An old conditioned response for sleep

Sleep is getting, well, marginally better. But it still eludes me. It's so exhausting just to get through a day if work, where I have to be "on" and focused and available/present for my patients. And since I'm not sleeping well, I start the day with less than a full tank. So by the time I get home, I'm so tired I can barely function. And getting to bed is so hard because I have to get up off the couch, take something to make me tired, and work hard at falling asleep. It's all an exhausting process. Which means I wake up the next day with even less energy. 

Don't you just love vicious cycles of doom?

I've been trying to think about ways I used to tackle insomnia - back in my 20s when too little sleep didn't really phase me. And I remembered one thing above everything else that used to work like magic when I couldn't sleep. And I've decided to put into immediate effect:

I conditioned my brain to feel sleepy when listening to Only Time by Enya. 

I used to play it in repeat on my old CD alarm clock (yeah, I'm old school) all night long. When I think of that song, I think of sleep. Might as well try to use this conditioning to my advantage, right? So, since I've long since gotten rid of that ild CD alarm clock, I downloaded the song onto my phone and it's playing all night tonight. 

Hopefully this helps the insomnia a little bit more...

Sleep

Okay people. Let's talk about sleep. And how I can't get any. It's either that I never feel tired enough to go to sleep, or I'm laying in bed and can't get to sleep for hours, or I wake up halfway through the night (that's a new one this year), or I don't sleep long enough to feel fully rested. 

I'm used to not feeling tired. That's been going on pretty much my entire adult life. I'm a natural night owl. So it's hard for me to go to bed early enough sometimes. But, I've got a handle on that one for the most part. I've gotten better about evening routines, and melatonin gummies are my best friend. I learned how to work around the fact that I have an earlier job and need earlier bedtimes. 

This new waking up in the middle of the night has been a kick in my ass. Because it usually takes me an hour (at least!) to get back to sleep, if I even ever get back to sleep. It started when I started some new medication trials over the summer, and only recently mostly stopped when I started my light box for the dark winter months. I say mostly because I still wake up halfway through the night on occasion. It's throwing me for a loop because I've always been a heavy sleeper. Like, once I'm out, I'm out for the night. Why brain? Why won't you just let me sleep? 

And then there's the waking up earlier than normal. I usually need a good 7 hours to feel fully rested. But lately I get 5 or 6 hours. (And that's assuming I didn't wake up halfway through the night, see above.) And after awhile, it becomes overwhelmingly not enough. 

What happens when I don't get the sleep I need? 

- My ADHD goes into overdrive. I can't focus, I can't think, I can't remember things. 

- My mood goes haywire. I'm naturally more irritable. I'm also very quick to go through emotions - happy and carefree one minute, low and sad the next. Paranoid and negative thoughts that no one likes me or I'm failing at everything start to overwhelm my brain. 

- My physical health suffers. I get achy, my joints get stiffer, my muscles tense more easily and I have harder time relaxing them. My complexion suffers (break outs, dry patches, etc), my hair dries out, my skin gets pale and dull looking. Those wonderful dark circles appear under my eyes. 

- My diet goes down the toilet. I tend to gravitate towards starchy, sugary foods. It's hard to focus on making meals or even buying groceries. Convenience foods reign supreme. 

And through all of this, my optimism betrays me. I think it's not that bad. I hold on to any night that goes semi well as a sign of progress. When really, if I take a step back and look at the trend, the data don't support that conclusion at all. I'm not getting better. I'm not getting worse either. I'm just stagnant in a cycle of bad sleep. Which slowly eats away at my mental health. 

I'm so very opposed to medication for medication sake. Popping pills is an American illusion of health, and it's killing people. But that also makes me more stubborn than maybe I should be about medication for myself. Maybe I need a discussion with my psychiatrist about a short term solution for getting my sleep back on track. I don't want to take something to make me sleep every night for the rest of my life. But, I work in an inpatient setting where I tell my patients all the time that we need to fix the NOW, and a shirt term solution, while not ideal, may be a necessary step toward getting back to health. 

Maybe I should take my own advice. 

Maybe I should adjust length of light therapy, or timing. 

Maybe I should stop all screen time for a week and see if that changes anything.

Maybe I should find a way to adjust my diet despite my utter lack of concentration for such things. 

Maybe I should do all of these things. 

Maybe I should get to bed now... and call my psychiatrist and/or therapist in the morning.

Dark Day

My Dark Day came early this year.

What is a "Dark Day," you ask? It's the day of the year (usually around mid-Fall) when I consciously recognize that the days are getting shorter. Said a different way, it's getting darker earlier, and I suddenly actively noticed. And there is a counterpart to the Dark Day, called the Light Day, which is the day (usually mid-Spring) when I consciously recognize that the days are getting longer, the sun is out later in the evening. These days are often near the equinoxes, but not always. And there's no way to predict exactly when they'll happen - they're often influenced by weather, recent mood status, stress levels, and a whole list of other things.

They're kind of like personal "holidays" (for lack of any better term). And I "celebrate" (acknowledge?) them with an evening of self compassion - in whatever form that needs to take. I do whatever I feel like doing, within reason - there's no irrational spending sprees or harmful behaviors. But if I feel like hanging out with people, I do. If I feel like bingeing Netflix and eating cake for dinner, I do. If I feel like calling someone, I do. If I feel like going to bed early, I do. Sometimes the evening involves crying, sometimes it involves laughter, sometimes it involves little emotion at all. The point is to allow myself a day to exist free of self judgment. Especially on my Dark Day, since I know there's plenty of self-judgment on the way as the days get shorter and the SAD kicks in.

I've noticed many people I know with Seasonal Affective Disorder tend to have a similar way of acknowledging the beginning and end of the depression side of the yearly mood cycle. What are some of your traditions/rituals for acknowledging the shift toward the dark side of the year?

I cried today.

Today I cried. I cried during a movie. It's the first time that's happened in a really long time. I've wanted this to happen again for so long, but now when it's here, I'm terrified. Having a full blown panic attack.

Of course I'm having a panic attack. Emotions did just occur. But see, I'm terrified mostly for reasons I don't know, which makes it confusing, which makes calming down that much harder. I'm terrified of the emotion, Because, rationally speaking, I know that one. It's where my heart floods with empathy for the characters and I have a real threat of losing myself in that emotion if I succumb to it. What if I can't get back out?

I'm terrified because I don't remember how to deal with feelings and emotions. My apathy and anhedonia have been here for so long this time, it's hard to remember when I ever felt anything other than, well, nothing.

I'm terrified because of the loss of control. While I know that crying during a movie means I'm getting better, it also means I'm more vulnerable. And vulnerability doesn't help me fight to stay "me" while the depression envelops me.

Writing this calmed me down some. Along with some deep slow breaths.

I wonder: what do YOU do to calm down when the panic strikes?

Delayed Reaction

So. My Dark Day happened about a month ago now. And usually that's the beginning of the depressive episodes, the social anxiety, the mild paranoia that everyone really just thinks I'm a big fat failure but they somehow passive aggressively won't tell me because they want to see me fail more (yeah, because that one's logical).

But that's not what happened this year. This year has brought a lot of great things in the latter half of the year - finishing grad school. Passing my RD exam. Getting a job. Making a great set of new friends. Dating some really great guys - and learning how to break it off with them and still remain friends because we just didn't work romantically. All really fabulous uppers. It's almost like I should have known it wouldn't last.

In a way I kinda have. I've had a pit in my stomach - this nervous feeling - for over a week now. I've been more consciously fighting the paranoia (successfully thus far, but still, I've been aware of it). I've been making myself be social even when I felt like I might be a little socially anxious - because it's good for me to get out.

And now it seems like it's all for nothing. Because here it is - my first big depressive episode of the winter. (drums roll, trumpets sound, cymbals crash, and choirs sing "Duh" in 5-part harmony) Talk about a delayed reaction to my Dark Day...

I was supposed to go out dancing tonight. I love the Wednesday night dance. It's at a bar - it's relaxing and has a really chill atmosphere. I love the people who go on Wednesdays. I love the music we choose to play. But all I wanted to do was sit and binge-watch The West Wing on Netflix and drink Cranberry Ginger Ale and eat PB&J for dinner. And I suppose one could make the argument that sometimes you just need a night in. Sure. But that's not what this is and we all know it. Despite my rationalizations otherwise, despite my logicking, despite my concessions to myself. This is depression. That gnawing sense of ennui, mixed with random anxieties, mixed with a sense of disarray, mixed with that horrible feeling of apathy. This is depression my friends. This. Is. Depression.

I wrote recently about playing the Blame Game with the Depression Entity. And one could make that argument that I'm blaming my failed social engagement plans on said Entity. But that's not what this post is. This post is part confession, part realization that the inevitable is not out-runnable (all efforts on my part notwithstanding), and part admission that no one or no Thing is to blame. It just is. Tonight I lost a battle. Not with the Entity. With myself. Not a battle in the sense of bombs and fighter plans or cannons and swordfights. But a battle of wills. And the depressed part of my brain triumphed tonight. It was just so much easier to sit on my comfy beanbag in my comfy clothes and not do things. So that's what I did.

Any number of counselors/social workers/ psychologists would tell me that I should be kinder to myself. That I should allow myself to have a day off. That I should forgive myself for succumbing to the easy hermetic attitude that accompanies any of my depressive episodes. And sure, I'll work very hard to forgive myself - because they're right in that sense. But are they right that I should allow this day off of myself when my intention was never just to take a day off but to consciously take no actions whatsoever, and thereby allowing a decision to be made without making it - namely, it became too late for me to get ready and out the door and to the thing tonight? Because it seems to me like "allowing myself" is code for "enabling myself" to give in to the pull of apathy.

What's the point of all of this? It's simple:

Depression doesn't wait for a convenient moment. Episodes pop up like pimples on a 16-year-old's face. And they are, most importantly, unexpected.

The Blame Game

Do you ever find yourself blaming the depression for bad habits or poor choices? As in, "I wouldn't do X if I wasn't this down," or "I must be more depressed since I just did X?" As if the depression is the answer to every negative thing in life?

Yeah, me too. It's so easy. It's THERE. The perfect scape-goat. You know that old depression med commercial (maybe for Zoloft?) where there's an umbrella that follows you around, only when you open it, it rains from the umbrella - because the umbrella is meant to represent your depression? I view my own depression similarly. Not specifically as an umbrella, but as a non-formed entity or presence that's always there. The Presence is stronger in the winter, but it is always there.

My point is that thinking of the depression as a separate entity that floats around like a shadow makes it super easy to place blame. Because there's a thing, an Entity. It's got substance of some sort (ideas are nouns too!) - and that means I can deflect blame for some (all? most?) of the stupid stuff I do onto the Entity that is not me. Convenient. Simple. It wasn't me, it was the depression. Boom.

Except, all I'm doing is a disservice to myself. If I simply get to blame everything wrong or stupid I do on the depression, all that does is allow me to trick myself into thinking that I'm above reproach. "It was the depression, not me." Meaning, of course I would never do anything like that. Only under the influence of the depression. But, if I allow that to be true all of the time, who's really in control here, me or the Depression Entity that I've created in my mind to separate myself in some way from my mental illness?

[That's a struggle I've, well, struggled with ever since I was diagnosed: who's in control? And if I cede control to the Depression Entity, who is really running my life? Hint: not me.] 

In order to truly come to terms with myself and my depression, I've known for awhile now that I need to stop viewing the depression as this separate Entity. The depression is just as much a part of me as my brown hair, my smile, my creativity, and my shoe size. The depression is part of my identity. I would not be who I am right now without it. I would be drastically different (and I like to think not nearly as fabulous). But, in order to allow the Depression Entity to dissolve I have to stop blaming it. I have to give up my scape-goat. I have to take responsibility for all of the stupid shit I do. [Let's be real for a second here... none of the "stupid stuff" I do is life-threatening or earth-shattering. I'm talking little things: like leaving the dishes in the sink overnight...not remembering to call my mom on her birthday...missing a deadline at work... forgetting to call HR about some mundane admin thing. But just because they're little things doesn't mean this applies any less.]

Aye, there's the rub. I love having a scape-goat. I don't want to say I'm to blame for the stupid shit I do from time to time. I don't like people seeing I'm less than perfect. Or at least that I'm as flawed as everyone else. Sometimes I feel like I need to prove myself more because of the depression. Like, "the depression doesn't make me worse, see guys? It makes me even better!" Which is ridiculous and silly and 100% real. And facing that is so much harder than dragging a Depression Entity behind me to act as the ever-convenient scape-goat.

What's my point in all of this rambling? Depression is easy to succumb to. It's easy to let it take over. Because it's so much easier to lie back down in bed and pull the covers over my eyes. It's so much easier to say the depression is the culprit and that's why I didn't call you mom - I was just having a down day. It's so much easier to watch 4 more hours of TV instead of doing the chores I should do so my roommates don't run into a mountain of dishes when they want to cook or bake in the kitchen. 

But just because it's easy doesn't make it right. And that's what I'm currently working on in my continued struggle with my depression: stopping the blame game and accepting the depression as truly a part of myself. 

Wish me luck.

Bad to worse...and how I keep the happy

It all started with a taxi ride. Okay no. It started with a job interview. That I had to get to. In SW DC. [Let's put this into context. I worked this morning in Bethesda. SW DC (the southern end) is 45 minutes by car or 1.5 hours by Metro.]

I'd miscalculated timing. To get to my interview. The Metro would make me a half hour late. Not okay. Answer: taxi ride. Expensive taxi ride. Ugh. But he gets me there on time. All good, right? No. My card gets declined when I go to pay him. Seems there's a hold on the check I deposited yesterday until Friday. Friday??? How does that help me? It doesn't. So I freak out. And I tell him I can't pay him. And he gets pissed. [rightfully so, here's this young white yuppie girl in a suit saying she can't pay this rather large fair after you drove her clear across the city] And threatens to call the police (which might have landed me in jail). But I'm crying at this point. And repeating "I'm so sorry, I don't know what to do." And telling him I'm trustworthy and I'll pay him and I don't know how to make him believe me.

So, we work out that I'll have to pay him later. He takes down all of my information. (So he can call the cops if I do try to evade the fare. Fair enough.) [See what I did there? Fare and fair? I'm hilarious.] And I let him keep my drivers license for collateral. [...right? exactly how stupid am i?] And we agree on a meet time. And I get out and miraculously ace my interview. [What can I say? I got mad interview game.]

Okay. Now I gotta get cash. So I call people. Lots of people. Too many people. How embarrassing. I'm broke, I need to pay this cab fare, and I feel like some beggar on the phone asking for money. Sure, friends/family are happy to help me out because I'm lucky and have awesome family and friends. But that doesn't change the feeling I get when I have to ask people for money. I feel worthless. And judged (yes by me). And irresponsible.

After a way-too-complicated web of complication, I find a way to get this man his money. And he doesn't show up. I wait AN HOUR. Because, you know, my phone's battery just died so that's helpful [if you didn't catch the sarcasm, I can assure you it's there]. And then I give up. And go home. Because it's warm there, and I can cry at will about how stupid I am and how bad this day has gone (except for that interview).

In the end? The cabbie was busy on a fare and he's going to drop by my house after his shift to get his money. Okay. Great. Relief! Angels sing! Fans do the wave! There is much rejoicing! The Monty Python guys dance a jig!

Here's the catch: depression sucks at times like this. Because it's so good at making me dwell on the negatives. All the stuff that went wrong. All the stupid decisions I made. All the embarrassment,  the shame.

This post did promise to explain how I keep the happy in spite of all the bad, though. You know what I do? I take 3 deep breaths. (Okay sometimes 5 or 7 or 10.) Then I ask myself if I can do anything about the past. [Hint: the answer is always "no."] No. I can't. I can't change what happened. It happened. So I consciously turn off the worrying. I turn off the negative thought reel. And I give myself a break. I'm human. I make mistakes. I do dumb things. It. Happens.

How do I just turn the worry and the negative thought reel off? Practice. It used to take me a day or two (or 5) to turn that all off. Usually by then, time had moved far enough that I could skip turning it off and just focus on forgetting it.

But, the truth is: practice. I bought a self-help book (Feeling Good, by David D. Burns). And I did the exercises in the first several chapters. And it was corny as hell. But it taught me how to challenge the negative thought reel. How to reverse it. Or simply shut it off. And I practice all the time - for a good 6 or 7 years now. And I talked with my counselor. She and I worked on how to let things go that I can't control. Interestingly, I found that was easiest when I focused in what I could control in the situation. I can control my reaction (sorta/sometimes). I can control my breathing! Awesome. I can control what I do next, be that asking for help or walking down a sidewalk or hiding under coats. [I've always wondered what that proverbial coat closet looks like. The one with all the coats that we all talk about hiding under. I imagine it as a large mound of coats heaped over a square footstool in a small sorta-walk-in closet. And when you go hide under them, you curl up on that footstool.] Learning to refocus on what I could control in order to stop worrying about what I couldn't control took a lot of hours with my counselor and a lot of practice. Again, we're talking 6 or 7 years here.

I practiced. I still practice. I call it "going to my calm place" - but that's kind of a misnomer because I don't really envision myself going to a place. Instead I ask the important question (can I do anything about the past), get the inevitable answer [insert clip of Rafiki hitting grown Simba over the head with his walking stick and saying "Eet doesn't mahttah, it's een de pahst"], and that answer has become a trigger that almost automatically grinds through the process of calming me down. And once I'm calm, I can reflect on what went well in the situation. What did I do right? What good came out of it? And once I have the answers, I've found my happy.

It strikes me that I know people who can naturally do this. They've been good at it all their lives. But how nice it is that it can be learned. It can be practiced. It can be taught.

(Of course, it's only October, so this is easier for me to do now than it will be in the dead of winter...but the only real difference is that what I've practiced takes a little longer, and a little more effort and focus. It's not nearly as automatic in the winter time. But it still works, and that is the ultimate point.)

I'll close with one of the best things that David Burns taught me in Feeling Good:
Happiness is not a state of mind that rushes over you. Happiness is a choice. And it's not always the easiest choice. But it's always the choice that feels better in the long run.