Sleep problems, and mania, hypomania and mixed episodes

Well it would appear I’m not having the best day. Nothing major happened – pretty much nothing at all happened (not the housework, not church, not any of the other things I wanted to do today) because I was so tired. I was barely able to sleep at all again last night, and even trying to get some sleep during the day today was a total failure.  In the bipolar world though, I am pretty lucky.  I have heard from many others that even one sleepless night is enough to trigger a manic (or at least  hypomanic) episode for them. For me it’s the reverse – sleeplessness doesn’t lead to mania, but mania sure leads to sleeplessness.

My entire life  I have suffered sleep problems. Problems with insomnia for as long as I can remember (and my mother swears since I was a baby).  While at other times, starting from when I was around 15 years old, problems with hypersomnia.  My insomnia is constant (except when I have hypersomnia) – the only thing that varies is the severity.  When I am hypomanic, I will usually only sleep 2-3 hours at most, and still feel energetic.  I have only had one full blown manic episode, and during that time I would go days without sleeping at all, and for months I lived on less than 2 hours sleep every night – usually only going to bed because my first husband was verbally abusive if I didn’t spend a few hours in bed with him trying to sleep.  And the whole time I was full of energy and felt like I didn’t need sleep at all.

When I’m depressed, it can go either way – I will be totally completely exhausted constantly, but sometimes despite the exhaustion, I just won’t be able to sleep much at all.  Instead I will lie awake, tossing and turning all night, too tired to get up, but still not able to sleep.  At other times, I will sleep for days on end, just getting up to use the bathroom and occasionally eat.

But I’m not always manic or depressed.  I can go months or years being “normal” – or perhaps I should say simply “in the middle”.  But even then insomnia and hypersomnia plague me.  The hypersomnia hits as soon as get the slightest bit physically sick – a simple cold is enough to knock me around for many weeks.  But usually the problem is my insomnia.  Lying awake in bed for most of the night, tossing and turning, so very tired but not able to switch my brain off.

Usually it’s bearable.  If I spend 12 hours in bed a day, I might get around 6 hours sleep and be able to function, but with work and two kids and many medical appointments, I’m lucky if I get 8 hours in bed and 4 hours actual sleep.  But then there are times like the last week, where even if I somehow manage to find 12 hours a day to be in bed, if I get 1-2 hours sleep, it’s a miracle.  I am getting some sleep, but it’s only ever just long enough to have a vicious nightmare and wake back up again and not be able to get back off to sleep.

I have to remind myself not to envy those whose mania is triggered by sleepless nights as I know how damaging manic can be for some people.  Except I’m not one of them.  For me, hypomanic episodes are wonderful things where I accomplish so much.  I have heaps of energy, don’t need sleep, love doing things I usually hate like housework, and also get really creative.  The only danger for me of hypomanic episodes is that I overdo things physically and have ended up making old injuries and arthritis worse and ending up with new injuries.

When it comes to manic episodes and mixed episodes, I’ve only had one of each.  The manic episode was in 2001 just after I married my first husband.  At the time I had full time uni and a part time job as well as volunteer work.  During that time I took on a second part time job and extra subjects (above a full time workload) at university. I would have days where I’d go to uni from 8am to 5pm and then work from 8pm to 5am (and spend 2-3 hours on public transport as well), several times on weekends I would go from one job to my second job and then back to the first. Not all my days were like that, but my usual day was uni 8am-5pm and then work 9pm-1am.  Although sunday shifts were rare, at one stage I worked 20 days straight as well as going to uni on weekdays during that time.  To this day, I don’t know how I managed to do maintain that lifestyle for 3 months straight, but I guess that’s the effects of a manic episode.

It wasn’t all good, or it wouldn’t be an illness. Even though I still managed to pass uni, I went from having a distinction average the year before, to only just barely passing that semester and even then, only because I got supplementary exams and exemptions from doing some activities because I had lots of medical appointments.  It also meant a lot of people took advantage of my energy and generosity during that time.  In the end, what snapped me out of it was having surgery on my knee otherwise I don’t know how long it would have gone for or how damaging it would have been for both my studies and my work if it had gone much longer.

I was really lucky that my manic episode didn’t end in disaster.  But nothing compares to the mixed episode I had in August to October last year.  A mixed episode is the most horrible thing you can have emotionally.  To be both manic and depressed at the same is a horrible feeling.  For me, some days I had both symptoms, other days I’d just be one or the other. It was like a bad lotto – I would never know what I’d wake up feeling each day, other than knowing it wouldn’t be good.

I think what really stood out to me though is that despite the fact I was working in an acute psych ward the whole time, not one of my colleagues (including the psychiatrist who I was also seeing myself personally) picked up on it.  Other people like the GPs and some of the counsellors/psychologists I was seeing could see it, but even though all my colleagues saw the symptoms (and as I found out later, complained about them behind my back), not one of them picked up it was a manic or mixed episode.

I think it comes back to the unconscious “us versus them” many mental health workers accidentally have.  It’s not deliberate, but until someone has a mental illness themselves, most people don’t understand that people with one are just normal regular people.  It was easier to label me as just talking too much, awkward, etc, than to accept a fellow staff member could be “one of them” [someone with a mental illness].  It also introduced to me to what I’d been warned about nursing and seen happen to others but had never been through myself until then – the gossiping about people behind their backs.  It’s why I no longer talk about my personal life at work at all unless completely unavoidable.  It’s not just in mental health nursing, but all of nursing.  Sadly one of my graduate colleagues has recently been savaged by gossiping and it’s not a nice thing to have happen, especially in what is supposed to an industry of “caring”.

Back to discussing mania… I’ve only had one each of manic and mixed episodes, but my hypomanic episodes average probably once a year – sometimes twice a year, sometimes only every second year.  I had one after getting out of hospital this year which lasted around 2 weeks.  It was a fantastic time where I got so much stuff done around the house that I’d been wanting to do since I moved here nearly two years ago.

I think the fact that my hypomanic episodes feel great and I don’t crash after (they just wear off) is part of why I didn’t go back on the abilify when I stopped it nearly two months ago.  I stopped it when I was depressed and didn’t go back on it a few days later when I restarted the cymbalta after John begged me to give the higher dose a try.  The main reason I didn’t go back on it was because I couldn’t be bothered, and then after a few weeks off it, when I realised some side effects I’d been having were caused by it and had stopped when I stopped it, is the second main reason I didn’t go back on it.  But honestly not caring if I have hypomanic episodes is why I didn’t do anything like look into taking something else instead.  Is it risky?  I guess.  I know I could have another full blown manic or mixed episode, but I doubt it.  The mixed episode was caused by pregnancy hormones, and the manic episode I believe was finally having freedom from my parents, feeling like I was finally free of being abused in my life.

If John and I ever do decide to have another baby, it’s something that I’ll definitely be careful about, but until then, I’m not worried.  Plus quite simply, the akathesia (really bad restlessness) was making my anxiety worse and it was good to stop it.  I didn’t even realise it was akathesia at first because I had akathesia for years while on seroquel, but how the restlessness came out was very different.  When I was on seroquel, I would suffer from awful spasms that would start in my hands and arms.  On abilify, it was just a constant feeling of needing to tap my feet usually.  I mean, with both, if I tried to ignore the sensation, it would intensify and eventually effect my whole body, but the fact that one was spasms and the other was tapping meant I didn’t realise it was akathesia at first.

I hope my post tonight hasn’t jumped too much all over the place.  The insomnia is really starting to get to me and I am so very tired.  Here’s hoping I sleep tonight because I have a huge day tomorrow.

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