I’ve always had a complicated relationship with sleep. When I am well and happy, sleep is something I actively enjoy. A nap is a treat for me, and if I wake up early I always choose going back to sleep over getting up and being productive. Yet there have been many times in my life when I have had problems with sleep, usually related to my mental health. Like most people, when I am very anxious I have difficulty dropping off to sleep, and tend to wake up in the night and lie there obsessing about whatever is causing my anxiety. If I am developing depression, I can display the classic symptom of early morning waking, and once depression has really got a grip on me I usually experience hypersomnia – feeling sleepy all the time and sleeping for long hours at night, and part of the day, too.
My currently diagnosis of bipolar disorder is based on a couple of discrete episodes of hypomania – thankfully fairly mild by the standards of many sufferers’ mania, but very disruptive to my normal life. Both have been characterised by (among other things) the AMAZING DISCOVERY that I DON’T REALLY NEED TO SLEEP ALL THAT MUCH! This should seem odd, given that under normal circumstances I enjoy a good nine-hour stretch, and feel deprived if I get under seven hours. But instead I feel absolutely fine being awake at night, in fact it’s a great time to THINK ABOUT MY FANTASTIC NEW PLANS before I get up early to BE SUPER-PRODUCTIVE! It’s certainly true that when I START THINKING IN WAYS THAT CAN ONLY BE REPRESENTED BY CAPITAL LETTERS AND EXCLAMATION MARKS!!! – it’s time to worry.
A couple of months ago I started on new medication intended to bring me down out of my manic state and prevent future episodes of either exhausting highs or dangerous depression. I was warned that it would be heavily sedative, a classic “do not drive, do not operate machinery” medication, but my doctor was hopeful that I would adjust to any tiredness fairly quickly. I needed to stop staying awake at night as my body was becoming physically exhausted, so initially the fact that I slept through the night (and well into the next morning) was a relief.
6 weeks or so into the new drug regimen, sleep is my number one preoccupation. The symptoms of the bipolar disorder have lessened, although not disappeared completely, but right now I am feeling that I don’t have much quality of life. Once I’ve taken the tablet, I have about a 2-3 hour window before I need to sleep. And I mean really NEED to sleep. That film or TV show I’ve been watching intently? Suddenly I don’t care whodunnit or who won or who got fired, because I need to sleep NOW. Staying awake beyond this point leads to feeling unpleasantly drunk, agitated, and very lacking in co-ordination. If I get up in the night to go to the bathroom, I am so incredibly sedated that I literally bounce off the walls of my hallway to get there. In general, I wake up about 13 hours after I take the tablet, and feel sleepy, confused, forgetful and slow until the afternoon. I’m beginning to relate big-time to zombies, who like me give an impression of life and movement, despite a lack of actual processing going on inside their skulls, poor things.
If I take my medicine too early, I’m asleep so early I can’t go out, or watch post-watershed TV, or have friends round. If I take it much later, it’s time for brunch when I even wake up. I am gradually facing up to the fact that if I stay on this drug, it’s going to be incredibly difficult for me to return to full-time work, or to have any sort of life outside work. To be at the office for 9am, I need to get up at around 7am. To achieve this if things stay as they are, I would have to go to bed about 8pm every night. 8pm. My teenaged kids don’t go to bed until 9.30 or 10.00pm. By the time my partner and I both get in from work and cook something to eat, we often don’t even get to start dinner until 8, or even later. The evening class I love only starts at 7.40pm, and is an hour’s journey away. The “quality time” period when my partner and I sit down and talk or watch a movie or whatever begins at 9pm.
And after my early night, what about the mornings? There’s often a zone between my first stirrings of consciousness and my actual rising where I am trapped in hypnogogia. Part of my mind wants to be awake, but I feel that I am unable to move my body and get up. I lie there, trapped by my own inert flesh, while my mind goes through repeated doze/wake cycles. Once I do make it up and out of bed, I’m fuzzy-headed, I can’t think clearly, my natural clumsiness is exacerbated, and if my sleep has been interrupted or curtailed (say, to under 10 straight hours) I am extremely irritable and my family’s in for a rough time. I need a good couple of hours of being alone and quiet before I feel fully ready to face other people and my tasks for the day. It’s hard to be sociable and inspired when you feel like you’ve just been re-animated.
At the moment, I can’t see how this medication is viable unless I give up my job, which is an economic impossibility. I’ve taken mental health meds more or less continually for the past 11 years, and always complied totally with the prescribed regimen. But right now I am, for the first time in my adult life, feeling that the treatment is part of the problem. I’ve always declared my mental health issues under what was the Disability Discrimination Act (now the Equality Act 2010) but in the past have almost felt a fraud for doing so, because as long as I took my meds I was basically fine. Over the past few months, however, I have felt more genuinely disabled by my condition and the treatment for it than at any time for a decade. Disabled in the sense that since last summer, I have not been able to have what I consider a “normal life” – I am genuinely unable to do things that I used to take for granted. A year ago, my life was vibrant, interesting; I had a job I was enjoying, hobbies I participated in regularly, and a good social life. At the moment, I feel that the focus of my life has narrowed down to getting basic tasks done around my ridiculous amounts of sleep. I have a projected return to work date of the start of August, but being able to even put in half a day of proper functioning feels improbable. Last week, I went out for a meal with friends in central London, and had to take my meds really late in order not to fall asleep on the tube home. The next day I paid for it by feeling so tired, irritable and frustrated on just the 8 and a half hours’ sleep, that I questioned whether it had even been worth it.
I have no idea what the answer is. Right now I am keeping a sleep diary to show both my consultant and my employer what I’m up against. I’m on the lowest dose considered effective for control of bipolar mood swings, and I’m not even fully symptom-free. I guess I’ll see what the consultant says when I see him in a couple of weeks. In the meantime, I’m off to bed.
This week, Purple has been reading Handling the Undead by John Ajvide Lindqvist.