Saturday, October 3, 2015

Mind Change Day 3: Sleep

Ever since I learned the HALT reminder from substance abuse training (i.e. if you're feeling lousy it's
often because you're hungry, angry, lonely or tired. Deal with those first and the urge to use will diminish) I've used it as a parent.
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Which of these is the greatest cause of child tantrums and meltdowns?

Overwhelmingly, the need for sleep. Tired kids and cranky kids are so synonymous we forget those states can be separate. And substitute "irritable" and the same is true for adults.Being exhausted diminishes your tolerance for everything, even good things, and increases your reactivity.

Being tired is often synonymous with chronic pain (and PCS) because of insomnia. On the PCS and MTBI Facebook page I follow there are many issues folks have but it's rare to hear insomnia isn't one of them. How many of them would be better if that person was getting good sleep?

Same with chronic pain so in the Back In Control program this is the first intervention after education, and since anyone with insomnia has typically tried lots of strategies, the DOCC model takes a "whatever it takes, for however long" approach to heavy-hitting medications to break the insomnia cycle.

Mine was Remeron, though others are listed on the Back In Control site here. I'd tried Ambien and Lunesta and they both made me dizzy. Remeron just made me tired. So I did break the pattern I'd had for more than three years, which is sleeping 3-4 hours, being up for a few hours and then falling asleep an hour or so before I had to get up. On the dose I got up to, I'd sleep 7-8 hours straight.

The problem was sluggishness in the morning. The dose that kept me from waking up at night also kept me from waking up in the morning...at least not capable of any sort of thinking. And that feeling, of exacerbating my already muddled brain was depressing. When you're exhausted, it's just one step to the right to feel downcast about your life and the increased negative thoughts--made worse by a new inability to write--offset the good sleep. I was worse.

I had tried some other meds over the last few years (melatonin, trazadone, elavil, pamelor) and they all had side effects worse than the insomnia--for me--so ultimately I was willing to go to bed earlier and stay in bed longer in order to get that second sleep cycle even if there was a 2-4 hour break in the middle. I also got a Fitbit (actually a Garmin Vivofit) which charted my sleep, and I that was reorienting too. If I read, I typically was awake the full 2+ hours. If I didn't, and I wasn't anxious, I would fall back asleep within 1 hour if I just lay there feeling comfortable. But if I woke up feeling anxious and didn't read, the ruminative thoughts made falling back asleep at any point impossible.

Then there's the drinking. If I do have a glass or beer I know I'll wake up after 2-3 hours. I only do that when I can stay in bed longer to get the second cycle.

So over 6-9 months I've training myself to stay with the "comfortable, drowsy" plan most nights, and staying in bed for 8-9 hours I can usually get the minimum of 7 hours of sleep. Most of it is light (I average about 2 hours nightly of deep sleep, according to my wrist) but I haven't been napping during day for a few months now. I'm more alert, and feeling better.

This is also my secret for getting so much reading done ;).

Love, Lisa


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