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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by super on January 9, 2001, at 8:46:24
I am interested in how other people with bipolar disorder try to keep their sleep under control. I know I need 8 hours but I get so much energy at night that I can't sleep, and then I still have to get up for work early. The next night, same thing: even though I was tired at work, I get wound up again. If I take a nap during the day, then it is even worse. For about a year, I was very good about getting seven or eight hours, but at that time, my whole life was structured to support my newfound stability. Then I started to feel more confident about being stable and I wanted to live again, so I started dating and going out more and this winds me up. I used to take Xanax to sleep but it doesn't work very well anymore. I'm sure I could get a better sleep med from my dr. but I was wondering what others do in terms of lifestyle. Do you tell friends not to call you after a certain hour? Do you make yourself go to bed even if you are feeling wound up? Do you meditate? What works? Should I just give up on trying to get a lot of sleep (and maybe if I stop worrying about it, the insomnia won't be so bad)? During the week, I average about five or six hours. I think I would be more stable and productive if I got more.
Posted by Ted on January 9, 2001, at 11:04:17
In reply to sleep for bipolars, posted by super on January 9, 2001, at 8:46:24
Poor sleep control for about 4-5 years is what pushed me over the edge and led to my hospitalization for bipolar disorder. Here is what I do:
1. no caffeine. period.
2. no alcohol. period.
3. no stimulating drugs, like pseudoephedrine (decongestant), etc.
4. Keep a regular sleep schedule. I try to be in bed between 9:20 and 9:45 pm every night.
5. I sleep with earplugs many nights (maybe 75% of the time). They do a lot to keep "sharp" noises from waking me up. However good they are, I can still hear the smoke alarm well (tried it). They help me sleep when my son wakes up and starts banging around in the mornings.
6. I take ambien nightly, 4-10 mg depending on just how "wired" I am.
7. If I am *really* wired, I will add 0.25 - 0.5 mg lorazepam (ativan) to the ambien. This mix will quickly put me out for 10 hours.
8. One last benefit I have is that my job allows "flex hours" -- I can arrive at any time I want as long as I make it to all scheduled meetings. I take advantage of this to sleep in some mornings to catch up on missed sleep.Even with all of this I still occasionally have sleep difficulties.
Good luck,
Ted
> I am interested in how other people with bipolar disorder try to keep their sleep under control.
Posted by judy1 on January 9, 2001, at 11:57:51
In reply to sleep for bipolars, posted by super on January 9, 2001, at 8:46:24
I think Ted gave you some wonderful suggestions. The sedating effects of xanax (and other benzos) wear off pretty quickly if you take them on a consistant basis, even though the anxiolytic (sp?) properties continue. When I complain of the same sleep deprivation (if I am manic I never complain), my pdoc informs me that my mood stabilizer is not working properly. His thinking is, if the mood stabilizer is working (right one or two or three, right dose, etc.) the insomnia will disappear. Good luck- Judy
Posted by super on January 9, 2001, at 12:44:08
In reply to Re: sleep for bipolars » super, posted by judy1 on January 9, 2001, at 11:57:51
Judy--Is your p-doc right? Does your insomnia go away when you increase your mood stabilizer dose? If your insomnia goes away, does it do this at the cost of sedating you during the day? Your p-doc's logic seems overly simplistic because people without mood disorders also have insomnia.
Ted--Do you still go to sleep early on the weekends? Taking Ambien, are you able to wake up during the night if necessary (like if your child is sick)? How do you effectively set boundaries with others so that they don't disturb you during the nighttime? My girlfriend, who is a surgical resident and is often on-call overnight in the hospital, only finds time to call me around 10 or 11, sometimes later, most nights that she is on-call. How would you handle this?
Thanks for the advice!!!
Posted by Ted on January 9, 2001, at 15:42:40
In reply to Re: sleep for bipolars, posted by super on January 9, 2001, at 12:44:08
Hi super,
In answer to your questions:
Re: Mood stabilizer, I *think* mine (depakote) is the right dose, and my blood tests show it to be in the exact middle of the theraputic range, but I still have sleep difficulties. I think that if I raised my depakote level, I would be very sleepy during the day.
Re: Me:
1. Yes, I still go to sleep early on weekends. I *try* to keep the same schedule continuously, every night. Now, I will stay up late some nights, sometimes as late as midnight, but I *always* pay a price for it in the coming days & nights. After staying up till midnight one night I usually have to do the ambien+lorazepam trick and *really* catch up the next night or else I will really get sick.
It doesn't matter what time you go to bed; what matters is how much sleep you get, and your sleep will be best when your schedule is constant.
2. Yes -- ambien does not knock me out totally. It's not like being intoxicated. I can get up in the middle of the night and be relatively lucid. The neat thing is that when I get back to bed, I go right back to sleep. BTW: **ONLY** take ambien right before bedtime, and *never* do anything like driving within 6-7 hours of taking it.
3. I set boundaries by using earplugs. My wife can watch TV and my son can bang around, but I usually still get to sleep.
4. About your girlfriend calling, that could be a problem. You have several choices, depending on what you want to do. You can just go to bed a little early so that a call and conversation won't take much from the total sleep, or you can just get awakened when she calls and put up with it. You can have her call *later* at night, so you can get some good, continuous sleep before she interrupts you -- something like 1-2am. Then you can go back to sleep until time to get up.
Remember: you just need regular sleep. How you get it is up to you.
Take care,
Ted
Posted by Noa on January 9, 2001, at 15:58:30
In reply to Re: sleep for bipolars (long) » super, posted by Ted on January 9, 2001, at 15:42:40
I have found that keeping as regular a sleep schedule as possible helps me feel more stabile. It isn't always easy, but it can be done.
But I am not bipolar, and I dont know what it feels like to be manic and not feel like I need any sleep.
I've had to pay attention to sleep issues because I have sleep apnea. The cpap machine helps, but not just for the apnea. the white noise from the machine also helps me not to wake up from street noises, neighbors coming in and out of the building, etc. Once asleep, I usually can even block out the phone (in the other room).
Posted by judy1 on January 9, 2001, at 23:23:06
In reply to Re: sleep for bipolars, posted by super on January 9, 2001, at 12:44:08
I guess I thought you were referring to insomnia that is a direct result of bipolar disorder- so yes in this context the proper mood stabilizer(s) and other meds (I have comorbid conditions) do in fact improve my sleeping patterns. During manic episodes my sleep decreases to 4-0 hrs/night, during depressions I can sleep 18hrs/day. When euthymic (rarely) I sleep 7hrs/night.- Judy
Posted by Todd on January 9, 2001, at 23:28:21
In reply to Re: sleep for bipolars (long), posted by Noa on January 9, 2001, at 15:58:30
I don't know about any of you guys, but sleep is a big issue for me. I am usually pretty good about getting to sleep and giving myself at least 7 hours, but I know I need more than that and worry about triggering a manic episode with too much activity. So oftentimes I will catch up on sleep on the weekends and sleep 9 or 10 hours or more. If I don't set an alarm, I could set world records with the duration of my sleep. The issue is that this makes me feel guilty. I feel like I should have been more constructive with my day, like I have blown valuable time. I think it's echoes of my parents' voices in my head, telling me "get out of bed! you'll sleep your life away!" and feeling like catching up on sleep is some kind of a horrible sin. And of course, it's not just the echoes in my head, it's ME telling myself that I could have done this or I could have done that. Why can't I just give myself a break and sleep when I feel I need to? What IS excessive sleep, anyway? Is there even such a thing?
Posted by super on January 10, 2001, at 7:53:55
In reply to Re: sleep for bipolars (long), posted by Todd on January 9, 2001, at 23:28:21
Hi Todd,
I have known a lot of people with bipolar disorder, including myself, who need a lot of sleep. If it makes you function better when you are awake, then I think there's nothing wrong with sleeping as much as you need to. Forget about what they say about seven or eight hours being normal for adults, and pay attention to your own needs. I had intense guilt for sleeping too much when I was in college, because I felt that it was harder for me to fit everything into my life than it was for my friends who only needed six or seven hours. Over time, I realized that guilt and jealousy were completely unproductive and tried to focus on how I use my awake time instead of worrying about my sleep. In any case, it was much easier for me to stop feeling guilty about sleep when I graduated, since I now have defined work hours, rather than the sense that I should 'study all the time'.
> I don't know about any of you guys, but sleep is a big issue for me. I am usually pretty good about getting to sleep and giving myself at least 7 hours, but I know I need more than that and worry about triggering a manic episode with too much activity. So oftentimes I will catch up on sleep on the weekends and sleep 9 or 10 hours or more. If I don't set an alarm, I could set world records with the duration of my sleep. The issue is that this makes me feel guilty. I feel like I should have been more constructive with my day, like I have blown valuable time. I think it's echoes of my parents' voices in my head, telling me "get out of bed! you'll sleep your life away!" and feeling like catching up on sleep is some kind of a horrible sin. And of course, it's not just the echoes in my head, it's ME telling myself that I could have done this or I could have done that. Why can't I just give myself a break and sleep when I feel I need to? What IS excessive sleep, anyway? Is there even such a thing?
Posted by Janice1 on January 10, 2001, at 20:09:12
In reply to Re: sleep for bipolars (long), posted by super on January 10, 2001, at 7:53:55
hi everyone,
I'm joining in at the end of your conversation. But Sleep is a very very Big Deal to me. My body doesn't seem to know how much it needs - 2 hours or 16 or 8 hours does not guarantee a rested body and mind. I find I have to impose the structure and the daily rhythms on my body.
I basically do everything Ted does. With a few exceptions, I try my best not to take medication to sleep. I wear a mask over my eyes because I find another very big issue for manic depressives is LIGHT. The masks helps my sleep.
I do my best to NEVER sleep in on the week-end.
I developed a rapid-cycling cycle from hell from this sleep-in on the week-end pattern that would come Thursday when I would 'go to bed' and not get out till Sunday at noon, when I would start my hypomania.I agree with Judy that the more stable you are, the shorter your circadian rhythm seems to be (I think that's what you were saying).
You could always try lights first thing in the morning. This is suppose to help regulate sleep.
Personally, I'd tell the girlfriend to call in the mornings or during the day.
good luck, Janice
Posted by Janice1 on January 10, 2001, at 20:14:46
In reply to Re: sleep for bipolars (long), posted by super on January 10, 2001, at 7:53:55
hi super,
I forgot one thing.
never any naps!
So basically my sleep (lying on the bed whether I am asleep or not) goes from 12pm - 8am every night of the week. that's it. no naps. If I'm not sleeping, no getting out of the bed.
This is the regiment (I guess you could call it) I followed to start sleeping well. I really made sleep a priority in my life and it worked. I am sleeping well now and I feel good (of course with the help of mood stablizers medications too).
good luck
Posted by Ted on January 10, 2001, at 23:50:53
In reply to Re: sleep for bipolars (long), posted by Janice1 on January 10, 2001, at 20:09:12
Hi Janice, et. al.,
> I basically do everything Ted does. With a few exceptions, I try my best not to take medication to sleep.
I wish I didn't have to. :-)
Really, though, when I ride my bicycle to work during the summer, I am usually too sleepy to need ambien.>I wear a mask over my eyes because I find another very big issue for manic depressives is LIGHT. The masks helps my sleep.
Interesting idea! I never considered that, but it makes sense. I tend to sleep more during the winter (more dark) than the summer.
> I do my best to NEVER sleep in on the week-end.
I can't. I have a 5-year-old who gets up between 6:30 and 7:00 and comes to get me up to make his breakfast and play with him.
And your other comment about no naps.... My pdoc said the same. But, if I am *really* tired, like from a poor night's sleep or a cold or whatever, I will still take a short nap. I find it has little effect on my nighttime sleep and it really makes me feel better.
And I agree with you all: Sleep is a BIG deal for me. It drives my wife crazy (no pun intended), but I really need it.
On that note, it is now bedtime. Good night, everyone.
Ted
Posted by Noa on January 11, 2001, at 11:38:46
In reply to Re: sleep for bipolars (long), posted by Ted on January 10, 2001, at 23:50:53
It is a BIG deal for me too. I find that when I am vigilant about allowing myself to get enough sleep, I feel much better.
For a number of years, it seemed all I could do was sleep, but what was really going on was that I had apnea, and my sleep was not really sleep. I was only getting 25% of the needed REM sleep, and little stage 4 deep sleep. I was also being oxygen deprived every night. I had micro-awakenings about 45 times every hour!
I would come home from work and fall asleep in the early evening. On weekends, I would sleep the entire time. I couldn't stay awake. I became super addicted to coffee, needed more and more ADs and ritalin, etc. I felt awful
Finally, after having some dreams that I was under water and unable to surface for air, I realized I must have apnea, and asked the MD to send me for a sleep study, which confirmed it. Once I got the nCPAP machine, and got through the initial adjustment to it, I started sleeping really well.
Before CPAP, I used to get up to pee every hour or two. But with CPAP, I found I was sleeping straight through the night. I also stopped having nighttime acid reflux, which I had had fairly often, and was a horrific experience. I also stopped getting as many colds, coughs, etc.
But, every so often, my sleep gets a bit out of whack. I am in such a phase at the moment, because my CPAP mask is broken and the way I have "rigged" it is barely adequate. Also, I recently increased my serzone from 300 to 350 because the effexor side effects of restless legs was starting to act up again.
Now that I am exercising, I find that helps, too. But I have been having trouble with the "behavioral" aspects of good sleep habits--ie, getting ready to get in bed at a good hour, since I have to be up so early.
Posted by Janice1 on January 13, 2001, at 18:49:53
In reply to Re: sleep for bipolars (long), posted by Ted on January 10, 2001, at 23:50:53
> Hi Ted, Janice, et. al.,
>
A naturopath told me that these medications are hard on the nervous system. That they are a 'quick fix'. This is why I try not to take them, as well as they are addictive. But I do take them, usually 3 times a months.
> Really, though, when I ride my bicycle to work during the summer, I am usually too sleepy to need ambien.you're right exercise is great!
>
> >I wear a mask over my eyes because I find another very big issue for manic depressives is LIGHT. The masks helps my sleep.
>
> Interesting idea! I never considered that, but it makes sense. I tend to sleep more during the winter (more dark) than the summer.
>
I used to use a dawn simulator to wake up in winter, but this winter I get up at 8am, and even in snowy Canada, it's light out at this time. But what my boyfriend noticed was that during the night I would often wake-up for 'no reason'. Then he noticed that everytime I woke up, the neighbours had turned their light on in the middle of the night. The mask solved that problem.Sounds to me Ted like you are doing a pretty good job. Of course, good pills help too. It sounds like you have your wife's cooperation. My boyfriend caters to me (because he knows if I'm not happy, no one is happy:+)
Sleep well, Janice
Posted by Janice1 on January 13, 2001, at 18:55:23
In reply to Re: sleep for bipolars (long), posted by Noa on January 11, 2001, at 11:38:46
hi Noa,
(just after I said I haven't responded to one of your postings for a long while)
We forget about the simple things in these illnesses, eating well, sleeping well. Or perhaps, better said, the simple things become the impossible or difficult things.
My father (nerves of steel) had sleep apnea. But unfortunately I took after my mother (bargain basement nerves). Sometimes I think perhaps I should be tested for this, just in case. I will keep it in mind.
Thanks for letting me know about it,
Janice
Posted by Noa on January 15, 2001, at 12:19:39
In reply to Re: sleep for bipolars (long), posted by Noa on January 11, 2001, at 11:38:46
Janice,
Some signs to look for are waking up with a humongo headache every morning, really bad snoring (and if your boyfriend is over, he would have something to say about that, I am sure!!), having a really hard time waking up in the morning, being sleepy all the time (feeling like you are going to fall asleep at the wheel, for example).
for more info:
Posted by super on January 15, 2001, at 14:16:51
In reply to Re: sleep for bipolars (long), posted by Noa on January 15, 2001, at 12:19:39
> Is there a seasonal pattern to your sleep problems? My p-doc seems to think my difficulty sleeping has to do with this time of the year, and that it will pass as the seasons change.
Posted by Janice1 on January 16, 2001, at 17:37:00
In reply to Re: sleep for bipolars (long), posted by super on January 15, 2001, at 14:16:51
thanks Noa, I snore sometimes, but none of the others really. I have friend who has it, and she said she has never been tired during the day.
Janice
Hi super,
yes, I have SAD in a big way. Sort of goes with the whole bipolar II thing. Everything flares up in the winter, but my bipolar problems are year long.
Janice
Posted by super on January 25, 2001, at 12:55:44
In reply to Noa and super, posted by Janice1 on January 16, 2001, at 17:37:00
I just wanted to let you all know that I'm getting my sleep back under control. After a very brief trial with Serzone (utter failure), my p-doc doubled my Depakote dose and told me to take more Xanax as needed. I'm now sleeping almost seven hours a night and more on weekends. I feel so confident in my new sleep schedule that I'm tapering the Xanax. I really think it's the increased Depakote that's doing the trick though, combined with telling my g/f not to call me too late at night.
> thanks Noa, I snore sometimes, but none of the others really. I have friend who has it, and she said she has never been tired during the day.
>
> Janice
>
> Hi super,
>
> yes, I have SAD in a big way. Sort of goes with the whole bipolar II thing. Everything flares up in the winter, but my bipolar problems are year long.
>
> Janice
Posted by Noa on January 25, 2001, at 15:56:35
In reply to Re: Noa and super, posted by super on January 25, 2001, at 12:55:44
Good news, super.
Enjoy the rest.
Posted by speedy on January 28, 2001, at 15:14:25
In reply to sleep for bipolars, posted by super on January 9, 2001, at 8:46:24
> I am interested in how other people with bipolar disorder try to keep their sleep under control. I know I need 8 hours but I get so much energy at night that I can't sleep, and then I still have to get up for work early. The next night, same thing: even though I was tired at work, I get wound up again. If I take a nap during the day, then it is even worse. For about a year, I was very good about getting seven or eight hours, but at that time, my whole life was structured to support my newfound stability. Then I started to feel more confident about being stable and I wanted to live again, so I started dating and going out more and this winds me up. I used to take Xanax to sleep but it doesn't work very well anymore. I'm sure I could get a better sleep med from my dr. but I was wondering what others do in terms of lifestyle. Do you tell friends not to call you after a certain hour? Do you make yourself go to bed even if you are feeling wound up? Do you meditate? What works? Should I just give up on trying to get a lot of sleep (and maybe if I stop worrying about it, the insomnia won't be so bad)? During the week, I average about five or six hours. I think I would be more stable and productive if I got more.
>I'm very sensitive to disturbances in s/w cycle with that being my #1 trigger for 15 years. I've come to accept that I can't 'play' at night. I also have had good results with anti-seizure meds using the lowest possible dose that works. Developing a routine associated with bedtime helps as does very light exercise.
This is the end of the thread.
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