Dozy

Dear lovely readers, I am having the best time! I’m well, I’m happy, I’m productive, I’m energetic, not needing as much sleep or naps, I’m doing stuff, back on my bike, I’m out taking photos of birds, socialising, I’m having house guests, getting organised, spring cleaning of all things!! It’s remarkable and it’s thanks to my psychiatrist, thanks to the extra purple pill per day that I’m taking and thanks to my brain for accepting the intervention gracefully and allowing these happy days. I owe thanks to every lovely person who checks in on me when I’m unwell, so thank you so much; I’m glad I can write good news!

[Written a couple of weeks ago on One Of Those Days! I’ve been too busy living a happy life to write this week! YAY!]

Today I didn’t wake up, not altogether. I’m feeling a bit dazed, and a lot like there is a thick fog well settled well over my brain, and down over my neck, my shoulders and half way down my chest!

I’m struggling to open my eyes, and to keep them open, more to the point. They certainly aren’t fully opening. They just have an irresistible almost magnetic draw to close, and the sleep in the corners of my eyes clagging them together is adding to the problem. You know those moments, when people say they need matchsticks to prop open their eyelids? Except that’s usually at the end of the day, not the start of it. Bleary eyed, irritated and itchy, my eyes just aren’t ready for a new day. I realise this isn’t a first in the history of humans. Other people wake up like this too, it’s not just me. But this is after a full night’s sleep, a good rest. I should be rearing to go.

My whole body feels like its wrapped in a deliciously warm lovely blanket from which it would have to put up a great and tiring fight to escape. Well, I guess that’s not so metaphorical; I am still in bed, and I roll around enough in the night that it’s quite likely I’m twisted tight in the sheets by morning. My body is heavy and weighty and it just seems too hard to move it at all. And why would I want to put in that level of effort when I’m in such a nice situation? Oh yeah, to be the adult that I apparently am. But I can’t really think straight enough even to start planning what shape the day is going to take. What time do I need to get up again? And do I really need to get up, or can I cancel whatever I had planned? Assuming I can actually get this hefty body up out of bed. It’s like I’ve lost all muscle tone and I have to use my mind like a lifting machine to lift each dead weight limb, one at a time and they won’t cooperate! You know, one of those caterpillar diggers with the lifting clamp? Or one of the machines that nurses use, whichever environment is easier for you to visualize.

Drowsy, thick in the head, awful eyes, impossible body, can’t see where to start. And it’s my fault, my husband would remind me! Love you, baby; you really know how to phrase these statements. I am of course joking, he only says it nicely and when I know its the truth anyway.

But it’s true, it is my fault, in a manner of speaking. I took my tablets too late last night, and now I’m hung over. Basically.

I take my tablets by alarm, sort of. When you are prescribed a medicine that has to be taken twice a day, you should ideally take the 2 doses 12 hours apart. Says Miss Pharmacist, but what does Mrs Patient do? So, when will you take it?

It actually takes a bit of working out. Will you take your tablets at 7am and 7pm? 8am and 8pm? Really anything 12 hours apart works. Except there’s a complication because one of the tablets that you take at night with the second dose makes you drowsy and then comatose! It kicks in anywhere between 15 and 30 minutes usually. Sometimes it doesn’t really kick in for ages and I can stay up for an hour longer or more, but sometimes it kicks in fast and that’s it for the day. When I feel it starting to make my eyelids heavy and my insides warm and fuzzy, I head upstairs before I can’t stand straight anymore from dizziness and lack of balance! Please never try to see me at this time of night: the whole whites of my eyes go reddish and I scare myself looking in the mirror! It’s all gone by morning thankfully. In the past I’ve tried to push through the sedating effects but they won’t be argued with! I’ve crashed my way around my bedroom, lurching from wall to wall unbalanced and unable to see straight, and unfortunately having to go to the bathroom! There I sit, having done with the toilet, unsure if I can stand up and get back to my bed next door, feeling weak and heavy as a dead weight. Ask my husband, I think he’s had some interesting amusements in the early days of me using this drug! I’m talking about quetiapine, a mood stabiliser very well known for the drowsiness that it causes, among other things.

So, theoretically I could take my morning tablets at whatever time, then most of my evening tablets 12 hours later, then the sedating medication when I’m ready to go to bed…but that means having life interrupted 3 times a day instead of 2. It sounds trivial when I’m taking so many meds crucial to my health, but when I’m well I’d rather not spend all day taking tablets. So I want my meds in two convenient slots, but what times? If I’m working, this is especially critical. I want to take my meds before work, say 8am. But I don’t want to take my sedating tablets at 8pm and go to bed with the children. Plus its so early in the evening that I’m be sure to be awake bright and early at 4am or something inconvenient! So I tend to push out the night dose to 9pm, 10pm or later. If I’m busy, I just wait til I’m finished doing whatever I’m doing and I’m ready to go to bed and THEN I take them. I intend to get to the point where I’m NEARLY ready for bed, take my tablets and get a little sleepy while finishing off whatever, and go to bed nice and drowsy read to go off to a deep sleep. But I often forget and finish what I’m doing completely before taking my meds. The later I take them, the more likely it is that their effect will hang over into the morning. By much trial and error over 2 years, we’ve figured out that 9 to 9.30pm is the ideal time to take my meds at night, giving me possibly up to 10pm to do whatever in the evening and allowing me to wake up fresher. But unfortunately last night I took my sedating tablets at 11.30pm! Which messes up my system, although it is a fairly flexible system to be honest! When my night tablet alarm goes off I’m just as likely to snooze or ignore as I am my morning alarm. Some little rebellion in me about having to take meds. It never works out well for me. And so, here we are. Sedated, drowsy, heavy, tired; finding it hard to get going.

It’ll get better but slowly, across the course of the day, and it’s probably just going to be one of those days where I shouldn’t drive, need to find something riveting to do to keep me awake, or just succumb and stay in/go back to bed! I guess this is one of those days where not having a job works out for me. I might manage to get up and go to work on a day like this, but it’s questionable what quality of work I would produce, and it’s probably in most people’s best interest that I don’t go at all. So if I’m working, I need to be a lot stricter with myself in taking my meds on time. There’s a fascinating concept called presenteeism which I recently became aware of. You know, like absenteeism where you’re absent from work? Except this is when you are unwell, under stress or otherwise compromised in some way, but you turn up anyway and consequently put in a worse day of work than you might usually. A workplace was looking at how much presenteeism cost them as opposed to absenteeism, and whether it is really better sometimes for staff to just stay home. Doing so would theoretically reduce errors, complications, injuries that may arise from incomplete focus. I don’t know how they’ll measure any of it, but I’m watching on with great interest.

So yes I supposed you could say that being hung over and non functional is my fault. I get tempted to have late nights, to be like everyone else, carefree and not worrying about things like tablets. I know it’ll catch up with me the next day, but in the evening when it’s all going down it doesn’t seem as bad as it will be in the morning. So I push out the time a bit here and a bit there, a lot here, too much there! I do have to be careful that I don’t get myself into a different time zone, taking my tabs at 11pm and 11am or worse and really messing up my hours. While I’m off work I can be a rebel and mess up my sleep pattern and sleep in til lunchtime. Who cares, basically! But work is something that I want and need, and when it comes it’s back to taking tablets by the alarm. Like a good girl. For the best.

Mania

[Written 20th October 2014, updated along the way, most recently 28th July 2015 ]

There’s a question that I’ve been trying to answer ever since I was first diagnosed with bipolar disorder and experienced the first obvious manic episode: how can I know when an episode of mania is coming on?

I have been working on answering this question for a while. Hence the start date for writing. It’s taken time, experience, reflection and I’m still not there yet. Here’s what I’ve got so far.

It’s not like people imagine. There’s no flash from the sky that strikes you down in the middle of your ordinary day changing you in an instant from deeply depressed to wildly happy.

There’s no sudden chemical reaction that causes an immediate switch from happy Harry to sad Sally. You won’t be mid conversation with me and I’ll sudden lash out with anger or anything dramatic like that. I promise. I also won’t suddenly slump into deep depression.

It’s much more subtle than that.

I have bipolar disorder type 2, or manic depression. As opposed to bipolar disorder type 1, or classic bipolar, which involves intense highs followed by agonizing lows.

In the six months or so before my diagnosis of bipolar, I would exist mostly in varying depths of depression with the odd dilly dally into sub-mania, or half strength, quarter strength mania. So sub-manic that I didn’t even know it was happening for the first few episodes! It was like a partial lessening of my depression, not very distinguishable from my usual depression. It certainly wasn’t the full mania thing; I didn’t get the happy, carefree, superhero mood to balance my sorrows. I actually noticed a worsening of my depression when the lighter mood ended rather than noticing a lightening of my depression. I felt that I was having cyclical worsening of my depression, whereas the mental health nurse in ED saw a recurring very weak mania.

Moods don’t change 50 times a day. I should know. When I was first provisionally (meaning this-is-what-we-think-it-is-but-we’ll-wait-to-see-before-we-commit-to-the-title) diagnosed with bipolar disorder I was in a phase called rapid cycling. As it kind of suggests, rapid cycling is where your mood cycles/changes rapidly! Pretty self explanatory.

What this meant for me literally was about once a week over three or four weeks I would descend into the big black pit from where I could see no possible exit other than stopping living in it. That’s what being suicidal is all about; utter hopelessness. It’s awful and very hard to bear.

But then I’d be a bit better again, and think, oh that wasn’t so bad. If it happens again I’ll definitely tell someone, but I’m okay now so it’s all good. Except that each time I went in it was worse! And worse, and worse until I was done with it! Luckily I had an appointment with my GP on the day I was done with it so that instead of being done, I went to hospital and you know the recovery story after that. Or if you don’t, it’s time to hit the archives!

So rapid cycling. Once a week, not once a day, 10 times a day or anything fantastical. That’s rapid cycling.

For the “regular” patient with bipolar 1…weird statement, I’m sure every one is different and there’s nothing regular about it!…mood changes might be more likely to occur every few months or even once or less per year. Maybe every few years once a person is medicated. But when they come, they can be a serious force to be reckoned with!

So my original question: how do you know when it’s coming?

I’m still not completely sure.

I’ve found that needing less sleep or unusually restless sleep, waking many times in the night and waking for good in the early morning hours is a sign of mania, which doesn’t rest, and wants to be on the move the whole time.

I usually have a couple of days of being more irritated/frustrated/annoyed about small things than usual. Ask my poor husband! I stub my toe and scream in full on rage at the pain and the stupidness of myself to do such a dumb, painful thing. I mess something up and totally lose it, raging at myself for my incompetence. I just can’t tolerate anything less than perfection in myself. I take a wrong turn in the car, get lost, run late and just burn up the road in furious outrage at my incapability to do anything right. I fumble my keys, my phone slips out of my fingers, 1 drop one of the 10 things I’m balancing in my arms while I walk blind down the stairs and write myself off as a useless, worthless human being! When actually I’m a regular human being possessed of a mood that makes me think I can do a lot more than I a) can or b) should.

At this point, the best way to end things and to not keep on getting worse and worse, is to go to bed and sleep. For however long it takes to wear off the mania.

It’s truly a strange disorder. In essence, this is what depression is, being upset and down on yourself, but this time instead of getting melancholy about being useless, I get mad, really mad! Not at you, don’t worry. The majority is forcefully muttering stupid, idiot, fool, dummy at myself under my breathe. The rest is taken out on my poor hubby, who tends to have a bad habit of laughing when I’m this mood and massively exaggerating the events of the day. Of course the more he laughs, the closer I get to bashing him with the rolling pin! Once the mood passes we laugh about it together, but at the time he makes me furious!!! Livid!!!

Then there is getting teary about silly things more than usual, although that can come with the depression cycle too. I’m naturally an easy crier, which goes against my attempt to be cool, calm and collected! I think I can see now that when these PMS-ish symptoms start, it’s time to take a breath and check what’s really going on. I say PMS-ish cause that’s how it kind of feels, although I maintain that I don’t get (much!) PMS…my husband prefers to not answer so who can tell?!?

Add some annoying heart palpitations which make me nervous about being anxious again and you have a pretty complete picture.

I suppose the more important question is, how do I know when I’m a bit manic? Easy! I have had some pretty perfect examples!

One day a while back, I woke up spontaneously at 5am without an alarm, feeling fully rested and completely ready to hit the floor running and get things moving! This from a famously unlover of mornings!
I had motivation, organisation, energy to boot and I’m full on into my job list!!! Check check check check check..what’s next???

All this despite being exhausted for the previous 4 days, not getting out of bed until 5pm one day a few days back and having a 4 hour “nap” two days before missing half of a family birthday! Whatever comes my way, today I’m all over it!
Before 8am I’d been for two laps around the park; most days I wouldn’t even be awake yet! And I never walk! I catch the bus/train/tram/friends car/taxi before I walk, except when Chester’s making an effort to get me out of the house and we do a slow stroll around the park…today I was striding! I was considering jogging! Today I’m on fire!

But I have to keep a careful check that I don’t get too cray-cray, too outgoing and chatty, too effervescent and bubble off the reservation! I don’t want to wander into the real manic territory of getting all spendy with the money I’m not earning, getting over confident with betting/gambling (not really a worry is my theory since I never do that anyway…), being over-enthusiastic/ambitious to the point of being a bit delusional or putting myself in dangerous situations that I think I can handle or just physically burning myself out being bouncy and happy and carefree and all over it!

The other classic manic thing is getting a bit over-affectionate…Chester won’t complain, as long as I keep it within the house!

And one perk: I’m so active, and busy PLUS I don’t get hungry as much and don’t wear out at all! So mania. Love it! Love it more when it stays more than a day or two but it’s usually pretty short lived. Love it the most when it isn’t followed by a big black lump of depression but that can be a common switch. In general, I’d prefer if I didn’t get depressed at all or manic at all. I love the energy of mania but it can also make me irritable, restless and impulsive and I start to get claustrophobic and nervous about all my typical old scary movie type phobias. And there’s nothing much I love about depression. So after an episode of sub-mania it’s back to the psychiatrist for a review and a new opinion of what to do next. I’m guessing there’s a lithium or valproate dose increase in the works…and that’s okay with me! Whatever it takes to get back to a comfortable holding pattern of “normal” moods. The aim is always for the lows to not be as low, and the highs not as high. Middle ground; that’s what we’re chasing. Here’s to it!

So, fortunately/unfortunately this has been the story of my bipolar. Fortunately I don’t get the massive mania with delusions, super hero thoughts and even hallucinations. Unfortunately my mood swings tend to be often, like weeks and months and they do throw me off balance each time. Despite what I’ve tried to learn about my mind and my body from my experience so far, and the fact that I know mood swings will come in spite of my meds, they still creep up and catch me unawares. And so far they do unfortunately seem to be getting bigger and more intense each time…but I won’t borrow trouble before it comes.

The last question is how can other people tell that I’m manic? My husband has some answers for that list! I may be a bit short with you, or seem a bit edgy and I will be less patient than usual. I’ll be more sociable than usual but it’ll be a bit fragile if things go wrong. I try to keep it together for everyone else but sometimes some sharp answers slip through my filter; I apologise in advance!