Sleep is highly under-rated

I haven't slept for seven years
I think I've forgotten what it's like to dream
But I know I used to close my eyes
and drift off into deep blue skies
At least, that's what I do remember...

To a Maddening Ghost, Sara Hickman, copyright 1993-2007, Sara Hickman/Sleeveless, LLC

Every once in awhile, you hear a song and it's so relevant, it stops you where you stand. The first time I heard the opening lines of this song, I literally got goosebumps and my breath caught in my throat. It was the first time in my life I heard someone describe insomnia so eloquently.

What do you know about insomnia? It's obvious we live in a sleep-deprived nation--just watch TV on any given evening and engaging commercials for Lunesta, Ambien, and Rozerem are ubiquitous. If only sleep itself would be present on such a regular basis.

I have endured bouts of insomnia from the time I was about 15 years old. They came on without warning and have dogged me ever since. When I had my pre-college physical, I remember the family doctor noting in my file, "Has chronic, episodic insomnia." My mother insisted I would outgrow it, but I never did.

If you have never had to make it through night after night of sleeplessness, you can't imagine how frustrating and depressing it actually is. I want to sleep, really, I do. If you say you can't sleep, almost anyone you talk to will have a quick remedy to recommend, and I can assure you that none of them are effective. My latest drug in the war on sleeplessnes is Ambien--Ambien in any strength and form. I feel like I'm collecting the whole set, and all of the bottles are lined up in the cabinet from mildest to strongest, regular on the left and CR (controlled release) on the right. They mock me, those little amber bottles from Walgreens. Hope springs eternal, though, so I keep taking the medication, usually to no avail.

One of the other medications I take, EMSAM, has "sleep disturbance" listed as its first possible side effect. No kidding. I was barely making friends with the sandman before EMSAM came into my life, and since I've been slapping those patches onto my body, sleep has become something I would dream about if I could ever achieve REM sleep.

Each night I lay me down to sleep
The Lord my soul I pray to keep
But as he watches over everyone
My night has only just begun
Staring at the ceiling...


Sometimes I think Sara Hickman is channeling me. Or I'm channeling her. To a Maddening Ghost is just one of many of Sara's songs that sound like they're based on my life. Sometimes it's spooky.

Sara says that her mind just won't stop and that's why she can't sleep. There are a lot of things you can do for that particular issue. My problem is strictly chemical, the result of neurotransmitter traffic that won't let the adenosine cross the intersection, so to speak. It's all about the brain, baby, and mine is not interested in getting any downtime. Sigh.

According to the National Institutes for Health, at least 40 million Americans suffer from chronic, long-term sleep disorders each year. That means that although I'm not alone, it frightens me that there 40 million people out there wandering around in my same sleep-deprivation-induced stupor. The NIH has a few tips on sleep hygiene, and let me tell you, I am the poster girl for sleep readiness, but to no avail. I am getting by on about four hours of sleep per night; unfortunately, those four hours do not come in a row. Yawn.

Today I stopped at the bookstore on my way home from work. I passed the sale section and found a book with 20,000 keys to interpreting dreams. Although the book looked intriguing and I almost bought it, in the end, I shrugged my shoulders and thought, what's the point?

Last night, after trying in vain to fall asleep, I got out of bed and moved to the couch thinking that a change of venue might do the trick. I lay on the couch, listening to the sound of distant traffic on the highway (something I don't notice during the day), the shafts of light coming in from the street and the moon, and the clicking of my dog's nails as she came down the hall checking on my whereabouts. It was cool in the living room, and very still. I drifted off, nearly slipping into the dreamworld, when something touched my bare ankle and I bolted awake. My cat, who is obsessed with any lotion from Bath and Body Works, had stealthily made it onto the back of the couch and upon detecting the irresistible yumminess of coconut-lime-verbena lotion, decided that my ankle was the perfect midnight treat. Damn it.

I envy people who sleep well. I envy people who fall asleep quickly and wake up refreshed eight hours later. I yearn to know what it's like to sleep without trouble, without effort, without going into sensory deprivation via sleep mask, earplugs, and Breathe-Right nasal strip. Apparently, when I do sleep, I snore. What a fetching bedtime specimen I must be.

Every night, I brush my teeth, take my medication, and hope that this time, this night, things will be better. Usually they aren't and I find myself giving up and doing things like gardening at 5:00 in the morning because I'm bored.

Sometimes I think I can't take it another night, and I won't make it through another hazy day. It's wearing me down. I am worn down. Sara said it best:

Please let me rest in peace
Oh, I'm dying to rest...in...peace

The Cost of Stability

What comes to your mind when someone says Bipolar Disorder? Do you think of a wild-eyed, ranting mess of a person burning down the house in a fit of rage? Do you think of someone who laughs one minute and cries the next? Do you think of someone who is so mentally unstable nothing that he or she says can or should be taken seriously?

If you answered "yes" to any of these questions, then you've just nailed the reason why I don't tell anyone about my condition. It's a conundrum. If I tell, then I risk be written off as a mentally ill wacko who has no credibility--the disorder itself gets pegged as the excuse for any behavior that anyone else might not particularly like. On the other hand, by never 'fessing up, I leave myself open to the brazen speculation of others who talk behind my back trying to identify the source of my erratic moods and words. I've decided to let them wonder.

The truth is, if you didn't know me within three years of my diagnosis, then you probably wouldn't have any idea that something had gone so seriously wrong in my brain. I go to work every day. I work not one, but two challenging jobs and I do them well. I pay my bills, I iron my clothes, I work in my garden, and I lead a productive life. This is why I bristle every time I hear that someone has made news because of their outrageous and unconscionable behavior and then chalked it up to Bipolar Disorder. I hate these people and the damage they cause to those of us who are trying to prove how fucking normal we are.

OK, I'm not completely normal, but I try very, very hard to maintain that illusion. Here's what happens when the medications fail:

• I am mean. I am a bitch. I say terrible things to people that are the verbal equivalent of being poked (hard) with a sharp stick.
• I do not sleep.
• While I'm not sleeping, my brain processes thoughts at about quadruple normal speed--at least. Trying to focus is akin to trying to catch minnows with your bare hands, fingers splayed. And it's just as frustrating.
• I spend money like I have the bank account of a lottery winner, just one of several self-damaging behaviors endemic to BP.
• I get depressed. When I say depressed, what I really mean is that I want nothing more out of life than to be finished with it and to die. die.die. Obviously, I haven't killed myself, but I must admit, I remain ambivalent about that.
• When I am depressed, I can do only two things: I can go to work, and I can lie on the couch watching TV. I can also drive while crying--sobbing in fact--without missing a turn or running a stop sign.

Bipolar depression is like the worst depression you can possibly imagine, but on steroids. It is one of the most difficult forms of depression to treat, and for many sufferers, it will always remain stubbornly treatment-resistant. There is a reason why one in five people with BP commits suicide. You really have to experience this kind of depression to even begin to comprehend how bad it is. This soul-gutting depression really does make death seem like a reasonable alternative. Why? Because it hurts. A lot.

A year ago this month, my doctor decided to take the bold step of putting me on a new medication. I don't mean it was new for me; it was on the market only about six weeks when I started on it. To understand why this matters, you should know this: When I was first diagnosed with BP, I read that it takes about three years to get the meds worked out. I felt so bad at the time, I decided that if I couldn't find relief within three years, I would kill myself.

Enter EMSAM. Before I could start EMSAM, I had to get off of several other medications I was taking. That in and of itself made me want to put a plastic bag over my head. During the withdrawal, my brain started having some kind of auto-electroshock therapy. Every few seconds, my brain emitted what felt like electrical shocks throughout my body, ending at my fingers and toes. Every few seconds for weeks. Zap! Zap! Zap! Zap! Zap! It was exhausting.

Then there was the nausea and the vertigo. For some reason nobody has been able to explain, my sense of smell became hypersensitive, and it made the nausea even worse. I couldn't sleep. I couldn't speak right, and I didn't want to even try to be socially integrated. Work was overwhelming, and my memory was like Swiss cheese. I think I missed an entire month's schedule of staff meetings simply because I forgot to go.

EMSAM took forever to kick in, but once it did, my mood improved dramatically. My moods became more stable in general. Who would have thought that a micro-thin, two-inch square of adhesive plastic would be the thing protecting me from death?

EMSAM isn't perfect, but it's close. It exacerbates my insomnia and causes its own special strain of irritability. That's OK because there are treatments for those side effects, and those side effects are a walk in the park compared to the alternative.

More on EMSAM, suicidal tendencies, and insomnia next time.

May