Posted by ramsea on July 14, 2005, at 3:48:37
In reply to Re: Too little Lithium vs. just enough? experiences » barbaracat, posted by smith562 on July 13, 2005, at 20:03:54
This is a hard question for me. My experience is that of Bipolar 1, with rapid cycling and Mixed Manias, as well as a "normal personality" that is naturally very emotional and warm and very sensitive to everything--sounds, substances, feelings of others, words, colors, etc.
Only lithium offers me relief from the villain that is most out to get me--Mixed Episodes of pure mania with profound darkness. It takes at least 500 mg. for me to start improving, as I seem to need less of most medicines than average. But 1200 mg will be tolerable in a deep mania, though sickening if just maintaining or starting up on it after a "med vacation".
To maintain a space of mind that feels "okay" for me ---not dulled and drugged out--but not prone to sudden bouts of rapid cycling which can lead to longer and more treacherous mental places if not treated sharply and well---I find the dose varies between 600-1200mg. I don't stay at the higher doses for long.
But as for sleep--------well, lithium never helps me sleep. How I envy people who sleep with just lithium. I take Seroquel for sleep, at a low dose of 25 mg. most nights. But when a rapid cycling episode hits, or I show signs of increased overexcitement/irritability/depressive thinking/rages hidden or obvious/horrid racing thoughts and images/etc., then it is time to increase Seroquel for me. 50 mg. -100 mgs can help me sleep and slow the show down.
But even with all that--the lithium and Seroquel---I still rarely manage to patch 4-5 hrs of sleep together without a known waking, where I check the clock, put on an audiobook that is restful, and try to breathe myself back to sleep. Without the medicines, I am often up every hour on the hour (sometimes uncannily exactly hour to next hour). I eat to try to sleep and that makes me gain weight, though it can calm my nerves. I find black-out curtains help some--I live in a climate of long summer days.
For me, I know the lithium is helping by a very easy test. In my mixed episodes I want only relief from what feels like interminable misery. I would poke a hole in my head to let the endless screaming sorrow and confusion stream out---a frequent fantasy when I feel like that.
During these times, I am often physically unbearbly jumpy in my own skin, unable to position myself in any restful way, until possibly I drift off to sleep for anxious dreams, and wake in a panic, crying, moaning, terrified. It seems this will never end. Hopelessness overtakes me.
And then, after a week or so on a dose of lithium that is higher than ***I*** am used to (such as up from 600 to 1000) I wake from a solid 3-4 hrs sleep, unaware of waking even once, and I feel a weird sensation---it's called feeling okay, ready for my little expresso and a piece of toast. If that sort of waking continues, I grow very, very grateful. And to sleep 3-4 hrs without waking and being fully conscious--that is wonderful.
Maybe it is a little sad that I measure my days in this way--few people feel over the moon just because they wake up feeling okay after 3 hrs of sleep, but for me this is a definite sign of health and well-being. Some of us are sicker than others....But--- I am doing well right now, so I am feeling fortunate. This problem can be dealt with.