. She helped me to realize that I always feel uncomfortable when I go through mood transitions. Sometimes recognizing a problem is the first step toward overcoming it. Although I don't want it to happen, I can pretty much guarantee, based on my history, that I will become manic sometime in the future. Next time I come down from a mania, I can reflect on the fact that mood transitions are hard for me, and maybe that will help me to push through negative emotions and anxiety more quickly.

Temazepam

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Since my 10-day hospitalization for mania, which ended in April, my psychiatrist has made adjustments to my combination of medications. I am now taking 1350 mg. lithium carbonate ER at night, 5 mg. of Saphris in the morning and 5 mg. of Saphris at night, 200 mg. of Lamictal in the morning, and 15 to 30 mg. of temazepam at bedtime, as needed, for sleep.

I just took my first dose of temazepam for sleep last night and I feel good today. I slept well, I did not have a medication hangover when I woke up, and I have been calm and productive all day. I'm thankful that my psychiatrist prescribed it, and I'm hoping that this will complete the perfect combination of medications for me. If it works, it will be the combination I have been hoping for for the past 23 years - one that lets me feel and act like my best self.

My former psychiatrist switched me from temazepam to Ambien about 7 years ago because, he said, Ambien was less likely to be habit forming. That didn't make sense to me, as I hadn't formed a habit, but he insisted that I needed to make the change, so I did, and I haven't experienced as much stability since then as I did before he made the switch.

I told my current psychiatrist what happened when I was switched from temazepam to Ambien, and she wrote a prescription for temazepam right away. Anyone who has bipolar disorder knows how important sleep is to managing the health condition. Some doctors avoid prescribing sleep medications, because they may be habit forming, and instead use other medications, like the antipsychotic Seroquel, for example. I tried to use Seroquel for sleep, but I felt very much impaired and overly sedated during the day. I made many more mistakes than usual, and always felt like I was ready for a nap. I'm happy that my current psychiatrist sees me as a unique individual and prescribes the medications that work best for me.

Many mental health bloggers shy away from writing about the medications that they take, but I don't. I've always been told, and I've learned through life experience, that medication is necessary for managing bipolar disorder, especially Bipolar Disorder I, the most severe form, and the one that I happen to have. Since I'm sharing everything else I do to maintain balance, and since medication is so important for that, I'm describing the medication that I take, and how my psychiatrist decides to prescribe it. She only likes to change one medication at a time, so she can evaluate how each one works in combination with my other medications. This can be a laborious process, but I feel that it is helping me to experience more wellness.

Every person who takes medication is a different person with a different lifestyle. There is no one size fits all in psychiatry - at least there shouldn't be. I'm not suggesting my exact cocktail of medications to anyone else, I'm just writing that it is what's currently working for me. Reading stories of recovery, including stories of people finding medications that work, has always given me hope. More than anything else, in writing this blog, I want to encourage anyone with a mental illness, as well as their friends and relatives, to hang on to hope.