To Sleep or Not to Sleep – It’s obnoxioius to worry about Both

I hope everyone had a delightful holiday weekend (for all of you who celebrate some sort of holiday this weekend past). I clearly did not. I’m doubly angry at myself because I left my Schema Therapy book at my parents’ house so I have to wait until they ship it to me in order to continue my blog series. I’m a little pissed because we’re  very close to the end and I wanted to make a clean break before moving on to something new.

::sigh:: I’m trying not to beat myself up about this, but it bothers me that I don’t have what I need at my disposal.

So here’s a story I picked up over Thanksgiving dinner.  We all know I have sleeping problems. It’s why I’ve been prescribed the Trazadone = help me sleep and stay asleep. Since starting the Pristiq though, I have been falling asleep pretty well without the need of my sleep meds. I’ve also mentioned on multiple occasions that I often have anxiety about going to sleep.  This is an entirely different problem from my insomnia. I’m not sure why I’m afraid to go to sleep some nights. The thought of turning off all my lights, pulling myself away from my computer, isolating myself in some small way, it inspires this low level dread and anxiety in the pit of my stomach. I’ll check, double check, and triple check many things just to put off going to bed for a few more minutes.

It’s weird because I actually like sleeping. I absolutely LOVE dreaming. I have such vivid, wild dreams and I find them all fascinating, even if they’re bad or nightmares.

The act of getting into bed, alone, is just awful for me.

And apparently always has been.

I have a darling wacky aunt that loves to tell all the silly and embarrassing stories of our youth after dinner, just before dessert and coffee. They’re usually pretty funny. This past dinner my aunt was recalling the times we would visit and spend the night at her place. My sister would fall asleep anywhere, no problem. My brother was the same. Not me. I would fight and scream and not want to go to sleep.  I would insist I wasn’t tired and want to stay up with her just a little longer. Then my mother chimed in. I would become incredibly upset if I had to go to sleep alone. My mother would lie down with me at bedtime until she had to go to work, hoping that I would be asleep by the time she had to leave. (Remember, she worked evenings so she would wake up in time to put us to bed and then go to work). I would apparently be inconsolable if she wasn’t there to fall asleep with me. I don’t remember any of this. I do remember often sneaking into my parent’s room at night to curl up in bed with them until I was too old (maybe 7 years old) and they forbid it. Now that I’m focusing on it I remember sleeping with my brother and sister whenever we could get away with it as well. My parents would send us to our rooms at night, but by morning, I would wake up next to one of my siblings.

One of my favorite things about being in a relationship is the fact that I don’t have to sleep alone. Sleeping alone is one of my most hated things ever. I also tend to have very affectionate friends that don’t mind falling asleep together. Sleeping together doesn’t have to be sexual, just comforting. Even having my cat to curl up with me is better than being all alone. One of the reasons I like having a roommate is that I’m never alone in the apartment at night. When Roommate is gone for weekends I often forsake my bed and bedroom altogether and sleep in the living room on the couch. The common area has an energy that is less solitary, more open, more comforting, plus I know right away if someone is trying to break in (there’s not going to be any sneaking up on me). It’s safer.

I don’t know why this is such an issue for me, but it’s apparently been an issue my entire life.

Logically I know there’s nothing waiting for me in the dark. All those breathing exercises and visualization techniques do me no good. It does help for me to have some kind of white noise on in the background, like a running fan or air filter, something to fill up the emptiness in the air. Even when I’m falling down exhausted the idea of going to bed alone makes me anxious. I’ll choose to sleep on the couch before going to bed alone (unless Roommate is home, in which case it would just be rude so I always force myself to go to my own room).

I just need someone to snuggle up to and I’m fine. This isn’t exactly a ‘cure’ for my anxiety but it’s definitely an acceptable fix as far as I’m concerned. I’m very curious as to why I have this problem and why I developed it so young.  It definitely makes me think that this is potentially something I’m predisposed to as my siblings have no similar problem at all. Is this a problem for any of my Borderline readers out there?

Curiouser and curiouser. In the meantime I’m accepting Cuddle Buddy applications!

Bordering on Wakefulness

I have a terrible time sleeping. Not that this should surprise any of you dear readers, as it’s something I complain about a lot. I’ve had sleep problems, probably sleep disorders, since I was very young. Though I was never treated for it (until recently) I self-diagnosed my own insomnia. All through my teenage years, into college, and periodically still, I’ve had it. Sleeping maybe 1-3 hours a night for weeks on end, then finally crashing for 14-16 hours one day only to repeat the cycle over and over. I’ve been much better than this over the last few years, though certainly not great.

When I don’t get enough sleep, I’m a mess. More of a mess than usual. General fatigue aside; I can feel my mind dragging itself down. My moods shifts, swings more than usual. Concentration is nearly impossible and I slip into daydreams trying to replace the night dreaming I don’t get enough of. My mood is very dependent on sleep. The longer the span of sleep deprivation I have the darker my moods and thoughts begin to get.

I can feel the pressure on the back of my eyes, trying to hold themselves open. My vision distorted by the fatigue I feel. Seeing things differently, especially myself, than I know appear in the real.

Time slips by slowly. The clock ticking endlessly as I wait to for my day to terminate.

My ability to distinguish between the rational and the irrational is obvious. At least it is to me. I can’t help it though. I can’t stop it. All I can do is hope that tonight I find some relief from the restlessness induced by the evening before.

My mind starts roaming and racing, creating scenarios and running away with me. Once my brain starts whirring, working itself up, it’s that much harder to ease myself in a calmer state conducive to restful sleep. I may be physically and mentally exhausted when I lay down, but as soon as I start thinking, my mental activity starts running a marathon and there is no slowing it down.

I love to dream. Dreaming is a wonderful escape for me. Wildly vivid, living a life filled with the fantastic. When I’m sleep deprived, the few hours I do manage to sleep, I seem to be more prone to nightmares. Even in these I’m fascinated by what my subconscious creates, but they only contribute to my fatigue. Causing me to waken frequently. Often in a cold sweat. Heart pounding. Which only makes it more difficult for me to fall back to slumber. Then when my alarm finally sounds I can barely pull myself out of bed. Slipping into deeper depression.

I’ve found very little research done on the correlation between sleep deprivation, insomnia and Borderline Personality Disorder. Most of what I’ve found is pretty typical of anyone that is sleep deprived. Regardless, as someone that doesn’t do it well, I can’t stress the importance of getting an adequate nights rest.

“Sleep disruptions can be a common occurrence for those with borderline personality disorder (BPD). It may be caused by everyday stress, medications, or even the hyper vigilance we’re so predispositioned to. Getting a good night sleep may be easier said than done, but recognizing a problem and discussing it with your treatment provider may help you get some needed relief.”

Since Borderline Personality Disorder is a highly affected mood disorder, anything that impacts emotional regulation is going to be a detriment to the moods in someone with BPD.  Sleep helps humans maintain optimal emotional and social functioning while we are awake by giving rest during sleep to the parts of the brain that control emotions and social interactions.The only small study I did find on BPD and sleep dep reported that “the risk of affective and impulsive personality disorder traits were exacerbated by lack of sleep”. I could have told you this with only myself as a test subject. Getting enough sleep is a serious factor with depression in general. Sleep deprivation is one cause of lower levels of serotonin in the brain. Serotonin as we all know, is the bodies natural way to encourage feelings of well being. Hence, having a deficit of sleep deprived seratonin production may contribute to greater levels of stress and depression. Sleep studies indicate that BPD is not {necessarily} related to depression but that serotonin studies do point to links with suicidal, aggressive and impulsive behaviors, stress and burnout.

“In tasks requiring judgment, increasingly risky behaviors emerge as the total sleep duration is limited to 5 hours per night. The high cost of an action is seemingly ignored as the sleep-deprived person focuses on limited benefits. These findings can be explained by the fact that metabolism in the prefrontal and parietal associational areas of the brain decrease in individuals deprived of sleep for 24 hours. These areas of the brain are important for judgment, impulse control, attention, and visual association.”

Only in the past few months (5-ish) was I finally able to get some treatment for my insomnia. This is actually one of the main things that brought me to finding my psychiatrist. I was having such a hard time sleeping. I knew how it affected me, so I went to see a regular doctor to see if he could prescribe me something for sleep. Turns out he couldn’t. That was something for a psychiatrist to do. That coupled with the fact that I was having very self-damaging thoughts he recommended I find a psychiatrist immediately (after he asked why I had come to see him instead of going straight to the psych ER).  As I’ve mentioned before, as a supplement to my current medication, I am also given Trazadone. Even this doesn’t always help. I can stay awake through it, continue to wake in the night, and feel completely exhausted when I need to get up. It does help sometimes though and something is certainly better than nothing. I have friends on Trazadone as well, and they seem to have much better results with it than I do, so I imagine I have other mitigating factors contributing to my sleep problems that most people simply don’t have.

Curling up in my big comfy bed, buried under blankets, surrounded by soft pillows, lying there waiting for unconsciousness to take me. I always look forward to trying.

“The best thing about dreams is that fleeting moment, when you are between asleep and awake, when you don’t know the difference between reality and fantasy, when for just that one moment you feel with your entire soul that the dream is reality, and it really happened.”

~Random Quote

Sleep please

Ugh. Therapist decided to change my appointment from Thursday to today. For the last few months I had therapy Monday and Thursday. I just recently went back to one day a week (Thursday).

I just, really don’t want to go in today. I had wanted to go to the gym, but I realized I can’t go to the gym because I can barely sit up straight. 2 glasses of wine and half a bottle of vodka on top of maybe 2 hours of sleep last night… practically no sleep for the last 2 weeks. I wanted to go home and go to bed. I had a really messy weekend, so I probably should go in, but I just can’t make up my mind. Sleep or therapy. I had my night all planned out already. It was easy and I didn’t have to think about it. Work, home, sleep. Therapy is driving all over, an extra two hours out of my night. It’s probably a good idea to tell her what happened this weekend while I’m still feeling the effects of it. But if I just went home and got some sleep I would feel better on my own. Or, at least, I wouldn’t have to think so much and that’s better all by itself, right?

I can do reasearch for an Institute of Nuclear Physics because I know exactly what needs to be done but ask me to deviate from my plans and my brain freezes. It’s not a big deal. Changing plans shouldn’t be so disconcerting. I can’t make decisions like this.

If I could get some sleep I could be productive in therapy. If I go to therapy I might actually be able to work out why I’m not sleeping. If I go to therapy I can’t get as much sleep. If I wasn’t so bloody tired this wouldn’t stress me out so much.

I’ll probably just go. What’s one more day of less sleep? Geezus this is asinine.

I just want to lie in bed and listen to the rain. Loves the sound of the rain.

EDIT: So I went to therapy, which is cutting into my going to bed early (as is the update for this post). However it was a good decision. Therapist sort of redeemed herself from Thursday which was important. Completely dissociating from my emotions is not the goal here. She got a clearer picture of what goes on in my head, how much I act in (impulsive/destructive), which is important because I don’t think she’d really gotten it so much and I’ve just been feeling misunderstood and frustrated. She talked almost more than I did. She made a point of validating my feelings. I’ll talk more about Validation in another post.

Therapy homework: I am apparently running from my feelings; hence the drinking and bulimic binges. Instead of dealing with my emotions I’ve turned them off. I don’t mean to, it’s just how I work at this point. When I am in a dissociative state it’s important to pay attention to my reactions from different experiences. I need to sit down and write everyday about those reactions. Recognize that I am feeling, what I’m feeling, where these emotions come from and why I’m experiencing them the way I do. Once I begin to recognize and process the states that I am in, hopefully I can begin to integrate my cognitive understanding of the emotions at the same time that I am feeling them. This is actually helpful advice.

So the moral of the story is: Go to therapy kids. You get homework. Hm, wait. Everyone has off days, but it doesn’t mean you can’t get something valuable from them.

Exhausted….

Posting this week may be a little off. Started the new job today. Full 8 hours of orientation.

I slept zero last night. None. I woke up everything 15-20 minutes to check my clock to make sure the alarm was set and that I hadn’t slept through it. Once I was up my brain started whirring about personal brain crazy and wouldn’t calm down enough to let me relax. When I did manage to doze off I had nightmares about getting up late, being late for work, and time suddenly becoming non-linear. Bloody f-ing subconscious. As if I’m not anxious enough when I’m awake, it has to overlap into my sleep. Gimme a break please.

I drank coffee today. That’s how exhausted I was. I hate coffee. Hate. It tastes like dirt and awful. Needed caffeine. I don’t care what anyone says. I’d rather do a triathlon than sit through videos and mindless droning all day. I’m not built to sit still like that.

So, in summation. I’ll try to resume more normal posting tomorrow evening. Good night everyone. 

Insomnia

When a glass of wine and 100mg of Trazadone don’t even phase you, you know it’s going to be a long night ::sigh::

Post Traumatic Stress Disorder – Stats and Facts Part 3

Approximately 25% of those with BPD/ERD also meet the criteria for post traumatic stress disorder.

So let me tell you a story. I had to go to a counseling session because I made a very poor decision concerning alcohol and driving. I had to have a psychological evaluation and talk to a social worker about my past and stuff. First off, let me tell you that I hate, HATE, talking to shrinks that are not of my choosing. I don’t believe it’s any of anyone’s business to ask me such personal questions, intimate, details of my life. Especially when they inevitably make snap decisions and diagnosis because one session is not enough time to understand anyone. So anyways, I had this session. The guy (the only male counselor other than my psych I’ve ever talked to) started asking me questions off of a list of psych questions. It was clear that he cared precisely zero about me as a person. He just needed to get through his checklist. Throughout the interview he ask me questions, then instead of letting me talk, cuts me off and proposes his own theories and tangents. So he’s asking me these questions when he gets to the section on pysical/mental/emotional abuse. It’s at this point I’m debating whether or not I want to tell him the truth or just get him to skim past this. I decided that the truth would work to my benefit as it was part of why I landed there in the first place. So as soon as I start saying yes to some of his questions his eyes light up and he proclaims that I have Post Traumatic Stress Disorder. WTF? He didn’t even ask me to elaborate on the situations he was asking about. He just went on and on about PTSD, cutting me off when I tried to elaborate, and got way to excited about my potential mental disorder. It was clear that PTSD was his pet subject. So while I have technically had a diagnosis of PTSD, I don’t believe it. It makes me wonder how accurate some diagnoses are too. People are human and therefore subject to their own biases.

And while I might fit the technical criteria for PTSD, the incidents that made him jump to this conclusion had less lasting traumatic effect on me than did a really bad car accident I was in while I was at university (years after my BPD emerged).

So let’s take a look at what PTSD is (and how I potentially fit the criteria):

Causes – Psychological trauma:

“PTSD is believed to be caused by either physical trauma or psychological trauma, or more frequently a combination of both. PTSD is more likely to be caused by physical or psychological trauma caused by humans such as rape, war, or terrorist attack than trauma caused by natural disasters. Possible sources of trauma include experiencing or witnessing childhood or adult physical, emotional or sexual abuse. In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).  Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, sexual assault, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, violent automobile accidents or getting a diagnosis of a life-threatening illness. Children or adults may develop PTSD symptoms by experiencing bullying or mobbing. Preliminary research suggests that child abuse may interact with mutations in a stress-related gene to increase the risk of PTSD in adults.”

Criteria:

The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as.

A: Exposure to a traumatic event

– This must have involved both (a) loss of “physical integrity”, or risk of serious injury or death, to self or others, and (b) a response to the event that involved intense fear, horror or helplessness (an event was “outside the range of usual human experience.”).

Yep. Definitely had a few such instances involving abuse and a particularly bad car accident.

B: Persistent re-experiencing

– One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).

You be the judge. I often have distressing dreams but they’re no longer terrorizing. Intense negative responses: If you consider an inability to let most guys touch me without utter revulsion, freaking out and regretting any instance where it occurs outside of my comfort zone, constantly disavowing any intimate male companionship (this never sticks) and quickly second guessing, overanalyzing their motives… or… when I’m a passenger in someone else’s vehicle I often have knee jerk reactions with braking too hard, or getting to close to other vehicles. This causes me to pull back, hard knees to chest, my heart rate to speed up, grabbing onto the ‘oh shit’ handle and my breath catching in my throat. I prefer to drive.

C: Persistent avoidance and emotional numbing

This involves a sufficient level of:

– avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the event(s);

– avoidance of behaviors, places, or people that might lead to distressing memories;

inability to recall major parts of the trauma(s), or decreased involvement in significant life activities;

– decreased capacity (down to complete inability) to feel certain feelings;

– an expectation that one’s future will be somehow constrained in ways not normal to other people.

Heh. After some such events I severed contact with certain people, wanting nothing to do with them or those that are involved with them. Avoiding situations where I might even have the possibility of running into them. Not places that I was sure they would be (though of course I won’t go there) but places they might be, where there is even a small chance of it. After one incident in my early 20’s I completely repressed events, only recalling it years later after I found a journal that I had written immediately after and then completely forgot about. I still only have flashes of this, not a full recollection. Decreased capacity to feel certain feelings. ::smirk:: I often have a complete inability to feel feelings at all. This problem is what lead to the diagnosis of my Dissociative Disorder. When I have extreme stress, loss, and/or conflict I depersonalize and derealize from my life and even my own body. I do absolutely expect that my future will be constrained. My present is currently constrained in ways not normal to other people. I have a Borderline Personality Disorder. I’m pretty sure, by definition, this qualifies for ways not normal to other people.  I believe this has more to do with my depression than any traumatic experience that I suffered after this problem began.

D: Persistent symptoms of increased arousal not present before

-These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hyper vigilance.

Long posts need more pictures

I think they need a better phrase than ‘increased arousal’. This did not immediately inspire thoughts of heightened awareness if you know what I mean. I have always had extreme difficulty with sleep. I had insomnia for years that still occasionally creeps back (last night for example – so freaking tired). Even with the prescribed medication that I’m on specifically to help me sleep I have a hard time falling asleep, staying asleep, and once I wake up, calming my brain down enough to return to sleep.  Anger, hah, see this post. My therapist just brought up my sense of hyper vigilance yesterday as a form of self protection. All of these things, however, were a problem well before any real trauma that I suffered and were not the result of bad experiences that I can recall. I imagine that some of the experiences I’ve had since the onset of this most likely exacerbated the problem.  

E: Duration of symptoms for more than 1 month

– If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute stress disorder.

How about years? Does years count? Acute stress disorder seems more accurate to me though.  Don’t ask me why. Maybe I just don’t want to have PTSD too.

F: Significant impairment

– The symptoms reported must lead to “clinically significant distress or impairment” of major domains of life activity, such as social relations, occupational activities, or other “important areas of functioning”.

– I’ve had significant distress and impairment in social relations since I was 12 years old. This was at the onset of my clinical depression and anxiety disorder. Both precursors to my BPD. By this point my abandonment issues were also in full swing. But, again, not due to an experiences that could be considered very traumatic. I think it has more do to with a predisposition to feel things in a way that is not normal to most – BPD.

So yeah, after this very long personal assessment, I am still not a psychologist or psychiatrist and am therefore not qualified to diagnosis myself. Thoughts?

Abuse is very common in the lives of people with BPD. It is often one of the root environmental contributors to the emergence of the borderline disorder. I do not have any doubt that many people with BPD also suffer from PTSD. Recognizing this is very important for treatment because it helps understand some of the underlying factors that need to be worked through and healed.

I do wonder if PTSD leads to BPD, or if being predisposed to BPD leads to an increased sensitivity to situations that feel traumatic but would not normally be considered a traumatic event required to define PTSD.  Then again, if something feels a certain way, a situation is perceived a certain way, doesn’t that make it reality for the person experiencing it? Therefore the event occurring is in fact something very traumatic.

I don’t know.  Most likely it is a co-morbid issue building and feeding off of each other.