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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Dinah on January 22, 2002, at 8:58:48
I feel terrible this morning. I've had trouble with increased anxiety and OCD, hypersexuality, "enthusiasms", and most of all insomnia since Christmas. In fact ever since I started feeling really cheerful. It's not hypomania, it's a step or two below that, but I was feeling pretty good. Unfortunately the cumulative effects of lack of sleep are beginning to show up. My thoughts are rambling and disorganized and I am having trouble focusing.
So I pulled out all the stops last night in an attempt to get some sleep. I took extra Klonopin. I had my husband hold me tight and my dog snuggle up to me. It worked to some extent and I had the longest night's sleep in weeks, but I feel awful this morning. Groggy and an awful headache. And I still feel somewhat overstimulated. I just can't decide whether to ride this out and enjoy it or if I should call my pdoc about increasing the Depakote at least for a while. My busy season at work is going to start soon and the insomnia and OCD will be helpful to me then, but I'm not sure I can sustain it that long.
Just rambling on, but any advice would be appreciated. I'm not sure how clearly I am thinking right now. In some areas I feel like I'm thinking more clearly than usual. I aced a game of memory last night! But in some areas I just feel muddled.
Posted by Krazy Kat on January 22, 2002, at 11:35:41
In reply to Feeling awful after a somewhat full night's sleep, posted by Dinah on January 22, 2002, at 8:58:48
I find it very refreshing that you point out the benefits of BPD and OCD. We may as well try to garner some good from these illnesses.
It really sounds to me like you are hypomanic. It fits the textbook def., anyway.
My manic episodes tend to start out with irritability, increase to that whole "I am invincible" thing, then to a small amount of psychoses (this is when I end up to talking to the ghost living in our house named Henry), and then I Crash.
I don't know what the right answer is - I've realized that I have to stay on a medium to high dose of a stabilizer b/c when manic, I tend to think I don't need my meds, sometimes I'll lower the dose or stop, and the outcome is a suicidal mess.
Keep in mind that one aspect of mania is feeling as if you're thinking clearly, you're on top of things, smarter, faster, brighter than you usually are. Perhaps this is true to some extent. But it also signals that you're cycling and a crash will eventually come.
I hope you feel better.
- KK
Posted by IsoM on January 22, 2002, at 13:11:38
In reply to Re: Feeling awful after a somewhat full night's sleep » Dinah, posted by Krazy Kat on January 22, 2002, at 11:35:41
Dianh, if you recognise a possible crash coming like KK mentioned, it would sound like your meds need a bit of adjusting. After all, you don't want the crash to come in the middle of the heavier work load coming up. The hypomania might not last through the whole period.
But just one night of good sleep may not have been enough. I know when I've had a rough time & finally do sleep good, one night isn't enough. I feel blah for a couple of days & need at least 2 or 3 good night's sleep to feel better. Perhaps that holds for you too?
>
> I find it very refreshing that you point out the benefits of BPD and OCD. We may as well try to garner some good from these illnesses.
>
> It really sounds to me like you are hypomanic. It fits the textbook def., anyway.
>
> My manic episodes tend to start out with irritability, increase to that whole "I am invincible" thing, then to a small amount of psychoses (this is when I end up to talking to the ghost living in our house named Henry), and then I Crash.
>
> I don't know what the right answer is - I've realized that I have to stay on a medium to high dose of a stabilizer b/c when manic, I tend to think I don't need my meds, sometimes I'll lower the dose or stop, and the outcome is a suicidal mess.
>
> Keep in mind that one aspect of mania is feeling as if you're thinking clearly, you're on top of things, smarter, faster, brighter than you usually are. Perhaps this is true to some extent. But it also signals that you're cycling and a crash will eventually come.
>
> I hope you feel better.
>
> - KK
Posted by Fi on January 22, 2002, at 16:41:17
In reply to Feeling awful after a somewhat full night's sleep, posted by Dinah on January 22, 2002, at 8:58:48
Obviously, you can judge better than me, but are you sure you're not a bit high? Your message is all very clear and organised, but some of the kind of things you describe do sound slightly on the mildly hypomanic side..? Is there anything (either meds or other) which you could do to slow things down a bit, at least till your busy period at work?
Fi
Posted by Dinah on January 22, 2002, at 18:25:31
In reply to Feeling awful after a somewhat full night's sleep, posted by Dinah on January 22, 2002, at 8:58:48
Thanks everyone. You're telling me what I need to hear. I have a tendency to enjoy the up times and ignore the high probability of a crash. And this time really isn't all that bad in comparison with other times. That's why I think I'm not hypomanic but somewhat short of that. I'm not spending my way to bankruptcy and while I'm not sleeping well, I'm getting more than the two or three hours sleep I need when I really get going.
However, I really can't afford to crash at this time. So I think that if I have trouble sleeping again tonight I'll give my doctor a call tomorrow. I can always just try raising the Depakote. I don't have to commit to it.
Thanks again.
Dinah
Posted by Dinah on January 22, 2002, at 19:19:28
In reply to Re: Feeling awful after a somewhat full night's sleep » Dinah, posted by Krazy Kat on January 22, 2002, at 11:35:41
> I find it very refreshing that you point out the benefits of BPD and OCD. We may as well try to garner some good from these illnesses.
>
Yes, Kat, most of my home improvements owe their existence to a hypomanic episode. Well actually, they owe their start to a hypomanic episode. Then I am left with an expensive half completed mess that I have to finish without the benefit of all that extra energy, but the end result is good.But it's my OCD that I'm really fond of. It makes me feel so safe. I really missed it on Luvox. Sure it's wrong a lot. (What was that bump? I must have driven over someone. I don't see anyone in the middle of the road, but maybe they're stuck under my wheels.)
And it causes me some extra time. (Touch the chicken, wash my hands, but did my fingers touch the faucet, wash the faucet, now may hands are dirty, wash my hands, pick up knife, wash my hands, can't take the chance of bringing disease to my family, it would be all my fault)
And it really has trouble telling the difference between thought and reality. If a picture enters my mind it is as real to my OCD as reality is. (Well the thought of doing something awful passed through my mind, so how do I know I didn't really do it and forgot it on purpose, how can you actually be sure you didn't do something you blocked from your mind, ok I checked and didn't do it, but how can I be sure I didn't deliberately not see what I did, better check again)
But it is right often enough for me to pay attention to what it says. I have remembered a lot of deadlines, thought of mistakes I might have made, etc. due to that little part of me that constantly reviews everything I did (or might have done) or didn't do. Plus I'm extra careful with what I do so that I don't set off my OCD. I'm not being sarcastic or anything, I really do like my OCD. I find it very helpful. I just wish I could control it and use it's power purely for good.
Actually as part of my way to deal with my OCD, I have personalized it. I picture her a an earnest and serious little girl with dark curly hair and big brown eyes. I've given her a name. She watches everything I do and worries about everything. She may cause me a lot of trouble, but she means well. Don't worry, it's a completely artificial construct. It's just a way to conceptualize and externalize my OCD so that I can deal with it better.
Posted by medlib on January 22, 2002, at 21:03:49
In reply to Re: Feeling awful after a somewhat full night's sleep » Dinah, posted by Dinah on January 22, 2002, at 18:25:31
Hi Dinah--
I've had considerable experience, professional and personal, with the sleep situation you described.
Many people who cycle moods are exquisitely sensitive to their amount of sleep; hi sleep- >lo mood, and vice-versa. Because this relationship is inverse and linear; one is a reliable indicator/predictor/result of the other. It becomes quite important to titrate sleep carefully, find your best personal "set point" and stick to a regimen (and meds) which provide that level of sleep--no more and no less. Easier said than done, I know (says Miss Inconsistency).
To a lesser extent, this sleep/mood relationship holds for non-BP "normals" as well. After the birth of their first child, my son and his wife found their sleep plummeting from 8 to less than 5 hours/night. Son was surprised that he felt alert and upbeat at work on so little sleep, but said that he felt "closer to the wall each day". I gave them 7 nights of uninterrupted sleep for Xmas, (not necessarily contiguous). When my son awoke from the "first night of Xmas", he had a headache and felt groggy all day. He's reassessing how much sleep he really "needs". Which begs the question, "How much of the typical 'Saturday/Sunday slump" is due to accumulated work week fatigue and how much is a product of weekend oversleep?"One caveat: 2-3 hours sleep per night is not enough to allow the body to get sufficient REM (dream) sleep. The body is quite rigid about this requirement, and prolonged deprivation of REM at night *will* lead to daytime REM (hallucinations).
Your headaches are likely vascular in origin. Prolonged horizontal positioning - > dilation of cerebral arteries/afterioles. Pain receptors are triggered by large/sudden changes in size of these vessels. Rx? Caffeine or other vasoconstrictors, if you don't have migraine meds.
You might need more Depakote to optimize your overall mood level; but, once you're where you want to be with that, something like Ambien, a short-acting sleeping pill, taken only when needed, might help keep you there.
Well wishes and sweet dreams---medlib
Posted by Dinah on January 22, 2002, at 21:49:24
In reply to Re: Sleep hangover? » Dinah, posted by medlib on January 22, 2002, at 21:03:49
Your post contained a lot of good advice. Thank you.
About sleep - I must confess that I can and do deliberately induce hypomania during my busy season by using sleep deprivation. I can keep it going from between one to three weeks. But otherwise I have extreme difficulty in regulating my sleep. In a hypomanic state or an agitated depression, it seems that not even increased Klonopin can get me to sleep and keep me asleep. I know this exacerbates the condition. And other times I just can't stay awake, no matter what I do. I take "involuntary naps." I just can't seem to get any control over this at all. So while I agree that mood states and the sleep cycle have a close relationship, in my case the mood cycle almost always leads the sleep cycle and I can't seem to make the reverse true. Other than a more potent sleeping pill, do you have any suggestions for taking control of the sleep cycle?
By the way, you are absolutely right about the headaches.
Thanks again,
Dinah
Posted by Shar on January 23, 2002, at 1:41:13
In reply to A tribute to my OCD (long and possible trigger) » Krazy Kat, posted by Dinah on January 22, 2002, at 19:19:28
D--Wow, what a great description you gave of the variations you experience. It gave me more insight on how busy or even buzzing one's head must feel during that time. (Being dysthymic is just blue to black to blue etc., no ocd or hypomania, unfortunately.)
Shar
> > I find it very refreshing that you point out the benefits of BPD and OCD. We may as well try to garner some good from these illnesses.
> >
> Yes, Kat, most of my home improvements owe their existence to a hypomanic episode. Well actually, they owe their start to a hypomanic episode. Then I am left with an expensive half completed mess that I have to finish without the benefit of all that extra energy, but the end result is good.
>
> But it's my OCD that I'm really fond of. It makes me feel so safe. I really missed it on Luvox. Sure it's wrong a lot. (What was that bump? I must have driven over someone. I don't see anyone in the middle of the road, but maybe they're stuck under my wheels.)
> And it causes me some extra time. (Touch the chicken, wash my hands, but did my fingers touch the faucet, wash the faucet, now may hands are dirty, wash my hands, pick up knife, wash my hands, can't take the chance of bringing disease to my family, it would be all my fault)
> And it really has trouble telling the difference between thought and reality. If a picture enters my mind it is as real to my OCD as reality is. (Well the thought of doing something awful passed through my mind, so how do I know I didn't really do it and forgot it on purpose, how can you actually be sure you didn't do something you blocked from your mind, ok I checked and didn't do it, but how can I be sure I didn't deliberately not see what I did, better check again)
> But it is right often enough for me to pay attention to what it says. I have remembered a lot of deadlines, thought of mistakes I might have made, etc. due to that little part of me that constantly reviews everything I did (or might have done) or didn't do. Plus I'm extra careful with what I do so that I don't set off my OCD. I'm not being sarcastic or anything, I really do like my OCD. I find it very helpful. I just wish I could control it and use it's power purely for good.
> Actually as part of my way to deal with my OCD, I have personalized it. I picture her a an earnest and serious little girl with dark curly hair and big brown eyes. I've given her a name. She watches everything I do and worries about everything. She may cause me a lot of trouble, but she means well. Don't worry, it's a completely artificial construct. It's just a way to conceptualize and externalize my OCD so that I can deal with it better.
Posted by Krazy Kat on January 23, 2002, at 11:15:32
In reply to Re: Sleep hangover? Thanks! » medlib, posted by Dinah on January 22, 2002, at 21:49:24
Dinah:
This is so similar (re: the mood cycles controlling the sleep cycles) to what I just posted on Babble. We have certainly been on the same wave length. :)
I really need some advice re: this. I've been sleeping way too much since restarting Depakote and I, too, understand the "forced naps". I really need to limit my sleep at night but I just can't wake up some mornings. God forbid I have to be somewhere. It's really not helping my self-esteem, or my husband's understanding b/c he ends up with more to do in the morning and he works.
Ug!!!
- KK
Posted by Krazy Kat on January 23, 2002, at 11:17:27
In reply to A tribute to my OCD (long and possible trigger) » Krazy Kat, posted by Dinah on January 22, 2002, at 19:19:28
I'm going to personalize my OCD and my manic depression. I think my mania ia male, my depression female, and I'm not sure about my OCD. Maybe a nagging great aunt? :) My mother... ooo, issues there. ;)
- KK
Posted by Dinah on January 23, 2002, at 14:38:05
In reply to Re: A tribute to my OCD (long and possible trigger) » Dinah, posted by Shar on January 23, 2002, at 1:41:13
"Busy" I like that description. :-) It's very apt at times. Other times my mind is completely blank and empty. And I've also experienced the flatness, which sometimes feels very refreshing. I try to see something good in all my mood states, but I can't quite manage it with an agitated depression. That one has has no redeeming qualities.
Thanks for reading that very long post.
Dinah
Posted by Dinah on January 23, 2002, at 14:43:49
In reply to Re: Sleep hangover? Thanks! » Dinah, posted by Krazy Kat on January 23, 2002, at 11:15:32
Yes, I saw that post and it does sound very similar. I called my pdoc and we'll try increasing my depakote by 50% and if that doesn't work, doubling it. So I may starting to feel that groggy, fall over asleep feeling soon. I really can't afford that right now. I'm ready for the spacey disconnected feeling though. I'm not going to let it bother me this time.
How is it going with you? How is your husband weathering the medication changes in getting ready to try to have a baby? My husband hates having to deal with all that. I hope the Zyprexa works out for you.
Dinah
Posted by Dinah on January 23, 2002, at 14:47:03
In reply to Re: A tribute to my OCD (long and possible trigger) » Dinah, posted by Krazy Kat on January 23, 2002, at 11:17:27
LOL. I was going to post some name suggestions for your great aunt OCD, but my OCD wouldn't let me. She's afraid I'll accidentally suggest someone's real name and they'll be mortally offended. Although my OCD has a very nice name, since I'm quite fond of her.
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