Lease Expiration

My fracture-healed body is the foil to my sense of well being.  Now that I'm back on my feet, the the greater trochanter fracture 95% healed, I've uniquivocally slipped back into the hell of chronic insomia, with the renewed sense that I no longer have the resiliency needed to navigate life (work, socialize, etc).   This is underscored  over the past 2 week by my repeated plunges into 2 -3 day successive "rips" where I sleep between 0-3 hrs per night, then crash the next day or two.  The last 10 years of my life have been absorbed by this black hole, and I've had a remarkable 11 week reprieve.  But now, desperate, unprecedented actions are going to be undertaken in the next year to remedy the situation.  All options are on the table now, because living the rest of my life alone in an insomnia mediated semi-stupor is not an option.

Currently thinking of doing another sleep lab study, perhaps with more of a medical trail, I can investigate whether I can go on disability, maybe getting some stronger sleep med drugs, taking a three week vacation to the amazon to drink ayahuasca - probably all will happen within the coming months.  Of other more sundry options on the radar screen I will not speak.  One step at a time, all hope is not yet lost.

life's new lease?

As puzzling and crazy-making the past 10 years of insomnia have been, its relinquishment over the past two months, starting nearly to the day that I broke my hip, has been nothing short of astounding.  So for as much as I've whined and moaned about my sleep problems with my highly sporadic posts, I'd be remiss not to note its lifting, and add a couple of comments and conjectures as to what I think might be going on.

First off, because visuals speak louder than words, I'll unveil a graph that tells part of the story.  I started keeping regular track of my sleep hours every night since January 2012 (I wish I had been doing this through the whole period since the nightmare started in 2003).  The red line is a 30 day moving average of sleep hours per night.  For those of you not familiar with moving averages, to get the sleep hour data point for any given day (say, June 1), I take the average sleep hours of the previous 30 days (The period of May 1 to June 2.  For the next day, June 2, take the average sleep hours per night from May 2 to June 2, and so on.)

I am lousy at formatting, so while it may not be pretty or slick, this will have to suffice.  I fractured my hip on August 31st 2013.  Though I am mostly back on my feet right now and have resumed most activities, I am still sleeping relatively well compared to before the fracture.

Those looking closer at the graph may notice that the trend line starts heading up a bit before the fracture.  For August 16 - August 30th, I averaged 6.5 hours per night, which is way better than all the previous graphed periods, so maybe the fracture had nothing to do with it.

So here is my alternative hypothesis:  Sometime this summer I slightly altered my supplement routine - I started taking right before bed 50gm of 5-HTP and ashwaganda.  I also exhausted my stash of cheap melatonin supplements and started buying better quality brands.  So I now take 3mg of time release melatonin right before bed as well, and when I inevitably wake up (usually around 2 - 4 AM), I take 3 non-time release.  Sometimes I will supplement with additional 1MG melatonin pills as well.  Sometimes I need to meditate for 30 min to an hour to get back to sleep as well.

I pretty sure that I am utterly dependent on both 5-HTP and melatonin now, but I will choose dependency over the semi-conscious living hell of insomnia.  I'm hoping that this, in combination with my regular habits of heavy exercise and mediation, will enable me to mostly shake this bugaboo.  Fingers crossed.  The 5-HTP is tricky for me.  50mg is a low dose, but it makes me prone to having seizures and gives my odd feelings of disconcerting physiological discomfort throughout the day.  More than 50mg, the problem with seizures and auras gets worse.  I'm sure my serotonin production/regulation system is totally whacked.

I occasionally (once every week or two) use and need pharmaceutical backstopping.  From current and leftover prescriptions, I now have restoril (which I've habituated to after over 2 years of sporadic use), ativan, and lunesta (which made me depressed and gave me wicked rebound insomnia when my prescription was active) to choose from.  From my hip fracture prescriptions, I have a few leftover diazepam and vicodin, which also tend to knock me out.  From here on out, I'm hoping that I can stay on an even keel, with only having to resort to the meds 1x every 3 weeks or so, relying mostly on benzodiazapenes, but with an option of the lunesta type meds.  Don't worry, I won't try to get more vicodin to use as a sleeping pill - I'm not that dumb!

I can only pray this is the light at the end of my insomnia tunnel.  Time will tell, and perhaps on this blog, I will tell as time does.  Now, back to living life. At the age of 49, I'm trying not to cry over the spilt milk of 10 lost years.

broken bones: insomnia foil?

It was spectacularly stupid.  Riding my bike to the Saturday morning farmers market on the last day in August here in Montpelier, my ball cap started to loosen as I picked up speed down a wicked hill.  Reaching for it to keep it on my head, I lost control of my bike, flying over the handlebars and landing on my hip.   I sat in the middle of the road stunned, contemplating my sudden change of status, from healthy male cyclist to injured citizen in need of medical attention.   It was one of the few times I did not wear my helmet.

I had a hip fracture – isolated fracture of the left greater trochanter.  In other terms, I broke off the pointy part of the hipbone that juts out from the outside part of the upper leg.  It is an unusual type of hip fracture, and perhaps not as serious as far as these injuries go, because neither the weight bearing integrity of my leg nor the hip joint itself were compromised in any way.

Aside a well-learned lesson in cycling safety, the pain, recovery, and having to tolerate a hopefully small number of weeks hobbling around on crutches, the experience has had a welcome silver lining thus far:  nearly normal amount of sleep.  It is amazing – I’ve sometimes been hitting 9 hours a night for over 2 weeks now, and feel human again, other than the broken hip part. 

The pain meds certainly had something to do with it at first – the vidcodin/acetominephin combo along with the diazepam prescription for pain relief and muscle relaxation really put my lights out.   But now that I’ve been weaning myself off of these, I’ve had some solid nights, (and even a long afternoon nap last Sunday!) without the meds.  And its been weeks since I’ve taken a benzodiazapene sleep aid (current Ativan prescription, with some left over Restoril, to which I’ve habituated). 

So hope springs eternal from the physical trauma of bone fracture.

Parade of the False Alarms

There is a risk that I'm posting about this too hastily and may yet need to reverse my course again (if I should be so fortunate), but I'm laid low once again by what might be the false promise of the serotonogenic supplements.  Its baaaaack, and I am a miserable puppy for it.  I had a tear of three normal nights of sleep last week - so simple and so utterly human a pattern it was - go to bed, fall asleep, wake up feeling great.  Last sunday it returned - I was forced to practice conscious nocturnal bed laying, at least till I took a restoril to knock me asleep (probably a big mistake).  So it began anew - the next night, it was a Lunesta.  As for that medication, it has outlived its usefulness.  I've maybe averaged taking about 30 Lunesta each year over the past few years, and it has stopped working for me.  Now, I take the pill, and it takes about 2 hours for it to finally knock me out.  Then I wake up 4 hours later feeling hung-over.  And worst of all, more often than not, is that I've noticed that I become really depressed later in the day - to the tune of suicidal thoughts and utter life-negating unassailable loneliness and hopelessness.  And that is much less the case when I do not take the pill and get only 4 hours of sleep (like last night).  The pills are a psychological crutch, and most of the time make you worse off for their use than if you had not taken them at all.

Sill I'm left with a sinking abyss-like feeling, as if my life is being eviscerated and dismembered into a pile of refuse that sits and waits......for sleep.

My “a-duh” moment: Brain Damage and SSRI’s

This should not have been so hard to grasp for me.  Zoloft, which I took in large doses (200mg) for a year in 2000 and just under 6 years in smaller doses (25-50mg; 2006-2011, with a few 3-4 month “off” periods) is an SSRI.  The acronym alone is informative and should have provided a clue “serotonin re-uptake inhibitor”.   It blocks your nervous system from re-assimilating  the serotonin that your body produces.  Its effects are supposedly to help with depression.  I took it as a sleep aid, which worked for a while.

The big “a-duh” moment  is my recent  realization (epiphany even) that the body, being the adaptable thing that it is, will probably eventually produce less serotonin if its re-uptake is blocked by some ingested pharmaceutical, in a quest for equilibrium.  This is a hypothesis that is not too hard to infer with a little bit of biochemical awareness and common sense.  I should have thought of this years ago.  And just as my thoughts were turning in this direction, an Internet search turns up this article http://www.psychologytoday.com/print/68229, which suggests as much.  This may explain much about why I have such low serotonin levels.   My last Zoloft pill was July 2011 – my ability to naturally produce serotonin is probably still impaired.

Its sobering that my insomnia may be fallout from SSRI–induced brain damage, with uncertain irreversibility.  BTW, I’ve relapsed back into insomnia-land despite my new serotonogenic supplement regime – hopefully temporarily. 

The Serotonin Elixir

Is this the end of the road for my trial by insomnia??  I am allowing myself to hope.  10 days ago my naturopath started me on serotonogenic dietary supplements, (a test indicated serotonin levels at the lowest 2% of the reference curve!!!) and after a week on 100mg of 5HTP right before bed (along with Magnesium Citrate and a Melatonin supplement with B6) I'm starting to sleep normally again - I think.  Three nights of 7 plus hours does not yet a happy ending make, but I am feeling human again, at least for now.  My life just may begin anew - out of the darkness.

It is very interesting - in 2006, after a failed attempt at CBT for insomnia, I went on 50mg of zoloft.  Zoloft immediately restored my sleep, but its sleep inducing effects waned over the years.  I got off it for good last summer.  Since zoloft is a serotonin re-uptake inhibitor, I wonder if my body decided that since the serotonin that it was producing was not being readily re-absorbed, that it did not need to produce any.  So after ceasing zoloft - whammo - full scale insomnia (though it took a good 4-5 months for it to develop into its most acute form).

What do I care about theories though if I can now return to the land of the living?  Onward.

No end to it

So what to do when it seems like there is no way out?   If anything, my ability to sleep has diminished in the past two weeks to the point that every night  is a replay of wakefulness and light if any sleep, and every day is a despair filled pit.  It honestly feels like my life is over.  I can't plan to do anything, I don't socialize, I barely scrape by at work.  And on weekends, I sit at home in a sleep deprived stupor. 

I continue to force myself to do sanity-saving activities.  Yesterday I went on a hike in the mountains, though it took me 2 hours of stumbling around to get my day hike stuff together.  This morning, after another piss-poor 4 hours of sleep, I grogged myself up, forced myself to do 40 minutes of yoga and a little meditation, which helped immensely, before I commenced with trying to slog through the rest of the day. 

Paperwork accumulates, I no longer clean my apartment, I'm no longer interested in playing music, and the near sleepless nights play out one after the other in agonizing succession.  I feel like the end of the rope is near.  I have no ability to think or interact with people, so my isolation in insomnia is almost perfect.

I have no control - I do all I can, have tried almost everything there is to try to remedy the issue.  I feel like all I can do is surrender to the black hole. 

I Remember......

Tantalizing memories of evenings full of the unspoken and implicit assumption that I would be able to sleep:  Of being able to plan to participate in social events without reservation, taking the ability to awake in the morning after a full night slumber very much for granted; of falling asleep once at my desk at work, unable to resist the pressure to sleep; of falling asleep during long drives to field sites in my consulting days; of going to conferences and sleeping fine on the floor of a motel room between beds in a roomful of people........

My life was once like this, until the fall of 2003, when it all changed for reasons that I don't quite understand.  Now most mornings are accompanied by the thought of "how much longer can I keep this up", driving to work trying to strategize the path of least resistance to get through the day.  Though I am single, have no family responsibilities/kids, have no money or debt worries, work no more than 40 or so hours a week, my time is still not my own.  My time by necessity is dedicated to self maintenance rituals that theoretically maximize my body's ability to sleep, but in reality fall well short of the mark.  Yesterday:  1 hour of intense weight training after work, drive home for dinner, some e-mail correspondence.  Then 30 minutes of tai chi, 1 hour of listening to a meditative drum CD while in supported shoulder stand, then under the sheets for what seems to be my latest pattern - 3 - 4 hours of fitful sleep with relatively rapid onset, then awake and strung out.  I did an hour of meditation between 4-5 AM (which turned out to be unusually deep), hoping that would enable me to get some more sleep, but nothing more than 2 hours of subsequent wakeful bed laying ensued.

Sigh..........is there any other option other than trying to get as comfortable as possible within this abyss?

A mission for the groggy

I suppose one of my motivations for posting here is to unequivocally lay to rest the assumption that all cases of insomnia are a state of mind rather than an affliction.  I'm sure that many cases are, but mine clearly is not.  After 8 years, I've tried just about anything and everything that I've heard of, and have come firmly to rest on the conclusion that my sleep mechanism is in a state of physiological/biochemical dysfunction that started when I was 39 years old.

So, for the record, I've tried and given good faith efforts to:

• Sleep Lab/ apnea assessment
• Cognitive Behavioral Therapy
• Pharmaceuticals
• Talk therapy
• Diet restrictions (gluten, sugar, caffeine, etc)
• Sleep psychologist
• Acupuncture (3 different occasions)
• "energy work" and massage
• Ayurvedic assessments
• EEG and MRI assessments (assessed because of association with problems with simple partial seizures)

And I continue to engage in, with persistence of my insomnia:

• Meditation (1-2 hrs/daily, 14 years of practice, over 10,000 hours of cushion time logged over the years)
• Weight training (2x/week, total 2 hrs/week)
• Cardiovascular exercise (4-5 days a week: hiking, running, biking, exercise bikes, xc skiing, swimming, etc)
• Yoga (2-3 times/week)
• Tai chi (1x/week)
• Gluten free diet, vitamin supplements, avoiding alcohol, avoiding TV (I don't even have one) or computer time before bed.

I have a low-stress job that I enjoy (for the most part), and because of a habitual money saving habit, I have a decent financial cushion, no debt, and no money stress.  I don't have a family to take care of, so no family-related stress.  I live in a rural area and take frequent hikes in the mountains.

I am not depressed - I have been depressed before in my life and now it creeps back in when I am completely hamstrung by insomnia (and, after effects of medications like Lunesta clearly make me depressed).

My life-maintenance activities are beneficial, and maximize my ability to function given the amount of sleep deprivation that I deal with, but they don't "cure".

If my insomnia is anything but an affliction, I have a huge cognitive or conceptual blind spot that I'm unable to see.  I am convinced that this is not the case.

My latest theories of causality:

1. low testosterone (recent blood test was not below reference level, but was low for my age)
2. benign brain tumor (glial cells in hypothalamus)
3. poorly understood side effects of spiritual practices (chi/prana imbalance, kundailini, etc)

Scary Good

Just to be sure, this is not an April fool's post:

I typically to get enough sleep to feel well rested 2-3 days out of the month - I only sleeps well enough to feel "normal" after I have accumulated via my brand of insomnia a staggering sleep deficit that overcomes my sleep mechanism dysfunction. 

I would be in total despair over the lack of effect on my sleep patterns of all the good-faith self maintenance efforts that I engage in (yoga, tai chi, meditation, weight training, hiking, bicycling, running, gluten free low sugar diet, regular bed times, managing excess stimulation, vitamin supplements, etc etc.) except that the benefit of all these activities on the days when I happen to sleep well are remarkably apparent.  Simply put, when I am blessed by minimally sufficient sleep, I feel scary good.

Engaged, energized, enthusiastic, friendly, sharp, resilient, optimistic - and more even - all are apt descriptors of how I feel when the sleep gods decide to smile ever so slightly upon me.  It lasts only until the next restless night, which is usually  only a mere hours away.  And it is marked by a bit of confusion on what to do with all the energy I have.  My sleep-deprived life is a study in isolation - no energy to do hardly anything except drag myself to work, stagger through my self maintenance activities, and then stumble around my apartment like a zombie.  My days are habitually structured to reflect my energy levels - avoiding all but the essential.  But it all gets turned on its head when the sun briefly shines - playing music, contradancing, writing, socializing, seeking out friends and looking for dating opportunities.  I want to do it all at once, but then the sun sets and and I'm back to rattling around in this infernal abyss of sleep deprivation.

The scary good part is enabled, I suspect, by the gluten-free diet and Vitamin D supplements that the naturopath that I've been working on my insomnia with has proscribed.  I've been gluten free for 8 months now, and have been on Vitamin D over a month, which a blood test revealed that I was highly deficient in (18 of whatever units Vit D is measured in).  Before these dietary measures, even when I did manage to sleep, my life was still a slightly more leavened version of dragging myself around.  So in some ways, I feel like I've reversed 15 years of the aging process.  Its too easy to torture myself over thinking about  sleep related  "what ifs".

Pulling out all the stops....

Often, it seems like that I need to dedicate nearly all my non-work hours to sleep-promoting self-maintenance activities in order to have any chance of being able to retain my ability to function and hold onto my means of livelihood.   When internal insomnia currents are strongest, they resist my every effort – I could, after a typical work day, lift weights for an hour, do 30 minutes of intense cardio exercise at a gym, come home and cook dinner, read or play music a little, then meditate for an hour, and still not be able to fall asleep.  This summer, I had a sleepless a night or two after intense day-long hikes in the mountains (8-12 miles) involving quite a bit of elevation gain.  A woman I was dating at the time was astounded and said half kiddingly that I was “hopeless”.

I seem to be on the cusp of a similar delicate sleep ability right now – yesterday after work I went right to an hour-long tai chi class, then did 40 minutes of weight training and 30 minutes of cardio at a gym.  Right before bed I  listened to a monotonous drum tape for an hour while in a supported shoulder-stand position, and took 6mg of melatonin.   And from all that, I was only able to generate a very light and fragmented sleep-state.  I woke up at 2:30 and took 6 more mg of melatonin, drifted back into light sleep land, and woke up with a too familiar feeling of groggy buzziness at 4:30.  I then resorted to an hour of zazen (zen meditation), and finally settled into a deep dream-state at about 6:30, only to awake for good at 8AM.  

This typifies my life.  After all the pro-active sleep promotion last night, today, I’m happy to report that I’m functional, alert, and friendly.   While I sometimes wonder why I’m such a social oddity – educated, fairly intelligent (IMHO), well-employed, and still single at 47 years (with a few LTR’s in my past), at least half the time I thank my lucky stars I don’t have a family to support.  I simply would not be able to manage it all – high degree of introversion, 40+ hour work week, family responsibilities, and a need to dedicate much of my free time to self-maintenance activities just so that I have a hope of sleeping a little.

The Insomnia Abyss

Time to resurrect and redirect this forsaken blog.  I've decided to use it to document and chronicle an issue which has flattened and eviscerated my life: a chronic sleep disability.  And I use the word "disability" very deliberately here, because it is an issue which has not yielded to 8 years of treatments and approaches of all sorts of orientations.  For me, I am convinced that it is a basic dysfunction of a crucial physiological/psychological need.  And the need to document it arises because I am utterly alone in my understanding of my brand of insomnia as such.  To the unafflicted, its a curable matter of de-stressing, exercising more, eating right, practicing good "sleep hygiene", thinking positive, etc etc.  My own brand of insomnia has defied 8 painstaking years of efforts of all of the above, which I'm sure I will get to detailing at some point.

In my aloneness within the insomnia abyss, in the depths of the despair, depression, impaired cognition and reasoning, when I'm able to barely function well enough to hang onto my job and then retreat to my home, unable to socialize or even clean my apartment, feeling like death warmed over, I sometimes wish it were a better understood affliction just so I would not be so alone within its walls.  Cancer would be easier in this respect.  I say this recognizing that probably every person battling cancer (terminal or otherwise) would readily trade places with me.  And now, more times than not, as they would trade with me, I with them.  If my affliction were understood, I could describe my situation to others and and not receive the blank stares that I mostly get when I try to explain my zombie-like presence at work, my hermit-like existence, my vanishing from the activities that once sustained me and provided me with social outlets.  Nor would I have to think up excuses for bowing out of planned activities when I'm too blotto to function.

I work, I eat, I take up space, I hardly sleep.  That is my life, once which offers me a profound basis to question the value of its existence.  So if I'm able to continue writing here, I hope that it at least offers me the knowledge that my experience has been documented, and maybe it will provide the solace of commiseration to the few others who may be experiencing similar.