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The Ongoing Sleep Experiment That Is My Life - Body by Henson, brain by Seuss. [entries|archive|friends|userinfo]
Kelly J. Cooper

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The Ongoing Sleep Experiment That Is My Life [Nov. 20th, 2012|06:55 am]
Kelly J. Cooper
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A couple of months ago, I asked my psychiatrist that given the amount of work we’d done over the past 2 years, diagnosing my ADD and determining that my depression is anxiety-based, good stuff that had NO noticeable effect on my sleep issues, should I go back to the neurologist? She suggested talking it over with my primary care physician.

When I asked my PC whether, given all the work I’ve done in the past 2 years without any improvement in my sleep, should I go back to the neurologist, she suggested going to see pulmonary specialist Dr. E instead (name available via private email). She liked him. (At that time, Dr. E had recently joined the practice where my PC, gyn, and endocrinologist work.)

On Wednesday, 26 September 2012, I had an appointment with Dr. E.

In preparation for the appointment, I put together a timeline document most of my medical history and a few major life events. To be honest, it was depressing. But it also forced me to review my records which, while voluminous, were not always regular or in a good order.

I also contacted that neurologist and asked that my records be sent over. They sent me a release form, I signed and mailed it back within a couple of days. I also signed and mailed one to my pshrink. Of course, neither of them actually sent him information in time. My pshrink sent him a paragraph about me that morning, since I’d bugged her via email the day before, but it hadn’t shown up in his digital database yet. (Reminder to me: Contact the neurologist and remind them they said they’d send the data over.)

The appointment was more or less the Dr. E show. He talked, I listened. It was difficult to get a word in edgewise. He asked a series of questions about a variety of aspects of my sleep, my health, and came to the conclusion that either my circadian rhythm is broken or easily influenced away from what’s healthy.

He instructed me to do several things. When I pointed out I’d done most of these things, he responded that I hadn’t done them all at once.

1. Keep a sleep log (include wake-ups during the night, wake time, bed time, sleep time, naps, and work)… he wanted a spreadsheet next time I saw him.
2. Set a stable wake & sleep time.
3. Begin using a light box – specifically, he wanted me to get a Philips goLITE BLU – for 30 minutes a day.
4. Exercise intensely soon after waking.
5. Socialize regularly during the daytime (to remind my body that this was the time to be awake).
6. Get black-out curtains for my bedroom and sleep in complete darkness
7. Two hours prior to my desired sleep time, take melatonin, dim the lights, and stop using technology (definitely no iPod, iPhone, or computer but TV should be OK). When I mentioned melatonin has previously given me a headache, he suggested getting the 3mg pills & cutting them in half.

When I pointed out that getting up was the big problem, he said to make myself.

When I pointed out I didn’t have the energy to exercise, he explained that sleeping at the wrong times, outside of the normal circadian rhythms, meant bad sleep. If I slept when I was supposed to, my sleep quality would improve.

He closed saying that insomniacs what a single solution right now, but fixing one’s sleep is more of a process. Once I’ve reorganized my life as prescribed, then we would do sleep test and he could examine the results.

Anyway, it was kind of insulting. But I bought some 1mg melatonin, and in that does it’s still effective but doesn’t give me a headache. Mostly. About once a week to every two weeks, I get a spectacular concentration headache – y’know, the kind you get when you watch TV for 8 hours? Only I get it if I don’t do anything at all or if I watch any TV or use the computer or concentrate on pretty much anything. It really sucks.

I’ve tried to stop using the computer at least 45 minutes before headed to bed, hoping to inch it back, but sometimes I have late-night work to do for crazy clients, so that’s hard. I drafted a random notebook into being my sleep log (I have a LOT of blank notebooks… turns out that one of my stress purchases/anxiety soothers is blank notebooks) and I’ve kept up with it.

I tried to set my desired wake-up time to be from 11am to 2pm and my desired bed time from midnite to 2am. It’s still hard. When I wake up and I don’t have the energy to get out of bed, it’s not an easier to “force” myself with a doctor’s orders than it was before I saw him.

As I consider the list he gave me, it’s like going back to when I worked a 9-5 job (well, 10-6 when I could). I got up at a regular time, fell asleep at a regular time, and socialized during daylight hours. I hadn’t the time or energy to exercise. Granted I didn’t track my sleep/wake times and I definitely used the computer until it was time to fall over and go to sleep. And since I didn’t suffer from Seasonal Affective Disorder, I’ve never used a light box.

I don’t know. The quality of my sleep is improved when I avoid the computer and go to bed at a “reasonable” hour. But my ability to wake up is not improved. My pshrink says it’s a lack of dopamine – that’s the stuff that makes you want to get up or go do stuff. If it’s low, you literally don’t have any get-up-and-go.

The lite box was expensive, but the BF used a gift card he got somewhere and picked one up for me from Amazon. I’ve only just started using it. I’m really reluctant to spend the money on blackout curtains. It’s hard enough to get up as it is without the light to help. And I use a sleep mask most nights (I’ve gotten good enough that if the light hits me, I put the mask on without really waking up… it’s kinda tough to fall asleep in it, unfortunately).

Anyway, I’ve been noodling on this post for a while and I should just friggin’ publish it.

[User Picture]From: rmd
2012-11-20 08:50 am (UTC)
I know several folks who get good results from light boxes.

Sorry this is all so ... gah.
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[User Picture]From: metagnat
2012-11-20 10:19 am (UTC)
Good god. That is a lot of stuff. This guy definitely sounds like a blowhard to me. "Make yourself" get up? Seriously, WTF?
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[User Picture]From: drwex
2012-11-20 12:59 pm (UTC)
Having dealt with insomnia a couple times in my life I understand the theory this doc is coming from. Basically what I think he's working with is a sense that the body responds to cues, sometimes ones that we're not even aware of. But we do train ourselves into (and hopefully out of) patterns. In my case my orders included "do not read in bed" and "if you aren't falling asleep after 15-20 minutes, get up and do something no matter how tired you feel."

The basic regime (mine was a lot less detailed than kjc's) was intended to behaviorally condition my body to fall asleep when lying in bed. All the cues (being horizontal, the smell of the sheets, etc) would work as operant conditioners for sleep if you remove them from other situations. Once they stopped being cues for "reading" or "lying there thinking about how much it sucks that I can't sleep" they started working better as cues for sleep itself.

THAT all said, theory is still theory and may work better or worse (or be more/less applicable) for different people in different situations. It worked for me, but might not work for other people.
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[User Picture]From: sweetmmeblue
2012-11-20 09:03 pm (UTC)


Is that why you haven't been reading in bed as much the last year+? I was wondering what it was.
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[User Picture]From: catness
2012-11-20 06:40 pm (UTC)
Confirmed: your doctor is a bit of a dick.

Not confirmed: your doctor might be right about doing all of these things at once.


Stef got me a light box a couple of years ago for Christmas. I don't think I have SAD either but the light does seem to make things better, in an overall sense, in terms of getting sleep.

One thing I will never be able to do is set a regular sleep time. A) Musician. B) Network Engineer with irregularly scheduled overnight maintenances. C) Generally on call.
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[User Picture]From: muffyjo
2012-11-20 11:54 pm (UTC)
I find that melatonin is both useful and makes waking up a groggy experience for me. I use a "long lasting" variety that is a sublingual spray and I use a half a spray (which technically means 0.75, I think as a full spray is 1.5).

As I approach 11pm on a school night (when my bedtime is 10pm) I can only nod in agreement and shuffle off to the bedroom to start my own bedtime routine which should have started an hour ago.

For me, I have to get up every morning at 6am (7am in the summers) because my cat needs her meds and since she has a fairly accurate internal clock, we stay consisten. Every day. Yep, even weekends. I've grown used to it. But it also means my body has finally given in and is on the same clock.

I know it feels like your Dr. has asked you to do the hokey pokey and turn yourself around but it sounds like a whole bunch of things you already want in your life anyway. It's just kind of a kick in the painful places to have it being externally driven instead of internally driven. Still, those were all your ideas in the first place. Maybe it's just like writing a really awesome song and finding a good arranger to fill it out and sing it back to you. It still is all your idea, just now it has more moving parts.
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