Avoiding a Bipolar Meltdown. Level: Expert

December 3, 2014 7:48 AM

I managed to get a cough over Thanksgiving Day, giving it to no one in the family (thank goodness) but ended up coughing for 5 days.Yes, there were little pockets of sleep and warmth and hydration, but it was mostly cough. This perfect storm got better when I spoke to my PA on Friday who informed me they were going to be closed all weekend. "If I gets bad go to an Urgent Care." Sound advice except a myriad of reasons, like they just moved out of our network and I didn't have $100. (The docs office only charges the copay up front.) I had some Tylenol AM/PM some Cheratussin AC from April 2014 (the one that takes like paint remover so you don't abuse it). It was awful and was effective for about 1/3 the time it said. Cough, read, doze, hydrate, rinse and repeat for five days. (Oh and don't forget the Lithium!) Monday I went to the PA who gave me scrips for Benzonate and a breathing treatment machine and also extra nebulizers. My boss has e-mailed me when I I think 'll be back to work.

To be fair, she is awesome and did not hear the whole story. I flatly told her I have been awake for five days and need to recover. "OH that sounds awful! - I really have three bosses: director, and the new one who's replacing the old one (who asked the question).

So two part question:
In a stroke of good luck, I still have weeks of intermittent FMLA I signed on for something unrelated earlier this year. Obviously it's nice to inform my psychiatrist, although he's more the "get in the hospital" type. (Psych talent is hard to find here and he returns calls). But I have become adept a managing my illness, my last visit was almost thirty years ago--Do I need to go on at length about this with my managers, or is just mention I'm taking the FMLA enough? Part two: tricks tips and coping mechanisms as I glide (hopefully) back into stability. Also excuse the myriad of mistakes -- I proofed as carefully as I could and I'm five days sleep deprived.

Gmail account: englandswing11

posted by anonymous to Health & Fitness (6 answers total)

I would suggest you just say you're taking the FMLA, don't get into more detail than that. I would also do this by email, and if possible, have someone else proofread. I am intimately familiar with bipolar lack-of-sleep meltdown and I still had to read this a few times to understand what you were saying the problem actually was - maybe I'm just slow today, but your sleep deprivation may be messing with your ability to articulate clearly.

As it sounds like you know, regular sleep patterns can be super-critical to bipolar management. I don't have any great tips, but again, if you have anyone around who can help, maybe they can come over and help keep you awake for longer periods of time so you can start getting back to a normal schedule. Maybe you can keep the other parts of your schedule (mealtimes, bathing, whatever you usually do) as strict as possible to help counteract how badly the sleep can throw things out of whack. Maybe you need to get out of bed and spend your day upright in a less comfortable place to help keep you awake. I know it sucks, it sucks really hard, but to whatever extent you can start to dial back on the napping, it might really help. Sleep wonkiness really screws with my partner's bipolar and naps are his major enemy in this area. Try to cut off the naps as soon as you can.
posted by Stacey at 8:22 AM on December 3, 2014 [2 favorites]

Sleep deprivation can trigger a manic episode so it sounds like right now you need sleep more than anything else.

Diphenhydramine (Benadryl) is an over-the-counter antihistamine that can be used as a sleep aid and also has calming effects. Don't take more than 100mg at once or (speaking from experience) you'll get so uncomfortably dehydrated that the dehydration will wake you up more than the antihistamine will put you to sleep.

If that doesn't work, maybe your psychiatrist can call in a script for a sleeping pill or sedative to your pharmacy?

Once you've had some good sleep, reassess how you're doing and if you need any other interventions to stabilize. Can you schedule a check-in with your psychiatrist for Monday to see how you're doing once you're over your illness and have gotten caught up on sleep?
posted by Jacqueline at 9:39 AM on December 3, 2014

If the question is only "do I have to go on at length to my supervisors about this?", then that's not a medical question and the answer is no.

I'm thinking you also have corollary medical questions (i.e. the tips/tricks part of your question) and so as general medical information I think it might be helpful to know that the average (mean) length of a cough with a standard upper respiratory infection is about 18 days. There are a number of simple methods for symptom relief that can be utilized without a prescription. Benzonatate (Tessalon perles) is something I think of as a sort of a placebo, because there's not a lot of evidence that it actually works, unfortunately.
posted by treehorn+bunny at 11:59 AM on December 3, 2014

Oh, oh, oh! My kids and I have been home with this cough thing for days! It super sucks!

In one of my kids it turned into pneumonia (infection in the lungs, not just the throat). In the other one it didn't. Antibiotics for the first kid helped immensely.

Take the time off, don't go into detail, and don't worry about it. There is a thing going around. I know a bunch of people who have taken time off of work for it, and a bunch of kids who have missed days of school. I'm in northern VA (USA), but wherever you are, if you have it, I imagine it's a similar situation.

You don't want to get anyone else sick, and if you go to work you're likely to get sicker yourself. Those are two totally sufficient reasons to take the time off without getting into detail.
posted by selfmedicating at 12:21 PM on December 3, 2014

To clarify, FMLA is just job-protection for you should you need to take more time off than your company wants to give you without firing you. If your boss(es) and company aren't demanding you return to work at a certain time or face being let go, I am not sure why you would need to invoke FMLA at all. At my company, this would necessitate getting HR involved and paperwork and would generally be seen as an overreaction for something like "I became quite ill and need to take off 5 or 6 days in a row." That's what sick leave or PTO is for, no need to involve FMLA.

I point this out only because it sounds from your question like your boss was merely asking when you'll be back at work, and not demanding you come in now. If it were me, I'd probably email back and say "As I mentioned, I became quite ill on Thanksgiving and am still recovering--I have a respiratory illness that exacerbated another long-standing medical issue that I'm now getting under control. It's likely that I won't be back at work until next Monday. Let me know if that is a problem." If it's not a problem, it's not a problem; if your boss pushes back and says you MUST report to work, that's when you'd start down the path of invoking FMLA intermittent leave to keep your job while unable to come to work.
posted by iminurmefi at 12:48 PM on December 3, 2014 [4 favorites]

You don't need to tell your boss why you're taking FMLA. iminurmefi's wording is perfect. If you do invoke FMLA, you do, however, need to get your psychiatrist to write you a letter excusing you from work for the time you're gone, for HR to keep on file.

As far as strategies for not melting down: get your psychiatrist to write you an Rx for something that will knock you out and force you to sleep (that also plays nicely with lithium and whatever else you might be on). Mine's prescribed trazodone in the past for precisely the same bipolar-and-sleep-deprived-for-days issue, and it worked beautifully. YMMV.
posted by culfinglin at 3:58 PM on December 4, 2014