I is for Insomnia

Insomnia is habitual sleeplessness or the inability to sleep. According to this definition, I don’t have insomnia. I am able to sleep. In fact I love sleep, I always want to sleep…except for those anxiety dreams, but that’s another post. If I don’t have insomnia, then why am I so tired all the time?

Upon further research, I learned there are three different patterns of insomnia. One is sleep onset insomnia, the inability to fall asleep. This I knew. It’s more common in people with anxiety. Your brain just doesn’t want to shut up and thoughts keep cycling in your head. Anxiety is similar to stress in that the hormone cortisol is at higher levels. One of the functions of cortisol is to keep you awake. I don’t have sleep onset insomnia. I have trouble staying awake!

Another pattern of insomnia is early morning awakening with an inability to go back to sleep. Usually you get around 6.5 hours of sleep. This pattern is typical of depression. I’ve been having this kind of trouble lately. I wake up at 3:30am and that’s it, I’m awake. It makes me pretty useless during the day.

The third pattern of insomnia is nocturnal awakenings. I didn’t know this counted as insomnia. I have this all the time. I wake up several times during the night for no apparent reason. Thankfully, I am usually able to get back to sleep, but it still leaves me waking up tired.

insomnia

How do you treat insomnia? By keeping good sleep hygiene for one thing. This includes going to bed and waking up at regular times, avoiding caffeine and alcohol close to bedtime, giving yourself time to wind down before bed, exercising during the day and keeping the bedroom a comfortable, dark place for sleeping, not TV! This stuff is pretty obvious. I try to follow these rules, but sometimes it just doesn’t work. Then what do you do? Well, I climb out from between hubby and Ewok and head to the couch where I watch the Phantom of the Opera until sleep finds me. Sometimes the movie has to play several times. My psychiatrist has prescribed me sleeping pills for when my insomnia is bad. I’m not comfortable taking them though. I’m sure there are lots of different options, but I am worried about becoming dependent or really wanting to sleep and taking too many. So I was pleased to discover an alternative to sleeping pills, cognitive behaviour therapy for insomnia (CBT-I)!

According the the Globe and Mail (a Canadian newspaper) it’s the first line of treatment for insomnia in Canada, USA and Britain……really? Then why was psych so quick to give me sleeping pills? CBT-I is supposed to teach you how to manage racing thoughts and limit the amount of time you stay in bed to your actual sleep time. This means only going to bed when sleepy, not napping, having a certain rise time and getting out of bed if you can’t sleep for some reason.

It’s hard to believe that this CBT-I stuff is recommended over sleeping pills for chronic insomnia and I’ve never heard of it. With 8 years of mental health treatment under my belt, I would have thought I’d come across it.

Has anyone else heard of this? Has anyone tried it? I’d love to hear from you about CBT-I or about what methods you use to get to sleep.

Sources:

Globe and Mail

Canadian Sleep Society

Confessions of a Java Junkie

My crazy professor hanging from the auditorium ceiling

Coffee is my lifeline. It wasn’t always like that though. I used to hate it, the nasty bitter taste made my stomach turn. Now, I drink it black, like my soul. I blame my coffee addiction on Physics 101 and my body image issues. It was my first year of university, I had a physics class that lasted an hour and a half in an auditorium that sat over 600 students. The auditorium was cold, so I always had my jacket wrapped around me. This, along with my level of interest in physics and my professor’s monotone voice was the perfect combination for nodding off. I remember trying to take notes and falling asleep mid sentence. My notes would go from legible to chicken scratch. One time, I completely fell asleep at the beginning of the lecture and woke up to find my professor hanging from the ceiling by a bungee cord. Look, simple harmonic motion! he was saying. I thought I was hallucinating! Time to find a method of staying awake.

Getting cozy, wrapped in my jacket was not a good idea, so I had to find a new strategy to stay warm. Tim Hortons (THE Canadian coffee/donut shop) was near by, so hot chocolate would be good I thought. Then the little devil on my shoulder woke up and said too many calories to have that all the time. Coffee has no calories. So I started drinking it. It’s an acquired taste. After having it several times a week for a semester, I started to like it. Now, I have it not only because I REALLY like it, I need it too. I’m not quite as alert without it.

Coffee has caffeine which acts as a stimulant. It increases heart rate, stimulates the central nervous system and temporarily boosts metabolism (yay!). Caffeine is similar in structure to a brain chemical called adenosine which makes us sleepy. Since our body can’t tell the difference between the caffeine and adenosine, it ends up using caffeine instead, causing the spike in energy. Caffeine is not unique to coffee, it is also in teas, soda and chocolate, but you get the most benefit from it in coffee. Moderate amounts of coffee can improve your attention span, reaction time and other brain skills. Coffee contains antioxidants along with caffeine. Antioxidants are tiny molecular warriors against diseases like cancer and Alzheimer’s. That’s not all coffee helps to fight. A 2011 Harvard study followed the caffeine intake of 50,739 women over a ten year period. They found that those who drank coffee had a decreased incidence of depression compared to those who didn’t. So more coffee = less depression. Hook me up to a coffee IV, stat!

Not so fast. It is recommended that the average person have 2 to 4 cups of coffee a day. Every body reacts differently to coffee. Caffeine toxicity is possible. The symptoms resemble anxiety and mood disorders, you can feel agitated, nervous and restless. Depression is often accompanied by anxiety and insomnia. Coffee can aggravate these. It best to see how you react to coffee before hooking up the IV. I noticed that if I have caffeinated coffee in the afternoon, I don’t sleep very well. So now I make sure to unhook my IV or switch to decaf (which has much less caffeine) by noon.

Coffee can also affect you differently depending on your medication. I haven’t read any research on this, I speak from experience and reading mental health forums. I recently increased the dosage of my bupropion (Welbutrin) to 300mg. This medication gives me more energy and a better outlook, but I have to put up with the side effect of tremors. They normally aren’t too bad, my hands shake a little, no big deal. I don’t know if this was because I was adjusting to the new dosage or what, but I had a pot of coffee one morning earlier this week and holy tremors Batman!! I was shaking so much I couldn’t write, type or draw. My muscles were doing strange twitchy things, especially the muscles in my face and it felt like my eyes were vibrating. In addition to all that, I was sooo nauseous! I didn’t actually throw up, but it kept coming and going in waves. I’ve never felt like that before. The last few days I’ve had two cups of coffee with lots of water and I haven’t had the same reaction thankfully. I would be really sad to give up my coffee.

What’s the moral of this story? Coffee has all sorts of benefits, but every body is different. Find out what amount is right for you. Also, watch out when you change your medication!

 

Down the Rabbit Hole

I’m feeling pretty low. That’s why my last few posts have been about things I have learned either through experience or reading. I think it’s important for you to either learn something new or feel uplifted after reading a post here. I’ve gotten to the point where my brain isn’t working well enough to come up with something. I’m falling down the rabbit hole, but unlike Alice, I’m not going to land in Wonderland. There is nothing wondrous about the place I’m going. It’s dark, lonely, hopeless and usually doesn’t make much sense. Well, maybe Alice and I have that latter part in common.

I can usually tell when I’m falling. I start getting really tired for no particular reason. Then I start to lose what little motivation I have. That’s how this spell started, but there were a few added perks. I changed the dosage on my medication and I’m having a hard time adjusting. The first few days I was really nauseous and shaky. The nausea went away, but the tremors stayed. It makes it extremely hard to draw which seems to be the only thing I can do without having to jump over the giant hurdle of dread. These symptoms, along with the lack of motivation have kept me from going to work. I think I feel guilty about not doing any work, or maybe I just think I should feel guilty, I don’t know. I don’t care enough to figure it out.

Yesterday was particularly wretched. I haven’t been sleeping very well and the night before last I pretty much didn’t. My lack of sleep has accumulated into that nauseating, photosensitive, headache-y feeling that leaves you stranded in bed or on the couch in the dark. So that’s where I’ve been for most of the day….and night.

While I was rotting on the couch, I got confirmation that my husband will definitely be out of a job for the next school year. There are no full-time science contracts in the school board he is tenured with. All these questions are swirling through my brain. What are we going to do?! Will he find something else? Will I have to leave my Ph.D.? Will we have to move? This would normally start a panic which I would talk myself down from, except I don’t have the energy to panic. So instead I curled up into a ball and prayed that I’d just disappear. Since it was not likely that my prayers would be answered, I needed a new strategy.

I’ve been told that when I start to fall apart I should try living life 10 minutes at a time so I don’t get overwhelmed and can stop thinking about the future. There was nothing I could do about my meds, my work or his job at the moment anyway. What could I do right now? Try to feel better. How? I have a list of things that usually cheer me up. I have it written down for times like this when I’m not rational. Starting at the top of my list is my husband, who is not currently home, next… Find Ewok (my cat). Check. Sweatpants. Check. Cup of coffee. Check. Put on the Phantom of the Opera. Check. Watch until I feel better.

The Phantom played through five times. I still feel the same. At least I haven’t completely lost hope yet.

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